diff --git "a/data/train.conll" "b/data/train.conll" --- "a/data/train.conll" +++ "b/data/train.conll" @@ -80028,4 +80028,193371 @@ diagnóstico I-EXPLORATION de I-EXPLORATION diabetes I-EXPLORATION insípida. I-EXPLORATION - I-EXPLORATION \ No newline at end of file + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +miope B-PAST_MEDICAL_HISTORY +magna, I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cristalino I-PAST_MEDICAL_HISTORY +transparente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ambos I-PAST_MEDICAL_HISTORY +ojos, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +junio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2000. I-PAST_MEDICAL_HISTORY +Un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +capsulotomía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +láser I-PAST_MEDICAL_HISTORY +YAG. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +2003 I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +DR I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +OD, I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +vitrectomía I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +inyección I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aceite I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +silicona I-PAST_MEDICAL_HISTORY +(AS), I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +retiró I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +después. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2004 I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +brusca I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +visión I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +OD. I-PRESENT_ILLNESS +En B-EXPLORATION +urgencias I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +(AV) I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +1, I-EXPLORATION +un I-EXPLORATION +tyndall I-EXPLORATION +de I-EXPLORATION +3+, I-EXPLORATION +una I-EXPLORATION +cámara I-EXPLORATION +anterior I-EXPLORATION +amplia I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +intraocular I-EXPLORATION +(PIO) I-EXPLORATION +de I-EXPLORATION +48 I-EXPLORATION +mmHg. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +del I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +la I-EXPLORATION +retina I-EXPLORATION +estaba I-EXPLORATION +aplicada, I-EXPLORATION +la I-EXPLORATION +excavación I-EXPLORATION +papilar I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +8, I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +silicona I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +posterior. I-EXPLORATION +Se B-TREATMENT +pautó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +dexametasona I-TREATMENT +alcohol I-TREATMENT +(maxidex®; I-TREATMENT +Alcon I-TREATMENT +Cusí, I-TREATMENT +S. I-TREATMENT +A.; I-TREATMENT +Barcelona; I-TREATMENT +España) I-TREATMENT +1 I-TREATMENT +gota I-TREATMENT +cada I-TREATMENT +2 I-TREATMENT +horas, I-TREATMENT +atropina I-TREATMENT +1% I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas, I-TREATMENT +maleato I-TREATMENT +de I-TREATMENT +timolol I-TREATMENT +0, I-TREATMENT +5% I-TREATMENT +(timoftol® I-TREATMENT +0, I-TREATMENT +5%; I-TREATMENT +Merck I-TREATMENT +Sharp I-TREATMENT +& I-TREATMENT +Dohme, I-TREATMENT +S.A.; I-TREATMENT +Madrid; I-TREATMENT +España) I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +acetazolamida I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +(edemox®; I-TREATMENT +Chiesi I-TREATMENT +Wasserman I-TREATMENT +S. I-TREATMENT +A.; I-TREATMENT +Barcelona; I-TREATMENT +España) I-TREATMENT +250 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas. I-TREATMENT + I-TREATMENT +Una B-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +acudió I-EVOLUTION +a I-EVOLUTION +nuestra I-EVOLUTION +consulta I-EVOLUTION +sin I-EVOLUTION +mejoría I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +del I-EVOLUTION +tratamiento. I-EVOLUTION +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +la I-EXPLORATION +AV I-EXPLORATION +se I-EXPLORATION +mantenía I-EXPLORATION +en I-EXPLORATION +0, I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +PIO I-EXPLORATION +en I-EXPLORATION +33 I-EXPLORATION +mmHg. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +figura I-EXPLORATION +1 I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +el I-EXPLORATION +aspecto I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +anterior. I-EXPLORATION +Lo I-EXPLORATION +que I-EXPLORATION +inicialmente I-EXPLORATION +se I-EXPLORATION +habían I-EXPLORATION +identificado I-EXPLORATION +como I-EXPLORATION +células I-EXPLORATION +inflamatorias I-EXPLORATION +resultaron I-EXPLORATION +ser I-EXPLORATION +microburbujas I-EXPLORATION +de I-EXPLORATION +aceite I-EXPLORATION +de I-EXPLORATION +silicona I-EXPLORATION +emulsificadas I-EXPLORATION +en I-EXPLORATION +cámara I-EXPLORATION +anterior, I-EXPLORATION +responsables I-EXPLORATION +del I-EXPLORATION +glaucoma I-EXPLORATION +secundario. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +falta I-TREATMENT +de I-TREATMENT +respuesta I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +se I-TREATMENT +planteó I-TREATMENT +la I-TREATMENT +implantación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +dispositivo I-TREATMENT +de I-TREATMENT +drenaje I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +rechazó, I-TREATMENT +no I-TREATMENT +acudiendo I-TREATMENT +a I-TREATMENT +las I-TREATMENT +revisiones I-TREATMENT +citadas I-TREATMENT +posteriormente. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +proptosis I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +(OI) I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +infiltración I-PRESENT_ILLNESS +palpebral I-PRESENT_ILLNESS +dolorosa, I-PRESENT_ILLNESS +caliente I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +consistencia I-PRESENT_ILLNESS +dura, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +limitación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mirada I-PRESENT_ILLNESS +vertical I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes, I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +mixto I-PAST_MEDICAL_HISTORY +ductal I-PAST_MEDICAL_HISTORY +lobulillar I-PAST_MEDICAL_HISTORY +infiltrante I-PAST_MEDICAL_HISTORY +multifocal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +multicéntrico I-PAST_MEDICAL_HISTORY +(carcinoma I-PAST_MEDICAL_HISTORY +escirro, I-PAST_MEDICAL_HISTORY +T4 I-PAST_MEDICAL_HISTORY +N3 I-PAST_MEDICAL_HISTORY +M0) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mama I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +siete I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +sometida I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +mastectomía I-PAST_MEDICAL_HISTORY +radical I-PAST_MEDICAL_HISTORY +modificada I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +Madden, I-PAST_MEDICAL_HISTORY +disección I-PAST_MEDICAL_HISTORY +axilar, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +ciclos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +quimioterapia I-PAST_MEDICAL_HISTORY +(Epirrubicina I-PAST_MEDICAL_HISTORY +75 I-PAST_MEDICAL_HISTORY +mg/m2), I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +remitió I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +encontrándose I-PAST_MEDICAL_HISTORY +restos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +misma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +estudios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +extensión. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +era I-EXPLORATION +7/10 I-EXPLORATION +con I-EXPLORATION +ambos I-EXPLORATION +ojos, I-EXPLORATION +cataratas I-EXPLORATION +nucleares I-EXPLORATION ++, I-EXPLORATION +presión I-EXPLORATION +intraocular I-EXPLORATION +OI I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +14 I-EXPLORATION +mmHg. I-EXPLORATION +Fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos. I-EXPLORATION +Presentaba I-EXPLORATION +un I-EXPLORATION +exoftalmos I-EXPLORATION +unilateral I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +OI. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +difusa I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas, I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +ósea, I-EXPLORATION +que I-EXPLORATION +desplazaba I-EXPLORATION +el I-EXPLORATION +nervio I-EXPLORATION +óptico I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +globo I-EXPLORATION +ocular. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +se I-EXPLORATION +realzaba I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +con I-EXPLORATION +Tecnecio I-EXPLORATION +99 I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +múltiples I-EXPLORATION +metástasis I-EXPLORATION +por I-EXPLORATION +acúmulo I-EXPLORATION +de I-EXPLORATION +radiotrazador I-EXPLORATION +en I-EXPLORATION +calota, I-EXPLORATION +raquis, I-EXPLORATION +parrilla I-EXPLORATION +costal, I-EXPLORATION +húmeros I-EXPLORATION +y I-EXPLORATION +pelvis. I-EXPLORATION +Ante I-EXPLORATION +el I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +rehusó I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +diagnóstica. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +quimioterapia, I-TREATMENT +tres I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +Taxotere I-TREATMENT +100 I-TREATMENT +mg/m2, I-TREATMENT +un I-TREATMENT +ciclo I-TREATMENT +de I-TREATMENT +Mitoxantrone I-TREATMENT +12 I-TREATMENT +mg/m2 I-TREATMENT +y I-TREATMENT +dos I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +Vinorelbina I-TREATMENT +25 I-TREATMENT +mg/m2, I-TREATMENT +y I-TREATMENT +esteroides I-TREATMENT +(6-metil-prednisolona) I-TREATMENT +(1 I-TREATMENT +mg/m2) I-TREATMENT +con I-TREATMENT +el I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +reducir I-TREATMENT +el I-TREATMENT +edema I-TREATMENT +y I-TREATMENT +la I-TREATMENT +congestión I-TREATMENT +orbitaria. I-TREATMENT +Pese B-EVOLUTION +al I-EVOLUTION +tratamiento, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +más I-EVOLUTION +tarde. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +antecedentes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia I-PAST_MEDICAL_HISTORY +quien B-PRESENT_ILLNESS +desarrolló I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +conjuntival I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +(OD) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Clínicamente B-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +pigmentada I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +conjuntiva I-EXPLORATION +nasal I-EXPLORATION +que I-EXPLORATION +invadía I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +córnea I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +afectaba I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +visual. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +inicial, I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +de I-EXPLORATION +20/20 I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +intraocular I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +mmHg I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos. I-EXPLORATION +Tanto I-EXPLORATION +la I-EXPLORATION +biomicroscopía I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +oftalmoscopía I-EXPLORATION +indirecta I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +(OI) I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +biomicroscopía I-EXPLORATION +del I-EXPLORATION +OD I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +densamente I-EXPLORATION +pigmentada, I-EXPLORATION +elevada, I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +4 I-EXPLORATION +mm., I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +delimitados, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +sector I-EXPLORATION +nasal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +conjuntiva I-EXPLORATION +bulbar I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +invadía I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +córnea. I-EXPLORATION +La I-EXPLORATION +masa I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +rodeada I-EXPLORATION +por I-EXPLORATION +algunos I-EXPLORATION +vasos I-EXPLORATION +nutricios I-EXPLORATION +prominentes. I-EXPLORATION +No I-EXPLORATION +hubo I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +melanosis I-EXPLORATION +adquirida I-EXPLORATION +primaria I-EXPLORATION +adyacente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica, I-EXPLORATION +incluyendo I-EXPLORATION +la I-EXPLORATION +fundoscopía, I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +escisión I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +con I-EXPLORATION +márgenes I-EXPLORATION +quirúrgicos I-EXPLORATION +amplios. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +macroscópico I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +con I-EXPLORATION +dimensiones I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +x I-EXPLORATION +4 I-EXPLORATION +x I-EXPLORATION +3 I-EXPLORATION +mm, I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +nodular, I-EXPLORATION +superficie I-EXPLORATION +externa I-EXPLORATION +lisa, I-EXPLORATION +multilobulada, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +café I-EXPLORATION +negruzco I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +mucoso. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +histopatológico I-EXPLORATION +demostró I-EXPLORATION +epitelio I-EXPLORATION +de I-EXPLORATION +revestimiento I-EXPLORATION +conjuntival I-EXPLORATION +con I-EXPLORATION +cambios I-EXPLORATION +de I-EXPLORATION +papilomatosis I-EXPLORATION +y I-EXPLORATION +acantosis I-EXPLORATION +irregular, I-EXPLORATION +esta I-EXPLORATION +última I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +basaloides, I-EXPLORATION +mismas I-EXPLORATION +que I-EXPLORATION +estaban I-EXPLORATION +mezcladas I-EXPLORATION +con I-EXPLORATION +pequeños I-EXPLORATION +grupos I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +escamosas I-EXPLORATION +y I-EXPLORATION +algunos I-EXPLORATION +melanocitos I-EXPLORATION +dendríticos. I-EXPLORATION +La I-EXPLORATION +sustancia I-EXPLORATION +propia I-EXPLORATION +presentaba I-EXPLORATION +además, I-EXPLORATION +áreas I-EXPLORATION +con I-EXPLORATION +degeneración I-EXPLORATION +elastótica, I-EXPLORATION +vasos I-EXPLORATION +sanguíneos I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +calibre I-EXPLORATION +dilatados I-EXPLORATION +y I-EXPLORATION +cúmulos I-EXPLORATION +variables I-EXPLORATION +de I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +formados I-EXPLORATION +por I-EXPLORATION +linfocitos I-EXPLORATION +maduros, I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +y I-EXPLORATION +algunos I-EXPLORATION +melanófagos. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +queratosis I-EXPLORATION +seborreica I-EXPLORATION +(QS) I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +conjuntiva. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agudeza I-PRESENT_ILLNESS +visual I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +insulino I-PAST_MEDICAL_HISTORY +dependiente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +padecido I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +contuso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Refería B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +visión I-PRESENT_ILLNESS +asintomático I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +La B-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +(AV) I-EXPLORATION +tomada I-EXPLORATION +mediante I-EXPLORATION +el I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Snellen I-EXPLORATION +era I-EXPLORATION +1 I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +ojo I-EXPLORATION +izquierdo, I-EXPLORATION +mejorando I-EXPLORATION +este I-EXPLORATION +último I-EXPLORATION +a I-EXPLORATION +1 I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +corrección I-EXPLORATION +esférica I-EXPLORATION +de I-EXPLORATION ++1, I-EXPLORATION +5D. I-EXPLORATION + I-EXPLORATION +Tanto I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +ocular I-EXPLORATION +intrínseca I-EXPLORATION +como I-EXPLORATION +extrínseca, I-EXPLORATION +biomicroscopía I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +tonometría I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +funduscopia I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +yuxtapapilar I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +rojo-anaranjado I-EXPLORATION +brillante, I-EXPLORATION +sobreelevada, I-EXPLORATION +bien I-EXPLORATION +delimitada. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +del I-EXPLORATION +epitelio I-EXPLORATION +pigmentario I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +macular I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +capa I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +nerviosas I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +oftalmoscópica I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +adelfo I-EXPLORATION +presentaba I-EXPLORATION +asimismo I-EXPLORATION +una I-EXPLORATION +leve I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +epitelio I-EXPLORATION +pigmentario. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +angiografía I-EXPLORATION +fluoresceínica I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +el I-EXPLORATION +relleno I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +árbol I-EXPLORATION +vascular I-EXPLORATION +intratumoral I-EXPLORATION +compuesto I-EXPLORATION +de I-EXPLORATION +finos I-EXPLORATION +capilares I-EXPLORATION +con I-EXPLORATION +exudación I-EXPLORATION +en I-EXPLORATION +tiempos I-EXPLORATION +tardíos, I-EXPLORATION +confirmando I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +hemangioma I-EXPLORATION +capilar I-EXPLORATION +yuxtapapilar. I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +fuga I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +ojos, I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +retinopatía I-EXPLORATION +central I-EXPLORATION +serosa. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +campo I-EXPLORATION +visual I-EXPLORATION +SITA- I-EXPLORATION +Standard I-EXPLORATION +24-2 I-EXPLORATION +(Zeiss-Humphrey I-EXPLORATION +Instruments, I-EXPLORATION +Dublin, I-EXPLORATION +CA) I-EXPLORATION +con I-EXPLORATION +visión I-EXPLORATION +corregida, I-EXPLORATION +estímulo I-EXPLORATION +III, I-EXPLORATION +hallándose I-EXPLORATION +un I-EXPLORATION +defecto I-EXPLORATION +infero-nasal I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +Cuatro I-EXPLORATION +semanas I-EXPLORATION +más I-EXPLORATION +tarde, I-EXPLORATION +la I-EXPLORATION +visión I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +6 I-EXPLORATION +corregida I-EXPLORATION +(+0.5 I-EXPLORATION +esf I-EXPLORATION ++ I-EXPLORATION +1 I-EXPLORATION +x I-EXPLORATION +48 I-EXPLORATION +cil) I-EXPLORATION +1; I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +visión I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +corregida I-EXPLORATION +(+0.5 I-EXPLORATION +esf I-EXPLORATION ++0.25 I-EXPLORATION +x I-EXPLORATION +170 I-EXPLORATION +cil) I-EXPLORATION +0, I-EXPLORATION +6. I-EXPLORATION +Una I-EXPLORATION +nueva I-EXPLORATION +angiograf��a I-EXPLORATION +fluoresceínica I-EXPLORATION +demostró I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +se I-EXPLORATION +debía I-EXPLORATION +a I-EXPLORATION +retinopatía I-EXPLORATION +central I-EXPLORATION +serosa. I-EXPLORATION + I-EXPLORATION +Ocho B-EVOLUTION +semanas I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +se I-EVOLUTION +encontró I-EVOLUTION +una I-EVOLUTION +regresión I-EVOLUTION +espontánea I-EVOLUTION +tanto I-EVOLUTION +del I-EVOLUTION +hemangioma I-EVOLUTION +capilar I-EVOLUTION +yuxtapapilar I-EVOLUTION +como I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +retinopatía I-EVOLUTION +central I-EVOLUTION +serosa I-EVOLUTION +bilateral, I-EVOLUTION +regresando I-EVOLUTION +la I-EVOLUTION +AV I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +1 I-EVOLUTION +difícil I-EVOLUTION +en I-EVOLUTION +ambos I-EVOLUTION +ojos. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +AV I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +ojos I-PRESENT_ILLNESS +(0, I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +OD I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +OI I-PRESENT_ILLNESS +). I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +EMQ I-EXPLORATION +bilateral. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +angiografía I-EXPLORATION +fluoresceínica I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +epiteliopatía I-EXPLORATION +pigmentaria I-EXPLORATION +difusa I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +exudativo I-EXPLORATION +y I-EXPLORATION +desprendimientos I-EXPLORATION +retinianos I-EXPLORATION +serosos I-EXPLORATION +secundarios. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +5 I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +edad, I-EXPLORATION +había I-EXPLORATION +sido I-EXPLORATION +tratada I-EXPLORATION +con I-EXPLORATION +éxito I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +histiocitosis I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Langerhans, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +sistémico I-EXPLORATION +completo, I-EXPLORATION +incluidas I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +craneal I-EXPLORATION +y I-EXPLORATION +orbitarias. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +ningún I-EXPLORATION +hallazgo I-EXPLORATION +significativo. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +corticosteroides I-TREATMENT +tópicos, I-TREATMENT +peribulbares I-TREATMENT +y I-TREATMENT +orales. I-TREATMENT + I-TREATMENT +Las I-TREATMENT +inyecciones I-TREATMENT +de I-TREATMENT +triamcinolona I-TREATMENT +peribulbar I-TREATMENT +se I-TREATMENT +repitieron I-TREATMENT +en I-TREATMENT +cuatro I-TREATMENT +ocasiones I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +largo I-TREATMENT +del I-TREATMENT +siguiente I-TREATMENT +año, I-TREATMENT +logrando I-TREATMENT +sólo I-TREATMENT +mejorías I-TREATMENT +transitorias I-TREATMENT +del I-TREATMENT +edema I-TREATMENT +macular I-TREATMENT +y I-TREATMENT +los I-TREATMENT +desprendimientos I-TREATMENT +serosos. I-TREATMENT +En I-TREATMENT +septiembre I-TREATMENT +de I-TREATMENT +2002, I-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ciclosporina I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +en I-TREATMENT +marzo I-TREATMENT +de I-TREATMENT +2003 I-TREATMENT +se I-TREATMENT +añadió I-TREATMENT +azatioprina, I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +del I-TREATMENT +EMQ. I-TREATMENT +Finalmente, I-TREATMENT +se I-TREATMENT +inyectaron I-TREATMENT +4 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +triamcinolona I-TREATMENT +intravítrea I-TREATMENT +en I-TREATMENT +ambos I-TREATMENT +ojos I-TREATMENT +en I-TREATMENT +julio I-TREATMENT +de I-TREATMENT +2003 I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +inicial I-TREATMENT +del I-TREATMENT +EMQ I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +AV. I-TREATMENT +Se I-TREATMENT +repitieron I-TREATMENT +las I-TREATMENT +inyecciones I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +en I-TREATMENT +el I-TREATMENT +OD I-TREATMENT +y I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +más I-TREATMENT +en I-TREATMENT +el I-TREATMENT +OI. I-TREATMENT +En B-EXPLORATION +diciembre I-EXPLORATION +de I-EXPLORATION +2004, I-EXPLORATION +se I-EXPLORATION +registraron I-EXPLORATION +PIO I-EXPLORATION +de I-EXPLORATION +27 I-EXPLORATION +mmHg I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +26 I-EXPLORATION +mmHg I-EXPLORATION +OI, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +indica I-EXPLORATION +terapia I-EXPLORATION +tópica I-EXPLORATION +con I-EXPLORATION +timolol I-EXPLORATION +0, I-EXPLORATION +5% I-EXPLORATION +y I-EXPLORATION +dorzolamida I-EXPLORATION +0, I-EXPLORATION +02% I-EXPLORATION +(Cosopt®). I-EXPLORATION +En I-EXPLORATION +marzo I-EXPLORATION +de I-EXPLORATION +2005, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +AV I-EXPLORATION +severa I-EXPLORATION +bilateral I-EXPLORATION +(<0,05) I-EXPLORATION +por I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +cataratas I-EXPLORATION +intumescentes. I-EXPLORATION +Tras B-EVOLUTION +cirugía I-EVOLUTION +de I-EVOLUTION +facoextracción I-EVOLUTION +con I-EVOLUTION +implantación I-EVOLUTION +de I-EVOLUTION +lente I-EVOLUTION +intraocular I-EVOLUTION +sin I-EVOLUTION +complicaciones, I-EVOLUTION +la I-EVOLUTION +AV I-EVOLUTION +es I-EVOLUTION +de I-EVOLUTION +0, I-EVOLUTION +3 I-EVOLUTION +en I-EVOLUTION +ambos I-EVOLUTION +ojos. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +Medicina I-DERIVED_FROM/TO +Interna I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +fondo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ojo I-DERIVED_FROM/TO +por B-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +midriasis I-PRESENT_ILLNESS +media I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +visión, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +midriasis I-EXPLORATION +bilateral I-EXPLORATION +arreactiva; I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +incluídas I-EXPLORATION +las I-EXPLORATION +papilas, I-EXPLORATION +es I-EXPLORATION +normal, I-EXPLORATION +salvo I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +cámaras I-EXPLORATION +anteriores I-EXPLORATION +estrechas I-EXPLORATION +y I-EXPLORATION +unas I-EXPLORATION +presiones I-EXPLORATION +intraoculares I-EXPLORATION +de I-EXPLORATION +65 I-EXPLORATION +y I-EXPLORATION +58 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +en I-EXPLORATION +cada I-EXPLORATION +ojo. I-EXPLORATION +Ante I-EXPLORATION +este I-EXPLORATION +cuadro I-EXPLORATION +se I-EXPLORATION +procede I-EXPLORATION +a I-EXPLORATION +tomar I-EXPLORATION +imágenes I-EXPLORATION +del I-EXPLORATION +polo I-EXPLORATION +anterior I-EXPLORATION +con I-EXPLORATION +OCT I-EXPLORATION +y I-EXPLORATION +BMU, I-EXPLORATION +mostrando I-EXPLORATION +un I-EXPLORATION +cierre I-EXPLORATION +angular I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +360º I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +bilateral. I-EXPLORATION +Con B-TREATMENT +estos I-TREATMENT +datos, I-TREATMENT +se I-TREATMENT +establece I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +ataque I-TREATMENT +agudo I-TREATMENT +de I-TREATMENT +glaucoma I-TREATMENT +bilateral, I-TREATMENT +se I-TREATMENT +prescribe I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +para I-TREATMENT +dicho I-TREATMENT +cuadro I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizan I-TREATMENT +iridotomías I-TREATMENT +bilaterales I-TREATMENT +que I-TREATMENT +resultan I-TREATMENT +permeables I-TREATMENT +como I-TREATMENT +muestran I-TREATMENT +las I-TREATMENT +imágenes I-TREATMENT +del I-TREATMENT +OCT, I-TREATMENT +ampliándose I-TREATMENT +la I-TREATMENT +profundidad I-TREATMENT +camerular I-TREATMENT +en I-TREATMENT +ambos I-TREATMENT +ojos. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que B-DERIVED_FROM/TO +acude I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +optometrista I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valorar I-DERIVED_FROM/TO +tumoración I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nivel I-DERIVED_FROM/TO +iridiano I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +repercusión I-DERIVED_FROM/TO +funcional. I-DERIVED_FROM/TO +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +sobreelevada I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +quístico I-EXPLORATION +y I-EXPLORATION +contenido I-EXPLORATION +lechoso I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +iris, I-EXPLORATION +cerca I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +pupilar. I-EXPLORATION +No B-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +oftalmológico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +obtienen I-EXPLORATION +imágenes I-EXPLORATION +con I-EXPLORATION +BMU I-EXPLORATION +y I-EXPLORATION +OCT I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +establece I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +estromal I-EXPLORATION +primario I-EXPLORATION +de I-EXPLORATION +iris. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +anteriormente I-EXPLORATION +mencionados, I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +exploración I-EXPLORATION +utilizando I-EXPLORATION +ambos I-EXPLORATION +instrumentes I-EXPLORATION +varío I-EXPLORATION +considerablemente, I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +forma, I-EXPLORATION +mediante I-EXPLORATION +el I-EXPLORATION +OCT I-EXPLORATION +se I-EXPLORATION +lograron I-EXPLORATION +exploraciones I-EXPLORATION +completas I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +anterior I-EXPLORATION +en I-EXPLORATION +tiempos I-EXPLORATION +inferiores I-EXPLORATION +a I-EXPLORATION +5 I-EXPLORATION +minutos. I-EXPLORATION +En I-EXPLORATION +cambio, I-EXPLORATION +la I-EXPLORATION +BMU, I-EXPLORATION +fundamentalmente I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +preparación I-EXPLORATION +previa I-EXPLORATION +que I-EXPLORATION +conlleva, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +mayor I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +localizar I-EXPLORATION +la I-EXPLORATION +lesiones I-EXPLORATION +a I-EXPLORATION +estudiar I-EXPLORATION +implicó I-EXPLORATION +tiempos I-EXPLORATION +de I-EXPLORATION +exploración I-EXPLORATION +superiores I-EXPLORATION +a I-EXPLORATION +10 I-EXPLORATION +minutos. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lagrimeo, I-PRESENT_ILLNESS +conjuntivitis I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +congestión I-PRESENT_ILLNESS +nasal. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +biomicroscópica I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +conjuntivocalasia I-EXPLORATION +bilateral I-EXPLORATION +marcada I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +aclaramiento I-EXPLORATION +de I-EXPLORATION +fluoresceína I-EXPLORATION +(FCT) I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +secreción I-EXPLORATION +basal I-EXPLORATION +elevada, I-EXPLORATION +un I-EXPLORATION +aclaramiento I-EXPLORATION +de I-EXPLORATION +fluoresceína I-EXPLORATION +enlentecido I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +secreción I-EXPLORATION +lagrimal I-EXPLORATION +refleja I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +instaura I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +lágrimas I-TREATMENT +artificiales I-TREATMENT +sin I-TREATMENT +conservantes, I-TREATMENT +limpieza I-TREATMENT +palpebral I-TREATMENT +diaria I-TREATMENT +y I-TREATMENT +oclusión I-TREATMENT +ocular I-TREATMENT +sin I-TREATMENT +objetivarse I-TREATMENT +mejoría I-TREATMENT +sintomática. I-TREATMENT +Se I-TREATMENT +añade I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +colirio I-TREATMENT +de I-TREATMENT +metilprednisolona I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +5% I-TREATMENT +sin I-TREATMENT +conservantes I-TREATMENT +3 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +2 I-TREATMENT +semanas. I-TREATMENT +Se B-EVOLUTION +produce I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +sintomática I-EVOLUTION +transitoria, I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +reaparecen I-EVOLUTION +al I-EVOLUTION +interrumpir I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION +Debido B-TREATMENT +a I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +estos I-TREATMENT +síntomas, I-TREATMENT +se I-TREATMENT +sugiere I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +bilateral, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +lleva I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +según I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +descrita I-TREATMENT +por I-TREATMENT +Tseng. I-TREATMENT +Bajo I-TREATMENT +anestesia I-TREATMENT +tópica, I-TREATMENT +se I-TREATMENT +extirpa I-TREATMENT +el I-TREATMENT +exceso I-TREATMENT +conjuntival. I-TREATMENT +La I-TREATMENT +esclera I-TREATMENT +expuesta I-TREATMENT +se I-TREATMENT +recubre I-TREATMENT +con I-TREATMENT +membrana I-TREATMENT +amniótica I-TREATMENT +orientada I-TREATMENT +con I-TREATMENT +la I-TREATMENT +membrana I-TREATMENT +basal I-TREATMENT +hacia I-TREATMENT +arriba. I-TREATMENT +Se I-TREATMENT +pliega I-TREATMENT +la I-TREATMENT +membrana I-TREATMENT +amniótica I-TREATMENT +sobre I-TREATMENT +sí I-TREATMENT +misma I-TREATMENT +para I-TREATMENT +distribuir I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +componentes I-TREATMENT +del I-TREATMENT +pegamento I-TREATMENT +de I-TREATMENT +fibrinógeno I-TREATMENT +(Tissucol®) I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +esclera I-TREATMENT +y I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +estromal I-TREATMENT +de I-TREATMENT +la I-TREATMENT +membrana I-TREATMENT +amniótica. I-TREATMENT +El I-TREATMENT +pegamento I-TREATMENT +se I-TREATMENT +distribuye I-TREATMENT +en I-TREATMENT +pequeñas I-TREATMENT +gotas I-TREATMENT +con I-TREATMENT +ayuda I-TREATMENT +de I-TREATMENT +una I-TREATMENT +cánula I-TREATMENT +de I-TREATMENT +cámara I-TREATMENT +anterior. I-TREATMENT +Se I-TREATMENT +estira I-TREATMENT +bien I-TREATMENT +la I-TREATMENT +membrana I-TREATMENT +amniótica I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +esclera I-TREATMENT +para I-TREATMENT +que I-TREATMENT +se I-TREATMENT +produzca I-TREATMENT +una I-TREATMENT +buena I-TREATMENT +adhesión I-TREATMENT +de I-TREATMENT +ambos I-TREATMENT +tejidos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +reseca I-TREATMENT +el I-TREATMENT +exceso I-TREATMENT +de I-TREATMENT +membrana I-TREATMENT +amniótica. I-TREATMENT +La I-TREATMENT +conjuntiva I-TREATMENT +residual I-TREATMENT +se I-TREATMENT +pega I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +membrana. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +postoperatorio I-TREATMENT +consiste I-TREATMENT +en I-TREATMENT +colirio I-TREATMENT +metilprednisolona I-TREATMENT +sin I-TREATMENT +conservantes I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +5% I-TREATMENT +3 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +y I-TREATMENT +colirio I-TREATMENT +de I-TREATMENT +ofloxacino I-TREATMENT +2 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +sin I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +una I-TREATMENT +oclusión I-TREATMENT +postoperatoria. I-TREATMENT +La B-EVOLUTION +mejoría I-EVOLUTION +biomicroscópica I-EVOLUTION +y I-EVOLUTION +sintomática I-EVOLUTION +se I-EVOLUTION +evidencia I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato, I-EVOLUTION +manteniéndose I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agudeza I-PRESENT_ILLNESS +visual I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estrías I-PAST_MEDICAL_HISTORY +angioides I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +lejana I-EXPLORATION +de I-EXPLORATION +unidad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +«contar I-EXPLORATION +dedos» I-EXPLORATION +a I-EXPLORATION +dos I-EXPLORATION +metros I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo. I-EXPLORATION +La I-EXPLORATION +tensión I-EXPLORATION +ocular I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +biomicroscopía I-EXPLORATION +estaban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +oftalmoscopia I-EXPLORATION +bajo I-EXPLORATION +dilatación I-EXPLORATION +mostró, I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos, I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +lineales I-EXPLORATION +serpenteantes I-EXPLORATION +radiales I-EXPLORATION +al I-EXPLORATION +disco I-EXPLORATION +óptico I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendían I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +periferia. I-EXPLORATION +Además, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo, I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cicatricial I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +movilización I-EXPLORATION +de I-EXPLORATION +pigmento I-EXPLORATION +y I-EXPLORATION +fibrosis I-EXPLORATION +que I-EXPLORATION +englobaba I-EXPLORATION +toda I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +macular. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +angiografía I-EXPLORATION +fluoresceínica I-EXPLORATION +(AGF) I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +resultados: I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +unas I-EXPLORATION +líneas I-EXPLORATION +hipo I-EXPLORATION +e I-EXPLORATION +hiperfluorescentes I-EXPLORATION +con I-EXPLORATION +movilización I-EXPLORATION +de I-EXPLORATION +pigmento I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +macular I-EXPLORATION +sin I-EXPLORATION +difusión I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +la I-EXPLORATION +mismas I-EXPLORATION +lesiones I-EXPLORATION +lineales I-EXPLORATION +acompañadas I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +hipo I-EXPLORATION +e I-EXPLORATION +hiperfluorescente I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +macular I-EXPLORATION +sin I-EXPLORATION +difusión I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +en I-EXPLORATION +tiempos I-EXPLORATION +tardíos I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +estrías I-EXPLORATION +angioides I-EXPLORATION +bilaterales I-EXPLORATION +y I-EXPLORATION +además, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo, I-EXPLORATION +complicadas I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +membrana I-EXPLORATION +neovascular I-EXPLORATION +subretiniana I-EXPLORATION +no I-EXPLORATION +susceptible I-EXPLORATION +de I-EXPLORATION +tratamiento. I-EXPLORATION +Se B-EVOLUTION +aconsejó I-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +clínico I-EVOLUTION +periódico. I-EVOLUTION + I-EVOLUTION +Dos I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +acudió I-EVOLUTION +refiriendo I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +agudeza I-EVOLUTION +visual, I-EVOLUTION +esta I-EVOLUTION +vez, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +ojo I-EVOLUTION +derecho. I-EVOLUTION +La B-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +de I-EXPLORATION +unidad I-EXPLORATION +con I-EXPLORATION +dificultad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +«contar I-EXPLORATION +dedos» I-EXPLORATION +a I-EXPLORATION +dos I-EXPLORATION +metros I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo. I-EXPLORATION +Funduscópicamente, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +derecho, I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +hemorragia I-EXPLORATION +y I-EXPLORATION +movilización I-EXPLORATION +de I-EXPLORATION +pigmento I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +posterior I-EXPLORATION +con I-EXPLORATION +estrías I-EXPLORATION +anaranjadas, I-EXPLORATION +ya I-EXPLORATION +presentes I-EXPLORATION +en I-EXPLORATION +exploraciones I-EXPLORATION +previas. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +AGF I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +hiperfluorescencia I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +macular I-EXPLORATION +desde I-EXPLORATION +tiempos I-EXPLORATION +iniciales I-EXPLORATION +rodeada I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +halo I-EXPLORATION +hipofluorescente I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fluorescencia I-EXPLORATION +hacia I-EXPLORATION +tiempos I-EXPLORATION +tardíos I-EXPLORATION +y I-EXPLORATION +mínima I-EXPLORATION +difusión, I-EXPLORATION +no I-EXPLORATION +existente I-EXPLORATION +en I-EXPLORATION +AGF I-EXPLORATION +previas, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +membrana I-EXPLORATION +neovascular I-EXPLORATION +subfoveal. I-EXPLORATION +Se I-EXPLORATION +estableció, I-EXPLORATION +por I-EXPLORATION +tanto, I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +diagnóstico, I-EXPLORATION +estrías I-EXPLORATION +angioides I-EXPLORATION +complicadas I-EXPLORATION +con I-EXPLORATION +membrana I-EXPLORATION +neovascular I-EXPLORATION +subfoveal I-EXPLORATION +en I-EXPLORATION +ojo I-EXPLORATION +derecho. I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +planteó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +TFD I-TREATMENT +y I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +sesión I-TREATMENT +se I-TREATMENT +produjo I-TREATMENT +la I-TREATMENT +reabsorción I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hemorragia I-TREATMENT +con I-TREATMENT +mantenimiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pigmentación I-TREATMENT +central. I-TREATMENT +Dichos I-TREATMENT +hallazgos I-TREATMENT +se I-TREATMENT +confirmaron I-TREATMENT +con I-TREATMENT +la I-TREATMENT +AGF I-TREATMENT +que I-TREATMENT +reveló I-TREATMENT +una I-TREATMENT +ligera I-TREATMENT +difusión I-TREATMENT +de I-TREATMENT +contraste I-TREATMENT +en I-TREATMENT +tiempos I-TREATMENT +tardíos. I-TREATMENT +Por I-TREATMENT +ello, I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +la I-TREATMENT +recuperación I-TREATMENT +visual, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +aplicar I-TREATMENT +dos I-TREATMENT +sesiones I-TREATMENT +más I-TREATMENT +de I-TREATMENT +TFD. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +última I-EXPLORATION +revisión I-EXPLORATION +la I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +se I-EXPLORATION +mantenía I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +unidad I-EXPLORATION +y I-EXPLORATION +angiográficamente I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hipo I-EXPLORATION +e I-EXPLORATION +hiperfluorescente I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cicatricial I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +macular. I-EXPLORATION +En I-EXPLORATION +tiempos I-EXPLORATION +angiográficos I-EXPLORATION +medios I-EXPLORATION +aparecía I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hiperfluorescencia I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +mantenía I-EXPLORATION +en I-EXPLORATION +tiempos I-EXPLORATION +tardíos, I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +difusión I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +fáquico, I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +degeneración I-PRESENT_ILLNESS +macular I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +exudativa I-PRESENT_ILLNESS +(DMAE) I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +al B-TREATMENT +que I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realiza I-TREATMENT +terapia I-TREATMENT +fotodinámica I-TREATMENT +(TFD). I-TREATMENT +48 I-TREATMENT +horas I-TREATMENT +después I-TREATMENT +se I-TREATMENT +le I-TREATMENT +inyecta I-TREATMENT +en I-TREATMENT +cámara I-TREATMENT +vítrea I-TREATMENT +20 I-TREATMENT +mg I-TREATMENT +en I-TREATMENT +0, I-TREATMENT +1 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +acetato I-TREATMENT +de I-TREATMENT +triamcinolona I-TREATMENT +obtenida I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +sedimentación. I-TREATMENT + I-TREATMENT +La I-TREATMENT +operación I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +en I-TREATMENT +el I-TREATMENT +quirófano I-TREATMENT +bajo I-TREATMENT +medidas I-TREATMENT +asépticas. I-TREATMENT +La I-TREATMENT +inyección I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +con I-TREATMENT +aguja I-TREATMENT +de I-TREATMENT +27 I-TREATMENT +G I-TREATMENT +a I-TREATMENT +4 I-TREATMENT +mm I-TREATMENT +del I-TREATMENT +limbo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +cuadrante I-TREATMENT +temporo-inferior I-TREATMENT +ayudado I-TREATMENT +de I-TREATMENT +un I-TREATMENT +blefarostato. I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +procedimiento, I-TREATMENT +y I-TREATMENT +coincidiendo I-TREATMENT +con I-TREATMENT +un I-TREATMENT +intento I-TREATMENT +de I-TREATMENT +cierre I-TREATMENT +forzado I-TREATMENT +de I-TREATMENT +los I-TREATMENT +párpados, I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +con I-TREATMENT +el I-TREATMENT +microscopio I-TREATMENT +cómo I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sustancia I-TREATMENT +lechosa I-TREATMENT +pasaba I-TREATMENT +a I-TREATMENT +cámara I-TREATMENT +anterior. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +decidió I-TREATMENT +actuar I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +expectante I-TREATMENT +instilando I-TREATMENT +colirio I-TREATMENT +de I-TREATMENT +ciprofloxacino I-TREATMENT +y I-TREATMENT +observando I-TREATMENT +el I-TREATMENT +pulso I-TREATMENT +arterial I-TREATMENT +espontáneo. I-TREATMENT +Al B-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentaba I-EVOLUTION +la I-EVOLUTION +triamcinolona I-EVOLUTION +precipitada I-EVOLUTION +en I-EVOLUTION +cámara I-EVOLUTION +anterior I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +cámara I-EVOLUTION +vítrea I-EVOLUTION +sin I-EVOLUTION +otros I-EVOLUTION +signos I-EVOLUTION +inflamatorios. I-EVOLUTION +La B-TREATMENT +PIO I-TREATMENT +era I-TREATMENT +de I-TREATMENT +25 I-TREATMENT +mm I-TREATMENT +Hg, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +prescribió I-TREATMENT +maleato I-TREATMENT +de I-TREATMENT +timolol I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +5% I-TREATMENT +en I-TREATMENT +colirio I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +le I-EVOLUTION +realizaron I-EVOLUTION +controles I-EVOLUTION +periódicos I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +detectó I-EVOLUTION +un I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +PIO I-EVOLUTION +hasta I-EVOLUTION +valores I-EVOLUTION +normales, I-EVOLUTION +una I-EVOLUTION +reabsorción I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +triamcinolona I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +córnea I-EVOLUTION +transparente I-EVOLUTION +sin I-EVOLUTION +reacción I-EVOLUTION +inflamatoria. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +quedaban I-EVOLUTION +escasos I-EVOLUTION +restos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sustancia, I-EVOLUTION +la I-EVOLUTION +PIO I-EVOLUTION +era I-EVOLUTION +de I-EVOLUTION +17 I-EVOLUTION +mm I-EVOLUTION +Hg I-EVOLUTION +sin I-EVOLUTION +tratamiento I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +biomicroscopía I-EVOLUTION +endotelial I-EVOLUTION +resultó I-EVOLUTION +un I-EVOLUTION +recuento I-EVOLUTION +celular I-EVOLUTION +normal I-EVOLUTION +e I-EVOLUTION +igual I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +ojo I-EVOLUTION +contralateral. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +sufrir I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +agresión I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +párpado I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +objeto I-PRESENT_ILLNESS +metálico, I-PRESENT_ILLNESS +fino I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +largo, I-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +deambulaba I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +calle. I-PRESENT_ILLNESS +Presentaba I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +fétor I-PRESENT_ILLNESS +etílico I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inestabilidad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +(AV) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +(OI) I-EXPLORATION +poco I-EXPLORATION +fiable I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +pésima I-EXPLORATION +colaboración I-EXPLORATION +del I-EXPLORATION +paciente, I-EXPLORATION +pero I-EXPLORATION +que I-EXPLORATION +al I-EXPLORATION +menos I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +7. I-EXPLORATION +La I-EXPLORATION +motilidad I-EXPLORATION +ocular I-EXPLORATION +intrínseca I-EXPLORATION +y I-EXPLORATION +extrínseca I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +refería I-EXPLORATION +diplopía I-EXPLORATION +en I-EXPLORATION +ninguna I-EXPLORATION +posición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mirada. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +objetivaba I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +palpebral I-EXPLORATION +superior I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +herida I-EXPLORATION +inciso-contusa, I-EXPLORATION +superficial, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +precisó I-EXPLORATION +ser I-EXPLORATION +suturada. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biomicroscopía, I-EXPLORATION +tensión I-EXPLORATION +ocular I-EXPLORATION +y I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +dejó I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +observación, I-EXPLORATION +presentando I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +horas I-EXPLORATION +siguientes I-EXPLORATION +un I-EXPLORATION +deterioro I-EXPLORATION +neurológico I-EXPLORATION +progresivo, I-EXPLORATION +consistente I-EXPLORATION +en I-EXPLORATION +desorientación I-EXPLORATION +temporoespacial, I-EXPLORATION +respuestas I-EXPLORATION +incoherentes, I-EXPLORATION +somnolencia I-EXPLORATION +progresiva I-EXPLORATION +y I-EXPLORATION +vómitos I-EXPLORATION +de I-EXPLORATION +repetición, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +Escala I-EXPLORATION +del I-EXPLORATION +Coma I-EXPLORATION +de I-EXPLORATION +Glasgow I-EXPLORATION +(GCS), I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +de I-EXPLORATION +12, I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +orbitaria, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +periorbitario I-EXPLORATION +izquierdo I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +óseo I-EXPLORATION +con I-EXPLORATION +fractura I-EXPLORATION +asociado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +margen I-EXPLORATION +superoposterior I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita I-EXPLORATION +izquierda, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +cerebral, I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +agudo I-EXPLORATION +intraparenquimatoso I-EXPLORATION +frontal I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +abría I-EXPLORATION +al I-EXPLORATION +asta I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +lateral I-EXPLORATION +adyacente I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +ventricular I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +hemorragia I-EXPLORATION +subaracnoidea I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cisura I-EXPLORATION +de I-EXPLORATION +Silvio I-EXPLORATION +izquierda, I-EXPLORATION +surcos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +convexidad I-EXPLORATION +izquierda, I-EXPLORATION +cisterna I-EXPLORATION +supraselar I-EXPLORATION +y I-EXPLORATION +perimesencefálicas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +analítica, I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +cualquier I-EXPLORATION +tendencia I-EXPLORATION +hemorrágica I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +(tiempo I-EXPLORATION +de I-EXPLORATION +sangrado, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +tromboplastina I-EXPLORATION +parcial I-EXPLORATION +activada, I-EXPLORATION +fibrinógeno I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +normales). I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +vaso I-EXPLORATION +sangrante I-EXPLORATION +activo I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +daño I-EXPLORATION +arterial, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +arteriografía I-EXPLORATION +por I-EXPLORATION +sustracción I-EXPLORATION +digital I-EXPLORATION +(ASD) I-EXPLORATION +cerebral, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +ingresado I-TREATMENT +en I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Cuidados I-TREATMENT +Intensivos. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +ingreso I-EVOLUTION +se I-EVOLUTION +realizaron I-EVOLUTION +TC I-EVOLUTION +y I-EVOLUTION +ASD I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +1, I-EVOLUTION +2, I-EVOLUTION +3, I-EVOLUTION +7 I-EVOLUTION +y I-EVOLUTION +14, I-EVOLUTION +que I-EVOLUTION +descartaron I-EVOLUTION +nuevos I-EVOLUTION +resangrados I-EVOLUTION +ó I-EVOLUTION +lesiones I-EVOLUTION +vasculares. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +GCS I-EVOLUTION +de I-EVOLUTION +15. I-EVOLUTION +La B-EXPLORATION +TC I-EXPLORATION +al I-EXPLORATION +alta I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +frontal I-EXPLORATION +izquierdo I-EXPLORATION +en I-EXPLORATION +resolución I-EXPLORATION +con I-EXPLORATION +pequeño I-EXPLORATION +componente I-EXPLORATION +intraventricular I-EXPLORATION +lateral I-EXPLORATION +frontal I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +restos I-EXPLORATION +hemáticos I-EXPLORATION +isodensos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cisura I-EXPLORATION +de I-EXPLORATION +Silvio I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tenía I-PRESENT_ILLNESS +«el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +hundido» I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aportaba I-PRESENT_ILLNESS +fotografías I-PRESENT_ILLNESS +anteriores I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +problema I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +evidenciar I-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +cambio I-PRESENT_ILLNESS +facial I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sufrido. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos I-EXPLORATION +sin I-EXPLORATION +corrección I-EXPLORATION +con I-EXPLORATION +motilidad I-EXPLORATION +ocular I-EXPLORATION +intrínseca I-EXPLORATION +y I-EXPLORATION +extrínseca I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +exoftalmometría I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +12, I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +ojo I-EXPLORATION +izquierdo. I-EXPLORATION +Se I-EXPLORATION +apreciaba I-EXPLORATION +un I-EXPLORATION +desplazamiento I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +mm I-EXPLORATION +del I-EXPLORATION +globo I-EXPLORATION +ocular I-EXPLORATION +derecho. I-EXPLORATION +Había I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +surco I-EXPLORATION +palpebral I-EXPLORATION +superior, I-EXPLORATION +con I-EXPLORATION +retracción I-EXPLORATION +palpebral I-EXPLORATION +superior I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +mirada I-EXPLORATION +inferior. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +un I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho I-EXPLORATION +colapsado, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +volumen, I-EXPLORATION +una I-EXPLORATION +retracción I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +adelgazamiento I-EXPLORATION +y I-EXPLORATION +desplazamiento I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +suelo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita. I-EXPLORATION +El I-EXPLORATION +proceso I-EXPLORATION +uncinado I-EXPLORATION +estaba I-EXPLORATION +retraído I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +orbitaria, I-EXPLORATION +obstruyendo I-EXPLORATION +el I-EXPLORATION +infundíbulo I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Sturge-Weber I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +glaucoma I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +luxación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cristalino I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +cámara I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +bloqueo I-PRESENT_ILLNESS +pupilar, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +intervenido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +evidenciaba I-EXPLORATION +una I-EXPLORATION +mancha I-EXPLORATION +en I-EXPLORATION +«vino I-EXPLORATION +de I-EXPLORATION +Oporto» I-EXPLORATION +hemifacial I-EXPLORATION +izquierda, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +territorio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +y I-EXPLORATION +segunda I-EXPLORATION +ramas I-EXPLORATION +trigeminales, I-EXPLORATION +exoftalmos I-EXPLORATION +severo I-EXPLORATION +con I-EXPLORATION +rechazo I-EXPLORATION +ínfero-temporal I-EXPLORATION +del I-EXPLORATION +globo I-EXPLORATION +ocular I-EXPLORATION +e I-EXPLORATION +ingurgitación I-EXPLORATION +marcada I-EXPLORATION +de I-EXPLORATION +vasos I-EXPLORATION +epiesclerales I-EXPLORATION +inferiores I-EXPLORATION +«en I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +Medusa». I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +con I-EXPLORATION +lámpara I-EXPLORATION +de I-EXPLORATION +hendidura I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +catarata I-EXPLORATION +madura I-EXPLORATION +totalmente I-EXPLORATION +luxada I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cámara I-EXPLORATION +anterior I-EXPLORATION +en I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +endotelio I-EXPLORATION +corneal I-EXPLORATION +con I-EXPLORATION +bloqueo I-EXPLORATION +pupilar I-EXPLORATION +y I-EXPLORATION +presión I-EXPLORATION +intraocular I-EXPLORATION +de I-EXPLORATION +60 I-EXPLORATION +mm I-EXPLORATION +Hg, I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +desprendimiento I-EXPLORATION +de I-EXPLORATION +retina I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +posterior I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +subyacente I-EXPLORATION +hiperecogénica. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +un I-TREATMENT +infructuoso I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +hipotensor, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +la I-TREATMENT +intervención, I-TREATMENT +realizándose I-TREATMENT +extracción I-TREATMENT +intracapsular I-TREATMENT +de I-TREATMENT +cristalino. I-TREATMENT +El B-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +coroidea I-EXPLORATION +peripapilar I-EXPLORATION +nasal I-EXPLORATION +superior I-EXPLORATION +con I-EXPLORATION +desprendimiento I-EXPLORATION +de I-EXPLORATION +retina I-EXPLORATION +exudativo I-EXPLORATION +asociado. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +(RMN) I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +lesiones I-EXPLORATION +hiperintensas I-EXPLORATION +en I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +T2 I-EXPLORATION +en I-EXPLORATION +leptomeninges I-EXPLORATION +de I-EXPLORATION +región I-EXPLORATION +frontoparietal I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +calcificaciones I-EXPLORATION +y I-EXPLORATION +atrofia I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +frontal. I-EXPLORATION +Una I-EXPLORATION +lesión I-EXPLORATION +coroidea I-EXPLORATION +y I-EXPLORATION +dos I-EXPLORATION +lesiones I-EXPLORATION +orbitarias I-EXPLORATION +extraconales I-EXPLORATION +en I-EXPLORATION +cuadrante I-EXPLORATION +nasal I-EXPLORATION +superior I-EXPLORATION +y I-EXPLORATION +temporal I-EXPLORATION +superior, I-EXPLORATION +bien I-EXPLORATION +delimitadas, I-EXPLORATION +asociadas I-EXPLORATION +a I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +oftálmica I-EXPLORATION +superior. I-EXPLORATION +Todas I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +eran I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +hemangiomas I-EXPLORATION +cavernosos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +presión I-EXPLORATION +intraocular I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +se I-EXPLORATION +mantuvo I-EXPLORATION +entre I-EXPLORATION +10 I-EXPLORATION +y I-EXPLORATION +16 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +sin I-EXPLORATION +necesidad I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +antihipertensivo I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +final I-EXPLORATION +fue I-EXPLORATION +menor I-EXPLORATION +de I-EXPLORATION +20/200 I-EXPLORATION +(visión I-EXPLORATION +de I-EXPLORATION +bultos). I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +coroideas I-EVOLUTION +y I-EVOLUTION +orbitarias I-EVOLUTION +siguen I-EVOLUTION +estables, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +precisan I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +periorbitario I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diplopía I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +motora I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +paresia I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +recto I-EXPLORATION +superior I-EXPLORATION +e I-EXPLORATION +interno I-EXPLORATION +y I-EXPLORATION +ptosis I-EXPLORATION +moderada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo. I-EXPLORATION +No I-EXPLORATION +hubo I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +oculares I-EXPLORATION +o I-EXPLORATION +neurológicos. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +nuclear I-EXPLORATION +magnética I-EXPLORATION +(RNM) I-EXPLORATION +craneal I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +diagnosticó I-TREATMENT +un I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +Tolosa-Hunt I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +corticoides. I-TREATMENT +Dos B-EVOLUTION +días I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +oftalmoplejía I-EVOLUTION +dolorosa I-EVOLUTION +persistía I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +comenzó I-EVOLUTION +a I-EVOLUTION +referir I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +agudeza I-EVOLUTION +visual I-EVOLUTION +próxima. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +midriasis I-EXPLORATION +izquierda. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +RNM I-EXPLORATION +orbitaria I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +en I-EXPLORATION +T2 I-EXPLORATION +un I-EXPLORATION +aneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +carótida I-EXPLORATION +interna-comunicante I-EXPLORATION +posterior I-EXPLORATION +(CI-CP) I-EXPLORATION +parcialmente I-EXPLORATION +trombosado. I-EXPLORATION +La I-EXPLORATION +angio-tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +(angio-TAC) I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +aneurisma I-EXPLORATION +CI-CP I-EXPLORATION +izquierdo I-EXPLORATION +multilobulado I-EXPLORATION +de I-EXPLORATION +10x5 I-EXPLORATION +mm. I-EXPLORATION +Se B-TREATMENT +realizaron I-TREATMENT +angiografía I-TREATMENT +cerebral I-TREATMENT +y I-TREATMENT +embolización, I-TREATMENT +siendo I-TREATMENT +rellenado I-TREATMENT +completamente I-TREATMENT +el I-TREATMENT +aneurisma I-TREATMENT +con I-TREATMENT +Hydrocoil I-TREATMENT +(MicroVention, I-TREATMENT +Aliso I-TREATMENT +Viejo, I-TREATMENT +CA) I-TREATMENT +Cerecyte® I-TREATMENT +(Micrus, I-TREATMENT +Sunnyvale, I-TREATMENT +CA). I-TREATMENT +El B-EVOLUTION +tamaño I-EVOLUTION +pupilar I-EVOLUTION +se I-EVOLUTION +normalizó I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +ptosis I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +adducción I-EVOLUTION +mejoraron I-EVOLUTION +completamente I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +embolización. I-EVOLUTION +Ocho I-EVOLUTION +meses I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +persistía I-EVOLUTION +un I-EVOLUTION +ligero I-EVOLUTION +déficit I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +elevación, I-EVOLUTION +sin I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refiriese I-EVOLUTION +diplopía. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +conocida I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +servicio, I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +traumático I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +(OI). I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destacamos I-PAST_MEDICAL_HISTORY +conjuntivitis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia, I-PAST_MEDICAL_HISTORY +artrosis I-PAST_MEDICAL_HISTORY +senil I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +hijos I-PAST_MEDICAL_HISTORY +sanos. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +observamos I-EXPLORATION +una I-EXPLORATION +abrasión I-EXPLORATION +corneal I-EXPLORATION +en I-EXPLORATION +OI, I-EXPLORATION +que B-TREATMENT +curará I-TREATMENT +con I-TREATMENT +oclusión I-TREATMENT +y I-TREATMENT +pomada I-TREATMENT +epitelizante I-TREATMENT +en I-TREATMENT +1 I-TREATMENT +semana. I-TREATMENT +Además B-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos I-EXPLORATION +(AO) I-EXPLORATION +un I-EXPLORATION +iris I-EXPLORATION +atrófico, I-EXPLORATION +desdoblado, I-EXPLORATION +desflecado I-EXPLORATION +con I-EXPLORATION +atrofia I-EXPLORATION +en I-EXPLORATION +sector I-EXPLORATION +inferior, I-EXPLORATION +más I-EXPLORATION +en I-EXPLORATION +OI I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +reducción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cámara I-EXPLORATION +anterior I-EXPLORATION +visible I-EXPLORATION +también I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +gonioscopia. I-EXPLORATION +Presenta I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +tensión I-EXPLORATION +ocular I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +mm I-EXPLORATION +Hg. I-EXPLORATION +en I-EXPLORATION +AO, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +campo I-EXPLORATION +visual I-EXPLORATION +(Humphrey I-EXPLORATION +30-2) I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +reducción I-EXPLORATION +general I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sensibilidad. I-EXPLORATION +Explorando I-EXPLORATION +el I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +encontramos I-EXPLORATION +lesiones I-EXPLORATION +hiperpigmentadas I-EXPLORATION +y I-EXPLORATION +atróficas I-EXPLORATION +(en I-EXPLORATION +«sal I-EXPLORATION +y I-EXPLORATION +pimienta»). I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +presunción I-EXPLORATION +de I-EXPLORATION +sífilis I-EXPLORATION +congénita, I-EXPLORATION +aún I-EXPLORATION +sin I-EXPLORATION +leucomas I-EXPLORATION +propios I-EXPLORATION +de I-EXPLORATION +queratitis I-EXPLORATION +intersticial I-EXPLORATION +antigua, I-EXPLORATION +solicitamos I-EXPLORATION +pruebas I-EXPLORATION +serológicas I-EXPLORATION +para I-EXPLORATION +lues I-EXPLORATION +obteniendo I-EXPLORATION +resultados I-EXPLORATION +positivos I-EXPLORATION +en I-EXPLORATION +test I-EXPLORATION +treponémicos I-EXPLORATION +(TPHA, I-EXPLORATION +FTA I-EXPLORATION +abs) I-EXPLORATION +y I-EXPLORATION +negativos I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +no I-EXPLORATION +treponémicos I-EXPLORATION +(RPR). I-EXPLORATION + I-EXPLORATION +En B-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +punto I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +evaluada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +medicina I-PAST_MEDICAL_HISTORY +interna I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +averiguamos I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +desconoce I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +causa I-PAST_MEDICAL_HISTORY +real I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +conjuntivitis, I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +relata, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +detallada: I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +tratamientos I-PAST_MEDICAL_HISTORY +recibidos I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +plena I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +preantibiótica, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +neobismuto I-PAST_MEDICAL_HISTORY +oral, I-PAST_MEDICAL_HISTORY +que B-FAMILY_HISTORY +su I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +«soltera» I-FAMILY_HISTORY +muere I-FAMILY_HISTORY +joven I-FAMILY_HISTORY +«deformada» I-FAMILY_HISTORY +y B-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +60, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +problemas I-PAST_MEDICAL_HISTORY +inespecíficos I-PAST_MEDICAL_HISTORY +articulares, I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +pautaron I-PAST_MEDICAL_HISTORY +unas I-PAST_MEDICAL_HISTORY +inyecciones I-PAST_MEDICAL_HISTORY +semanales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +mensuales I-PAST_MEDICAL_HISTORY +(penicilina I-PAST_MEDICAL_HISTORY +probablemente). I-PAST_MEDICAL_HISTORY +Hallazgos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +anamnesis I-PAST_MEDICAL_HISTORY +compatible I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sífilis I-PAST_MEDICAL_HISTORY +congénita I-PAST_MEDICAL_HISTORY +tardía, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +queratitis I-PAST_MEDICAL_HISTORY +intersticial I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +éxito, I-PAST_MEDICAL_HISTORY +pues I-PAST_MEDICAL_HISTORY +carece I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +leucomas. I-PAST_MEDICAL_HISTORY +Adquirida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +trasplacentaria: I-PAST_MEDICAL_HISTORY +madre B-FAMILY_HISTORY +con I-FAMILY_HISTORY +artropatía I-FAMILY_HISTORY +severa I-FAMILY_HISTORY +compatible I-FAMILY_HISTORY +con I-FAMILY_HISTORY +sífilis I-FAMILY_HISTORY +secundaria. I-FAMILY_HISTORY +Y B-PAST_MEDICAL_HISTORY +curada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +resultado I-PAST_MEDICAL_HISTORY +negativo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +test I-PAST_MEDICAL_HISTORY +RPR. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +dermatólogo I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +IP, I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +descartar I-DERIVED_FROM/TO +patología I-DERIVED_FROM/TO +ocular I-DERIVED_FROM/TO +asociada. I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +lesiones I-EXPLORATION +típicas I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +enfermedad, I-EXPLORATION +las I-EXPLORATION +denominadas I-EXPLORATION +líneas I-EXPLORATION +de I-EXPLORATION +Blaschko. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +ocular I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +buen I-EXPLORATION +comportamiento I-EXPLORATION +visual I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos I-EXPLORATION +(AO), I-EXPLORATION +segmento I-EXPLORATION +anterior I-EXPLORATION +normal, I-EXPLORATION +motilidad I-EXPLORATION +ocular I-EXPLORATION +intrínseca I-EXPLORATION +y I-EXPLORATION +extrínseca I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +(FO) I-EXPLORATION +con I-EXPLORATION +oftalmoscopio I-EXPLORATION +indirecto I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +(OD) I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +(OI) I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +tenue I-EXPLORATION +hemorragia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +nasal. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +dificultad I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +por I-EXPLORATION +movimientos I-EXPLORATION +continuos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente, I-EXPLORATION +se I-EXPLORATION +programó I-EXPLORATION +nueva I-EXPLORATION +exploración I-EXPLORATION +del I-EXPLORATION +FO I-EXPLORATION +bajo I-EXPLORATION +narcosis I-EXPLORATION +y I-EXPLORATION +angiografía I-EXPLORATION +fluoresceinica I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +vasculares I-EXPLORATION +ocultas. I-EXPLORATION +En I-EXPLORATION +dicha I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +nueva I-EXPLORATION +exploración I-EXPLORATION +del I-EXPLORATION +FO I-EXPLORATION +con I-EXPLORATION +oftalmoscopio I-EXPLORATION +indirecto I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +Retcam I-EXPLORATION +II I-EXPLORATION +(Massie I-EXPLORATION +Lab.) I-EXPLORATION +que I-EXPLORATION +permite I-EXPLORATION +archivar I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +en I-EXPLORATION +formato I-EXPLORATION +digital, I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +ulterior I-EXPLORATION +análisis I-EXPLORATION +detallado. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hipopigmentada I-EXPLORATION +paramacular I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +trayecto I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +vaso I-EXPLORATION +en I-EXPLORATION +extrema I-EXPLORATION +periferia I-EXPLORATION +temporal. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +OI I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +hemorragia I-EXPLORATION +lineal I-EXPLORATION +en I-EXPLORATION +periferia I-EXPLORATION +nasal I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +hallazgos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +angiografía I-EXPLORATION +fluoresceinica, I-EXPLORATION +inyectando I-EXPLORATION +vía I-EXPLORATION +intravenosa I-EXPLORATION +5 I-EXPLORATION +ml I-EXPLORATION +de I-EXPLORATION +fluoresceína I-EXPLORATION +sódica I-EXPLORATION +por I-EXPLORATION +kilogramo I-EXPLORATION +de I-EXPLORATION +peso, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +caso I-EXPLORATION +fueron I-EXPLORATION +0, I-EXPLORATION +35 I-EXPLORATION +ml. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +fotografías I-EXPLORATION +seriadas I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +Retcam I-EXPLORATION +II I-EXPLORATION +que I-EXPLORATION +pusieron I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +lesiones I-EXPLORATION +no I-EXPLORATION +observadas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +oftalmoscopia I-EXPLORATION +previa. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +exudación I-EXPLORATION +puntiforme I-EXPLORATION +en I-EXPLORATION +extrema I-EXPLORATION +periferia I-EXPLORATION +temporal. I-EXPLORATION +En I-EXPLORATION +OI I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +la I-EXPLORATION +no I-EXPLORATION +perfusión I-EXPLORATION +de I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +periferia I-EXPLORATION +nasal. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +láser I-TREATMENT +de I-TREATMENT +diodo I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +nasal I-TREATMENT +afectada I-TREATMENT +del I-TREATMENT +OI I-TREATMENT +(1.200 I-TREATMENT +impactos, I-TREATMENT +300 I-TREATMENT +mW, I-TREATMENT +300 I-TREATMENT +ms). I-TREATMENT + I-TREATMENT + +Una B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +sana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +acude B-DERIVED_FROM/TO +referida I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +oftalmólogo I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +evaluación I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ojo I-DERIVED_FROM/TO +rojo I-DERIVED_FROM/TO +doloroso I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +aproximadamente I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +mes I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución. I-DERIVED_FROM/TO +No B-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +excepción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +catarata I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +complicada I-PAST_MEDICAL_HISTORY +(facoemulsificación) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +unos I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +sobreelevada I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +limbo I-EXPLORATION +superonasal I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +(próxima I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +incisión I-EXPLORATION +quirúrgica) I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +múltiples I-EXPLORATION +microinfiltrados I-EXPLORATION +corneales, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +ingurgitación I-EXPLORATION +vascular I-EXPLORATION +conjuntival I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +plexo I-EXPLORATION +escleral I-EXPLORATION +profundo. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +colirios I-TREATMENT +antibióticos I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro, I-TREATMENT +añadiéndose I-TREATMENT +además I-TREATMENT +instilaciones I-TREATMENT +de I-TREATMENT +colirios I-TREATMENT +de I-TREATMENT +suero I-TREATMENT +autólogo I-TREATMENT +y I-TREATMENT +medroxiprogesterona. I-TREATMENT + I-TREATMENT +Debido B-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +escasa I-EXPLORATION +respuesta I-EXPLORATION +al I-EXPLORATION +tratamiento, I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +diversas I-EXPLORATION +pruebas I-EXPLORATION +serológicas I-EXPLORATION +(incluyendo I-EXPLORATION +bioquímica, I-EXPLORATION +hemograma, I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda I-EXPLORATION +y I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +autoinmunidad). I-EXPLORATION +Paralelamente B-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +corticoides I-TREATMENT +sistémicos I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +mg/kg. I-TREATMENT +Además I-TREATMENT +decidimos I-TREATMENT +tomar I-TREATMENT +una I-TREATMENT +muestra I-TREATMENT +escleroconjuntival, I-TREATMENT +previa I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +conjuntiva I-TREATMENT +adyacente, I-TREATMENT +con I-TREATMENT +posterior I-TREATMENT +implante I-TREATMENT +de I-TREATMENT +membrana I-TREATMENT +amniótica I-TREATMENT +(técnica I-TREATMENT +«inlay») I-TREATMENT +unido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +adhesivo I-TREATMENT +biológico I-TREATMENT +(Fibrin I-TREATMENT +Glue®) I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +área I-TREATMENT +de I-TREATMENT +lesión. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +fue I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +granulomatosis I-EXPLORATION +necrotizante I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +hiperplasia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +sin I-EXPLORATION +indicios I-EXPLORATION +de I-EXPLORATION +vasculitis I-EXPLORATION +acompañante. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +serológicas I-EXPLORATION +realizadas I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Considerando B-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +ENIC, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +instaurar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Ciclosporina I-TREATMENT +A I-TREATMENT +(3 I-TREATMENT +mg/kg/día) I-TREATMENT +unido I-TREATMENT +a I-TREATMENT +los I-TREATMENT +corticosteroides I-TREATMENT +orales I-TREATMENT +(1 I-TREATMENT +mg/kg/día), I-TREATMENT +pero I-TREATMENT +unas I-TREATMENT +ocho I-TREATMENT +semanas I-TREATMENT +tras I-TREATMENT +su I-TREATMENT +inicio I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +inflamatorio I-TREATMENT +persistía I-TREATMENT +y, I-TREATMENT +dada I-TREATMENT +su I-TREATMENT +severidad, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +sustituir I-TREATMENT +Ciclosporina I-TREATMENT +por I-TREATMENT +Azatioprina I-TREATMENT +(100 I-TREATMENT +mg/día) I-TREATMENT +manteniendo I-TREATMENT +los I-TREATMENT +corticosteroides I-TREATMENT +orales. I-TREATMENT + I-TREATMENT +Este B-EVOLUTION +régimen I-EVOLUTION +terapéutico I-EVOLUTION +consiguió I-EVOLUTION +progresivamente I-EVOLUTION +controlar I-EVOLUTION +el I-EVOLUTION +proceso I-EVOLUTION +inflamatorio. I-EVOLUTION +Siete I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +continúa I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +craneoencefálico I-PRESENT_ILLNESS +presenta, I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +medular I-PRESENT_ILLNESS +incompleto I-PRESENT_ILLNESS +sensitivo I-PRESENT_ILLNESS +motor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +par I-PRESENT_ILLNESS +VI I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +(OI) I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +produce I-PRESENT_ILLNESS +diplopía I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +todas I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +posiciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mirada. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +motora I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +limitación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +abducción I-EXPLORATION +de I-EXPLORATION +-3, I-EXPLORATION +tortícolis I-EXPLORATION +cara I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +10o, I-EXPLORATION +endotropía I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +r I-EXPLORATION +en I-EXPLORATION +posición I-EXPLORATION +primaria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mirada I-EXPLORATION +con I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +(OD) I-EXPLORATION +fijador. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +sensorial, I-EXPLORATION +la I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +Worth I-EXPLORATION +muestra I-EXPLORATION +supresión I-EXPLORATION +intermitente I-EXPLORATION +de I-EXPLORATION +OI. I-EXPLORATION +La I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +(AV) I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +OD I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +OI I-EXPLORATION +1. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +dos I-TREATMENT +inyecciones I-TREATMENT +de I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +5 I-TREATMENT +UI I-TREATMENT +en I-TREATMENT +recto I-TREATMENT +medio I-TREATMENT +del I-TREATMENT +OI, I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +disminuyó I-TREATMENT +la I-TREATMENT +endotropía I-TREATMENT +a I-TREATMENT +30 I-TREATMENT +r I-TREATMENT +sin I-TREATMENT +mejorar I-TREATMENT +la I-TREATMENT +abducción. I-TREATMENT + I-TREATMENT +A I-TREATMENT +los I-TREATMENT +6 I-TREATMENT +meses I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +TRV I-TREATMENT +con I-TREATMENT +fijación I-TREATMENT +escleral I-TREATMENT +en I-TREATMENT +OI I-TREATMENT +con I-TREATMENT +anestesia I-TREATMENT +general. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +exotropía I-EVOLUTION +consecutiva I-EVOLUTION +de I-EVOLUTION +45 I-EVOLUTION +r, I-EVOLUTION +inversión I-EVOLUTION +del I-EVOLUTION +tortícolis, I-EVOLUTION +limitación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +aducción I-EVOLUTION +de I-EVOLUTION +-1 I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +abducción I-EVOLUTION +de I-EVOLUTION +-1 I-EVOLUTION +del I-EVOLUTION +ojo I-EVOLUTION +afectado I-EVOLUTION +y I-EVOLUTION +diplopía. I-EVOLUTION + I-EVOLUTION +A B-TREATMENT +los I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +se I-TREATMENT +inyectan I-TREATMENT +5 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +en I-TREATMENT +recto I-TREATMENT +lateral I-TREATMENT +del I-TREATMENT +OI I-TREATMENT +sin I-TREATMENT +que I-TREATMENT +se I-TREATMENT +modificase I-TREATMENT +el I-TREATMENT +resultado, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +a I-TREATMENT +los I-TREATMENT +2 I-TREATMENT +meses I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +retirar I-TREATMENT +la I-TREATMENT +fijación I-TREATMENT +escleral, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +técnicamente I-TREATMENT +imposible I-TREATMENT +por I-TREATMENT +las I-TREATMENT +adherencias I-TREATMENT +encontradas. I-TREATMENT +Se I-TREATMENT +reinterviene I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +realizando I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +recto I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +OI I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +mm I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inyectan I-TREATMENT +5 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +en I-TREATMENT +recto I-TREATMENT +lateral I-TREATMENT +del I-TREATMENT +OI I-TREATMENT +intraoperatoriamente. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +quedó I-EVOLUTION +con I-EVOLUTION +tortícolis I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cara I-EVOLUTION +derecha I-EVOLUTION +de I-EVOLUTION +10o, I-EVOLUTION +limitación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +abducción I-EVOLUTION +de I-EVOLUTION +-1, I-EVOLUTION +exotropía I-EVOLUTION +de I-EVOLUTION +10-15 I-EVOLUTION +r I-EVOLUTION +en I-EVOLUTION +posición I-EVOLUTION +primaria I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mirada I-EVOLUTION +(PPM) I-EVOLUTION +sin I-EVOLUTION +diplopía. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +diplopía, I-EVOLUTION +exotropÍa I-EVOLUTION +de I-EVOLUTION +20-30 I-EVOLUTION +r I-EVOLUTION +en I-EVOLUTION +PPM, I-EVOLUTION +limitación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +abducción I-EVOLUTION +de I-EVOLUTION +-1, I-EVOLUTION +limitación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +aducción I-EVOLUTION +de I-EVOLUTION +-1 I-EVOLUTION +y I-EVOLUTION +tortícolis I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cara I-EVOLUTION +derecha I-EVOLUTION +de I-EVOLUTION +20o. I-EVOLUTION + I-EVOLUTION +Se B-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +recto I-TREATMENT +medio I-TREATMENT +del I-TREATMENT +OI I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +mm. I-TREATMENT + I-TREATMENT +Un B-EVOLUTION +año I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +última I-EVOLUTION +cirugía I-EVOLUTION +presenta: I-EVOLUTION +limitación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +abducción I-EVOLUTION +de I-EVOLUTION +-1, I-EVOLUTION +tortícolis I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cara I-EVOLUTION +derecha I-EVOLUTION +de I-EVOLUTION +5o, I-EVOLUTION +exotropía I-EVOLUTION +de I-EVOLUTION +10-15 I-EVOLUTION +r I-EVOLUTION +en I-EVOLUTION +PPM I-EVOLUTION +sin I-EVOLUTION +diplopía. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +satisfecho I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +resultado. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hepatitis I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +virus I-PRESENT_ILLNESS +C I-PRESENT_ILLNESS +genotipo I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +carga I-PRESENT_ILLNESS +viral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4.300.000 I-PRESENT_ILLNESS +copias/ml I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipertensión I-PRESENT_ILLNESS +arterial I-PRESENT_ILLNESS +(HTA). I-PRESENT_ILLNESS +Se B-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +IFN I-TREATMENT +pegilado I-TREATMENT +alpha-2b I-TREATMENT +(180µg/semana) I-TREATMENT +junto I-TREATMENT +a I-TREATMENT +ribavirina I-TREATMENT +(800mg/día). I-TREATMENT +Dados B-EXPLORATION +sus I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +HTA I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +15 I-EXPLORATION +días I-EXPLORATION +del I-EXPLORATION +inicio I-EXPLORATION +del I-EXPLORATION +tratamiento. I-EXPLORATION +Presentó I-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +(AV) I-EXPLORATION +de I-EXPLORATION +10/10 I-EXPLORATION +con I-EXPLORATION +corrección I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +(FO): I-EXPLORATION +papilas I-EXPLORATION +y I-EXPLORATION +máculas I-EXPLORATION +normales. I-EXPLORATION +Esclerosis I-EXPLORATION +arterial I-EXPLORATION +y I-EXPLORATION +tortuosidad I-EXPLORATION +venosa I-EXPLORATION +con I-EXPLORATION +cruces I-EXPLORATION +arterio-venosos I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses, I-EVOLUTION +y I-EVOLUTION +estando I-EVOLUTION +asintomática, I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +valorada. I-EVOLUTION +Presentó B-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +AV I-EXPLORATION +pero I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +FO I-EXPLORATION +aparecían I-EXPLORATION +múltiples I-EXPLORATION +exudados I-EXPLORATION +algodonosos I-EXPLORATION +en I-EXPLORATION +arcadas I-EXPLORATION +y I-EXPLORATION +polo I-EXPLORATION +posterior, I-EXPLORATION +con I-EXPLORATION +respeto I-EXPLORATION +de I-EXPLORATION +área I-EXPLORATION +macular, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +alguna I-EXPLORATION +microhemorragia I-EXPLORATION +y I-EXPLORATION +microaneurisma. I-EXPLORATION +Se B-TREATMENT +etiquetó I-TREATMENT +de I-TREATMENT +retinopatía I-TREATMENT +por I-TREATMENT +IFN I-TREATMENT +y I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +continuar I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +dada I-TREATMENT +la I-TREATMENT +nula I-TREATMENT +repercusión I-TREATMENT +en I-TREATMENT +la I-TREATMENT +AV, I-TREATMENT +la I-TREATMENT +carga I-TREATMENT +viral I-TREATMENT +alta I-TREATMENT +y I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +un I-TREATMENT +seguimiento I-TREATMENT +estrecho. I-TREATMENT + I-TREATMENT +La I-TREATMENT +respuesta I-TREATMENT +virológica I-TREATMENT +fue I-TREATMENT +tardía I-TREATMENT +en I-TREATMENT +la I-TREATMENT +semana I-TREATMENT +24, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +prolongó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +72 I-TREATMENT +semanas I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +produjo I-TREATMENT +neutropenia I-TREATMENT +que I-TREATMENT +como I-TREATMENT +máximo I-TREATMENT +llegó I-TREATMENT +a I-TREATMENT +ser I-TREATMENT +de I-TREATMENT +600/mm3 I-TREATMENT +y I-TREATMENT +anemia I-TREATMENT +como I-TREATMENT +máximo I-TREATMENT +de I-TREATMENT +8, I-TREATMENT +5g/dl I-TREATMENT +de I-TREATMENT +hemoglobina, I-TREATMENT +pero I-TREATMENT +no I-TREATMENT +se I-TREATMENT +modificaron I-TREATMENT +las I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +IFN. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +sucesivos I-EVOLUTION +controles I-EVOLUTION +siempre I-EVOLUTION +mantuvo I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +AV, I-EVOLUTION +los I-EVOLUTION +exudados I-EVOLUTION +se I-EVOLUTION +fueron I-EVOLUTION +reabsorbiendo I-EVOLUTION +y I-EVOLUTION +quedó I-EVOLUTION +sólo I-EVOLUTION +una I-EVOLUTION +microhemorragia I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +arcada I-EVOLUTION +vascular I-EVOLUTION +temporal I-EVOLUTION +superior I-EVOLUTION +del I-EVOLUTION +ojo I-EVOLUTION +derecho. I-EVOLUTION + I-EVOLUTION + +El B-PRESENT_ILLNESS +cuarto I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +visual I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +intervención I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cirugía I-PRESENT_ILLNESS +refractiva I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +LASIK I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +antes. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +dudoso I-PAST_MEDICAL_HISTORY +diagnostico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esclerosis I-PAST_MEDICAL_HISTORY +múltiple I-PAST_MEDICAL_HISTORY +dudosa I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +pruebas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +imagen I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +constataran. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +visión I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +05 I-EXPLORATION +y I-EXPLORATION +movimiento I-EXPLORATION +de I-EXPLORATION +manos. I-EXPLORATION +El I-EXPLORATION +flap I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +alteraciones. I-EXPLORATION +Al I-EXPLORATION +explorar I-EXPLORATION +su I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +de I-EXPLORATION +mielina I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +nervio I-EXPLORATION +óptico I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +palidez I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +izquierdo. I-EXPLORATION +La I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +simulación I-EXPLORATION +surge I-EXPLORATION +cuando I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +desenvuelve I-EXPLORATION +perfectamente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +consulta, I-EXPLORATION +llegando I-EXPLORATION +a I-EXPLORATION +enviar I-EXPLORATION +un I-EXPLORATION +mensaje I-EXPLORATION +con I-EXPLORATION +su I-EXPLORATION +móvil. I-EXPLORATION +Refiere I-EXPLORATION +que I-EXPLORATION +trabaja I-EXPLORATION +y I-EXPLORATION +conduce I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +supuesta I-EXPLORATION +baja I-EXPLORATION +visión. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +visión I-EXPLORATION +binocular I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +estereopsis I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +(120"-60"). I-EXPLORATION +Pruebas I-EXPLORATION +específicas I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +Bravais I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +escritura I-EXPLORATION +o I-EXPLORATION +Roth I-EXPLORATION +resultaron I-EXPLORATION +positivas. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +fue I-EXPLORATION +capaz I-EXPLORATION +de I-EXPLORATION +escribir I-EXPLORATION +su I-EXPLORATION +nombre I-EXPLORATION +con I-EXPLORATION +visión I-EXPLORATION +monocular I-EXPLORATION +y I-EXPLORATION +siguiendo I-EXPLORATION +una I-EXPLORATION +línea, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +interrumpirla I-EXPLORATION +en I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tarea. I-EXPLORATION +También I-EXPLORATION +dibujó I-EXPLORATION +una I-EXPLORATION +línea I-EXPLORATION +recta, I-EXPLORATION +reanudando I-EXPLORATION +el I-EXPLORATION +trazo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +punto I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +lo I-EXPLORATION +había I-EXPLORATION +dejado I-EXPLORATION +tras I-EXPLORATION +distraerla I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +intencionada. I-EXPLORATION +Pruebas I-EXPLORATION +complementarias I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +AFG I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +ERG I-EXPLORATION +aportaron I-EXPLORATION +resultados I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +PEV I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +leve I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +conducción I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +nervio I-EXPLORATION +óptico I-EXPLORATION +izquierdo. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +neurología I-EXPLORATION +fue I-EXPLORATION +descartada I-EXPLORATION +la I-EXPLORATION +esclerosis I-EXPLORATION +múltiple, I-EXPLORATION +con I-EXPLORATION +RM I-EXPLORATION +y I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +SA I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +alteraciones I-PAST_MEDICAL_HISTORY +oculares I-PAST_MEDICAL_HISTORY +(lenticono I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +retinopatía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +flecos), I-PAST_MEDICAL_HISTORY +acudió B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +AV I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +OD. I-PRESENT_ILLNESS +Resultó B-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cataratas I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +OCT I-EXPLORATION +previa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +detectó I-EXPLORATION +disminución I-EXPLORATION +bilateral I-EXPLORATION +del I-EXPLORATION +espesor I-EXPLORATION +macular, I-EXPLORATION +con I-EXPLORATION +adelgazamiento I-EXPLORATION +de I-EXPLORATION +capas I-EXPLORATION +internas I-EXPLORATION +retinianas, I-EXPLORATION +fundamentalmente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +macular I-EXPLORATION +temporal. I-EXPLORATION +La I-EXPLORATION +AV I-EXPLORATION +fue I-EXPLORATION +0, I-EXPLORATION +01 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +0, I-EXPLORATION +7 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OI. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +del I-EXPLORATION +OD I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +un I-EXPLORATION +AM I-EXPLORATION +de I-EXPLORATION +espesor I-EXPLORATION +completo, I-EXPLORATION +comprobado I-EXPLORATION +mediante I-EXPLORATION +OCT, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +diámetro I-EXPLORATION +de I-EXPLORATION +1.400µm. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +decidió I-TREATMENT +no I-TREATMENT +ser I-TREATMENT +intervenido, I-TREATMENT +adquiriéndose I-TREATMENT +actitud I-TREATMENT +expectante. I-TREATMENT +Actualmente B-EVOLUTION +persiste I-EVOLUTION +el I-EVOLUTION +AM, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +diámetro I-EVOLUTION +de I-EVOLUTION +2.900µm, I-EVOLUTION +con I-EVOLUTION +pérdida I-EVOLUTION +importante I-EVOLUTION +del I-EVOLUTION +tejido I-EVOLUTION +retiniano I-EVOLUTION +y I-EVOLUTION +alteraciones I-EVOLUTION +quísticas. I-EVOLUTION +El I-EVOLUTION +OI I-EVOLUTION +muestra I-EVOLUTION +adelgazamiento I-EVOLUTION +progresivo I-EVOLUTION +similar I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +macular I-EVOLUTION +temporal I-EVOLUTION +con I-EVOLUTION +espesores I-EVOLUTION +de I-EVOLUTION +164µm. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +raza B-PAST_MEDICAL_HISTORY +mestiza, I-PAST_MEDICAL_HISTORY +procedente I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +área I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ciudad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Palmira I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +departamento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Valle I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Cauca I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Colombia. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +consistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +rechazo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +bipedestación I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +sedestación, I-PRESENT_ILLNESS +principalmente I-PRESENT_ILLNESS +manifestado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +ponerse I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pie. I-PRESENT_ILLNESS +Afebril I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +toda I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +manifestaciones I-PRESENT_ILLNESS +intermitentes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +disminuía I-PRESENT_ILLNESS +parcialmente I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +administración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +acetaminofeno, I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +mg/kg/dosis. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraron I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trauma, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tejido I-PAST_MEDICAL_HISTORY +conectivo, I-PAST_MEDICAL_HISTORY +hipertensión, I-PAST_MEDICAL_HISTORY +diabetes, I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +congénita I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +tuberculosis. I-PAST_MEDICAL_HISTORY +Los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +perinatales I-PAST_MEDICAL_HISTORY +eran I-PAST_MEDICAL_HISTORY +desconocidos I-PAST_MEDICAL_HISTORY +dado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +entregada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +adopción I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +protección I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +sustituta. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +eutrófica, I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable. I-EXPLORATION +Se I-EXPLORATION +destaca I-EXPLORATION +el I-EXPLORATION +rechazo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bipedestación I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +marcha, I-EXPLORATION +con I-EXPLORATION +irritabilidad I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +caderas, I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +lumbar, I-EXPLORATION +contractura I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +paraespinosos, I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lordosis I-EXPLORATION +lumbar I-EXPLORATION +y I-EXPLORATION +localizaba I-EXPLORATION +el I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +lumbar. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +la I-EXPLORATION +maniobra I-EXPLORATION +de I-EXPLORATION +Gowers, I-EXPLORATION +ni I-EXPLORATION +afectación I-EXPLORATION +neurológica. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +clínicos I-EXPLORATION +iniciales I-EXPLORATION +destacaba I-EXPLORATION +hemograma I-EXPLORATION +normal, I-EXPLORATION +Proteína I-EXPLORATION +C I-EXPLORATION +Reactiva I-EXPLORATION +(PCR) I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +mg/dl I-EXPLORATION +(rango I-EXPLORATION +de I-EXPLORATION +0 I-EXPLORATION +a I-EXPLORATION +5 I-EXPLORATION +mg/dl), I-EXPLORATION +Velocidad I-EXPLORATION +de I-EXPLORATION +Sedimentación I-EXPLORATION +Globular I-EXPLORATION +(VSG) I-EXPLORATION +de I-EXPLORATION +40 I-EXPLORATION +mm/h), I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +normal, I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +hepática I-EXPLORATION +normales, I-EXPLORATION +antígenos I-EXPLORATION +para I-EXPLORATION +Salmonella I-EXPLORATION +negativos, I-EXPLORATION +Anticuerpos I-EXPLORATION +Antinucleares I-EXPLORATION +(AAN) I-EXPLORATION +negativos, I-EXPLORATION +Creatin I-EXPLORATION +Fosfoquinasa I-EXPLORATION +(CPK) I-EXPLORATION +normal. I-EXPLORATION +Entre I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +imagenológicos I-EXPLORATION +destacó I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +de I-EXPLORATION +región I-EXPLORATION +lumbosacra I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +caderas I-EXPLORATION +informadas I-EXPLORATION +como I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +Resonancia I-EXPLORATION +Magnética I-EXPLORATION +(RM) I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +de I-EXPLORATION +pelvis I-EXPLORATION +con I-EXPLORATION +énfasis I-EXPLORATION +en I-EXPLORATION +cadera I-EXPLORATION +izquierda, I-EXPLORATION +evidenció I-EXPLORATION +compromiso I-EXPLORATION +articular I-EXPLORATION +coxofemoral, I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +femoral I-EXPLORATION +normales, I-EXPLORATION +acetábulo I-EXPLORATION +adecuado I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +coronal I-EXPLORATION +y I-EXPLORATION +sagital. I-EXPLORATION +Se I-EXPLORATION +encontró I-EXPLORATION +alteración I-EXPLORATION +del I-EXPLORATION +disco I-EXPLORATION +L5-S1, I-EXPLORATION +con I-EXPLORATION +erosiones I-EXPLORATION +óseas I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +espondilodiscitis. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +búsqueda I-EXPLORATION +intencionada I-EXPLORATION +para I-EXPLORATION +tuberculosis I-EXPLORATION +y I-EXPLORATION +descartar I-EXPLORATION +Mal I-EXPLORATION +de I-EXPLORATION +Pott I-EXPLORATION +como I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial; I-EXPLORATION +con I-EXPLORATION +Prueba I-EXPLORATION +de I-EXPLORATION +Tuberculina I-EXPLORATION +(PPD), I-EXPLORATION +tres I-EXPLORATION +baciloscopias I-EXPLORATION +(BK) I-EXPLORATION +seriados I-EXPLORATION +en I-EXPLORATION +jugo I-EXPLORATION +gástrico, I-EXPLORATION +tres I-EXPLORATION +BK I-EXPLORATION +seriados I-EXPLORATION +en I-EXPLORATION +orina, I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +contrastado, I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +total, I-EXPLORATION +sin I-EXPLORATION +encontrarse I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +estas I-EXPLORATION +ayudas I-EXPLORATION +diagnósticas. I-EXPLORATION + I-EXPLORATION +Durante B-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +se I-EVOLUTION +documentó I-EVOLUTION +exacerbación I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +manifestado I-EVOLUTION +en I-EVOLUTION +rechazo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +bipedestación I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +marcha, I-EVOLUTION +con I-EVOLUTION +irritabilidad I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +flexión I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +caderas. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +con I-EVOLUTION +reactantes I-EVOLUTION +de I-EVOLUTION +fase I-EVOLUTION +aguda I-EVOLUTION +destacó I-EVOLUTION +elevación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +PCR I-EVOLUTION +a I-EVOLUTION +12 I-EVOLUTION +mg/dl I-EVOLUTION +y I-EVOLUTION +VSG I-EVOLUTION +a I-EVOLUTION +60 I-EVOLUTION +mm/h. I-EVOLUTION + I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +exploración I-EXPLORATION +quirúrgica I-EXPLORATION +y I-EXPLORATION +drenaje I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cc I-EXPLORATION +de I-EXPLORATION +secreción I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +purulento, I-EXPLORATION +cultivo I-EXPLORATION +y I-EXPLORATION +biopsia. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +reportó: I-EXPLORATION +Trabécula I-EXPLORATION +ósea I-EXPLORATION +usual I-EXPLORATION +y I-EXPLORATION +medula I-EXPLORATION +ósea I-EXPLORATION +con I-EXPLORATION +espacio I-EXPLORATION +medular I-EXPLORATION +con I-EXPLORATION +celularidad I-EXPLORATION +del I-EXPLORATION +30%, I-EXPLORATION +conservación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +relación I-EXPLORATION +granulo-eritroide, I-EXPLORATION +sin I-EXPLORATION +evidenciarse I-EXPLORATION +inflamación I-EXPLORATION +granulomatosa I-EXPLORATION +o I-EXPLORATION +proceso I-EXPLORATION +neoplásico. I-EXPLORATION +Reporte I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +cultivos I-EXPLORATION +(incluyendo I-EXPLORATION +estudios I-EXPLORATION +para I-EXPLORATION +Brucella I-EXPLORATION +y I-EXPLORATION +Bartonella), I-EXPLORATION +neoplasia I-EXPLORATION +y I-EXPLORATION +tuberculosis. I-EXPLORATION + I-EXPLORATION +En B-TREATMENT +junta I-TREATMENT +médica I-TREATMENT +interdisciplinaria, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +Clindamicina I-TREATMENT +40 I-TREATMENT +mg/kg/día I-TREATMENT +y I-TREATMENT +Ceftriaxone I-TREATMENT +100 I-TREATMENT +mg/kg/día I-TREATMENT +endovenoso I-TREATMENT +durante I-TREATMENT +4 I-TREATMENT +semanas I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +semanas I-TREATMENT +con I-TREATMENT +Cefalexina I-TREATMENT +100 I-TREATMENT +mg/kg/día I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT +Para I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +dolor, I-TREATMENT +recibió I-TREATMENT +Naproxeno I-TREATMENT +y I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +rehabilitación I-TREATMENT +física, I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +resolución I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +clínico, I-TREATMENT +evidenciado I-TREATMENT +en I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +dolor, I-TREATMENT +mejoría I-TREATMENT +en I-TREATMENT +bipedestación, I-TREATMENT +marcha I-TREATMENT +y I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +los I-TREATMENT +reactantes I-TREATMENT +de I-TREATMENT +fase I-TREATMENT +aguda. I-TREATMENT + I-TREATMENT + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +controles I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +policlínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +broncopulmonar, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuadros I-PAST_MEDICAL_HISTORY +bronquiales I-PAST_MEDICAL_HISTORY +obstructivos I-PAST_MEDICAL_HISTORY +frecuentes I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +infecciones I-PAST_MEDICAL_HISTORY +respiratorias I-PAST_MEDICAL_HISTORY +recurrentes, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +convencional. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Por B-EXPLORATION +referir I-EXPLORATION +dolor I-EXPLORATION +torácico I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +pesquisó I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +derecho I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +SP I-EXPLORATION +intralobar. I-EXPLORATION +Fue I-EXPLORATION +evaluado I-EXPLORATION +con I-EXPLORATION +electrocardiograma I-EXPLORATION +y I-EXPLORATION +ecocardiograma I-EXPLORATION +resultando I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +hemodinámico I-EXPLORATION +para I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +usó I-EXPLORATION +sedación I-EXPLORATION +y I-EXPLORATION +anestesia I-EXPLORATION +local I-EXPLORATION +con I-EXPLORATION +lidocaína, I-EXPLORATION +se I-EXPLORATION +cateterizó I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +femoral I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +introductor I-EXPLORATION +5 I-EXPLORATION +French. I-EXPLORATION +Se I-EXPLORATION +efectuó I-EXPLORATION +una I-EXPLORATION +aortografía I-EXPLORATION +torácica I-EXPLORATION +con I-EXPLORATION +catéter I-EXPLORATION +Pig I-EXPLORATION +Tail I-EXPLORATION +5 I-EXPLORATION +French I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +pesquisó, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +torácica, I-EXPLORATION +un I-EXPLORATION +vaso I-EXPLORATION +aberrante I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +calibre I-EXPLORATION +que I-EXPLORATION +nacía I-EXPLORATION +de I-EXPLORATION +ésta I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +dirigía I-EXPLORATION +al I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +pulmón I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +diámetro I-EXPLORATION +mínimo I-EXPLORATION +2 I-EXPLORATION +mm I-EXPLORATION +y I-EXPLORATION +máximo I-EXPLORATION +6 I-EXPLORATION +mm. I-EXPLORATION + I-EXPLORATION +Posteriormente, B-TREATMENT +con I-TREATMENT +catéter I-TREATMENT +multipropósito I-TREATMENT +5 I-TREATMENT +French I-TREATMENT +se I-TREATMENT +canalizó I-TREATMENT +el I-TREATMENT +vaso I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +al I-TREATMENT +cambio I-TREATMENT +de I-TREATMENT +introductor I-TREATMENT +N° I-TREATMENT +6 I-TREATMENT +French I-TREATMENT +y I-TREATMENT +por I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +multipropósito I-TREATMENT +se I-TREATMENT +ubicó I-TREATMENT +una I-TREATMENT +guía I-TREATMENT +de I-TREATMENT +intercambio I-TREATMENT +a I-TREATMENT +distal I-TREATMENT +de I-TREATMENT +vasos I-TREATMENT +que I-TREATMENT +nutrían I-TREATMENT +el I-TREATMENT +secuestro I-TREATMENT +por I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +introdujo I-TREATMENT +catéter I-TREATMENT +largo I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +French I-TREATMENT +y I-TREATMENT +por I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +este I-TREATMENT +se I-TREATMENT +implantó I-TREATMENT +un I-TREATMENT +dispositivo I-TREATMENT +AVP I-TREATMENT +II I-TREATMENT +(AmplatzerR) I-TREATMENT +de I-TREATMENT +dimensiones I-TREATMENT +4/6 I-TREATMENT +mm, I-TREATMENT +posterior I-TREATMENT +a I-TREATMENT +su I-TREATMENT +ubicación I-TREATMENT +y I-TREATMENT +comprobando I-TREATMENT +su I-TREATMENT +estabilidad I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +su I-TREATMENT +liberación, I-TREATMENT +obteniendo I-TREATMENT +oclusión I-TREATMENT +total I-TREATMENT +del I-TREATMENT +vaso I-TREATMENT +a I-TREATMENT +la I-TREATMENT +angiografía I-TREATMENT +de I-TREATMENT +control. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +controlado I-EVOLUTION +con I-EVOLUTION +radiografía I-EVOLUTION +de I-EVOLUTION +tórax I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +evidenció I-EVOLUTION +dispositivo I-EVOLUTION +in I-EVOLUTION +situ I-EVOLUTION +y I-EVOLUTION +campos I-EVOLUTION +pulmonares I-EVOLUTION +libres. I-EVOLUTION +Fue I-EVOLUTION +controlado I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +semana, I-EVOLUTION +mes, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses, I-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +años, I-EVOLUTION +encontrándose I-EVOLUTION +en I-EVOLUTION +todos I-EVOLUTION +sus I-EVOLUTION +controles I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +excelentes I-EVOLUTION +condiciones. I-EVOLUTION + I-EVOLUTION + +Recién B-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +hijo B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +primigesta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +36 I-PAST_MEDICAL_HISTORY +semanas, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +prenatal I-PAST_MEDICAL_HISTORY +irregular, I-PAST_MEDICAL_HISTORY +quien I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +vaginal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +líquido I-PAST_MEDICAL_HISTORY +amniótico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +meconio. I-PAST_MEDICAL_HISTORY +Pesó I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacer I-PAST_MEDICAL_HISTORY +1.240 I-PAST_MEDICAL_HISTORY +g I-PAST_MEDICAL_HISTORY +(< I-PAST_MEDICAL_HISTORY +p I-PAST_MEDICAL_HISTORY +3), I-PAST_MEDICAL_HISTORY +midió I-PAST_MEDICAL_HISTORY +41 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +(< I-PAST_MEDICAL_HISTORY +p I-PAST_MEDICAL_HISTORY +3), I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +apgar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +9. I-PAST_MEDICAL_HISTORY +Presentó I-PAST_MEDICAL_HISTORY +dificultad I-PAST_MEDICAL_HISTORY +respiratoria I-PAST_MEDICAL_HISTORY +temprana I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +requirió I-PAST_MEDICAL_HISTORY +soporte I-PAST_MEDICAL_HISTORY +ventilatorio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +surfactante I-PAST_MEDICAL_HISTORY +pulmonar, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +adecuada I-PAST_MEDICAL_HISTORY +respuesta. I-PAST_MEDICAL_HISTORY +Se B-DERIVED_FROM/TO +logró I-DERIVED_FROM/TO +extubación I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +CPAP, I-DERIVED_FROM/TO +pero I-DERIVED_FROM/TO +presentó I-DERIVED_FROM/TO +taquicardia I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +taquipnea I-DERIVED_FROM/TO +persistente, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +cual I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realizó I-DERIVED_FROM/TO +ecocardiograma I-DERIVED_FROM/TO +sugestivo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +coartación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +aorta I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +mayor I-DERIVED_FROM/TO +complejidad, I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +13 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vida. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +institución I-EXPLORATION +se I-EXPLORATION +tomó I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +en I-EXPLORATION +cuatro I-EXPLORATION +extremidades: I-EXPLORATION +Miembros I-EXPLORATION +superiores I-EXPLORATION +derecho I-EXPLORATION +e I-EXPLORATION +izquierdo I-EXPLORATION +88/49 I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +media I-EXPLORATION +(PAM) I-EXPLORATION +62 I-EXPLORATION +y I-EXPLORATION +90/52 I-EXPLORATION +PAM I-EXPLORATION +63, I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +derecho I-EXPLORATION +e I-EXPLORATION +izquierdo I-EXPLORATION +86/43 I-EXPLORATION +PAM I-EXPLORATION +61, I-EXPLORATION +78/44 I-EXPLORATION +PAM I-EXPLORATION +53, I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +180 I-EXPLORATION +y I-EXPLORATION +respiratoria I-EXPLORATION +65 I-EXPLORATION +x I-EXPLORATION +min. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +segmentario I-EXPLORATION +destacaba I-EXPLORATION +hepatomegalia, I-EXPLORATION +frialdad I-EXPLORATION +distal, I-EXPLORATION +taquicardia, I-EXPLORATION +soplo I-EXPLORATION +en I-EXPLORATION +foco I-EXPLORATION +pulmonar I-EXPLORATION +II/VI, I-EXPLORATION +pulsos I-EXPLORATION +femorales I-EXPLORATION +presentes, I-EXPLORATION +retracción I-EXPLORATION +subcostal, I-EXPLORATION +temblor I-EXPLORATION +distal I-EXPLORATION +fino, I-EXPLORATION +exoftalmo I-EXPLORATION +marcado I-EXPLORATION +y I-EXPLORATION +precordio I-EXPLORATION +hiperdinámico. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +Ecocardiograma I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +coartación I-EXPLORATION +aórtica, I-EXPLORATION +pero I-EXPLORATION +mostró I-EXPLORATION +disfunción I-EXPLORATION +miocárdica I-EXPLORATION +que I-EXPLORATION +requirió I-EXPLORATION +soporte I-EXPLORATION +inotrópico. I-EXPLORATION +Ecografía I-EXPLORATION +transfontanelar I-EXPLORATION +y I-EXPLORATION +abdominal I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +iníciales I-EXPLORATION +destacaron I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática, I-EXPLORATION +bilirrubina I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +8 I-EXPLORATION +mg% I-EXPLORATION +(directa I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +3 I-EXPLORATION +mg%). I-EXPLORATION + I-EXPLORATION +Al B-FAMILY_HISTORY +evaluar I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +se I-FAMILY_HISTORY +observó I-FAMILY_HISTORY +fenotipo I-FAMILY_HISTORY +sugestivo I-FAMILY_HISTORY +de I-FAMILY_HISTORY +hipertiroidismo, I-FAMILY_HISTORY +con I-FAMILY_HISTORY +delgadez I-FAMILY_HISTORY +marcada I-FAMILY_HISTORY +y I-FAMILY_HISTORY +exoftalmo, I-FAMILY_HISTORY +por I-FAMILY_HISTORY +lo I-FAMILY_HISTORY +que I-FAMILY_HISTORY +se I-FAMILY_HISTORY +sospechó I-FAMILY_HISTORY +enfermedad I-FAMILY_HISTORY +tiroidea I-FAMILY_HISTORY +no I-FAMILY_HISTORY +tratada. I-FAMILY_HISTORY +Debido B-EXPLORATION +a I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +hipertiroidismo I-EXPLORATION +neonatal, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +perfil I-EXPLORATION +tiroideo, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +TSH I-EXPLORATION +0, I-EXPLORATION +01 I-EXPLORATION +uUI/ml I-EXPLORATION +y I-EXPLORATION +T4 I-EXPLORATION +Libre I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +7 I-EXPLORATION +(valores I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +0, I-EXPLORATION +71-1, I-EXPLORATION +85 I-EXPLORATION +ng/dl). I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +además I-EXPLORATION +anticuerpos I-EXPLORATION +antimicrosomales, I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +pudo I-EXPLORATION +realizar I-EXPLORATION +anticuerpos I-EXPLORATION +estimulantes I-EXPLORATION +del I-EXPLORATION +receptor I-EXPLORATION +de I-EXPLORATION +tirotropina I-EXPLORATION +(TRAab). I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +reevaluar I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +bocio I-EXPLORATION +difuso I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +con I-EXPLORATION +ecografía. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +metimazol I-TREATMENT +1 I-TREATMENT +mg/kg/día I-TREATMENT +dividido I-TREATMENT +en I-TREATMENT +3 I-TREATMENT +dosis, I-TREATMENT +propanolol I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +mg/kg/día I-TREATMENT +dividido I-TREATMENT +en I-TREATMENT +2 I-TREATMENT +dosis, I-TREATMENT +logrando I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +taquicardia. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +se I-EVOLUTION +notó I-EVOLUTION +poca I-EVOLUTION +ganancia I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +manejo, I-EVOLUTION +situación I-EVOLUTION +revertida I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION +Se B-TREATMENT +logró I-TREATMENT +retiro I-TREATMENT +de I-TREATMENT +oxígeno, I-TREATMENT +resolución I-TREATMENT +de I-TREATMENT +hepatomegalia I-TREATMENT +y B-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +1 I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +la I-EVOLUTION +T4 I-EVOLUTION +Libre I-EVOLUTION +descendió I-EVOLUTION +hasta I-EVOLUTION +3, I-EVOLUTION +1 I-EVOLUTION +mg/dl, I-EVOLUTION +persistiendo I-EVOLUTION +con I-EVOLUTION +supresión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +TSH I-EVOLUTION +(0, I-EVOLUTION +015 I-EVOLUTION +uUI/ml) I-EVOLUTION +al I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +egreso. I-EVOLUTION + I-EVOLUTION +En B-TREATMENT +la I-TREATMENT +semana I-TREATMENT +13 I-TREATMENT +de I-TREATMENT +evolución I-TREATMENT +se I-TREATMENT +normalizaron I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +de I-TREATMENT +función I-TREATMENT +tiroidea, I-TREATMENT +retirándose I-TREATMENT +la I-TREATMENT +medicación I-TREATMENT +antitiroidea. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +lactante I-EVOLUTION +permaneció I-EVOLUTION +en I-EVOLUTION +condición I-EVOLUTION +eutiroidea, I-EVOLUTION +sin I-EVOLUTION +alteraciones I-EVOLUTION +cardiovasculares I-EVOLUTION +ni I-EVOLUTION +del I-EVOLUTION +neurodesarrollo. I-EVOLUTION +La I-EVOLUTION +madre I-EVOLUTION +fue I-EVOLUTION +referida I-EVOLUTION +a I-EVOLUTION +endocrinología I-EVOLUTION +para I-EVOLUTION +manejo I-EVOLUTION +y I-EVOLUTION +asesoría I-EVOLUTION +para I-EVOLUTION +futuros I-EVOLUTION +embarazos. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +urgencias I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +precordial I-DERIVED_FROM/TO +intermitente I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +1 I-DERIVED_FROM/TO +mes I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución, I-DERIVED_FROM/TO +asociado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +alteración I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +electrocardiograma I-DERIVED_FROM/TO +(ECG): I-DERIVED_FROM/TO +atenuación I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +QRS I-DERIVED_FROM/TO +e I-DERIVED_FROM/TO +inversión I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +onda I-DERIVED_FROM/TO +T I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +derivaciones I-DERIVED_FROM/TO +precordiales. I-DERIVED_FROM/TO +No B-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +palpitaciones, I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +vegetativos I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +sincopales. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presentaba I-EXPLORATION +buen I-EXPLORATION +aspecto I-EXPLORATION +general, I-EXPLORATION +manteniéndose I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable, I-EXPLORATION +destacando I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +torácica I-EXPLORATION +izquierda I-EXPLORATION +que I-EXPLORATION +aumentaba I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +inspiración I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +movilización I-EXPLORATION +de I-EXPLORATION +miembros I-EXPLORATION +superiores. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +cardíaca I-EXPLORATION +se I-EXPLORATION +escuchaba I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +ruidos I-EXPLORATION +cardíacos I-EXPLORATION +en I-EXPLORATION +precordio I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +atenuados I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +Dado I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +del I-EXPLORATION +dolor I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +alteración I-EXPLORATION +electrocardiográfica I-EXPLORATION +referida, I-EXPLORATION +se I-EXPLORATION +repitió I-EXPLORATION +ECG, I-EXPLORATION +persistiendo I-EXPLORATION +eje I-EXPLORATION +QRS I-EXPLORATION +y I-EXPLORATION +onda I-EXPLORATION +P I-EXPLORATION +de I-EXPLORATION ++150°, I-EXPLORATION +QRS I-EXPLORATION +estrecho I-EXPLORATION +de I-EXPLORATION +voltaje I-EXPLORATION +atenuado I-EXPLORATION +en I-EXPLORATION +precordiales I-EXPLORATION +V3-V6 I-EXPLORATION +y I-EXPLORATION +ondas I-EXPLORATION +T I-EXPLORATION +negativas I-EXPLORATION +en I-EXPLORATION +V1-V4 I-EXPLORATION +y I-EXPLORATION +aVL. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +dextrocardia, I-EXPLORATION +además I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +burbuja I-EXPLORATION +gástrica I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +sombra I-EXPLORATION +hepática I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +izquierda, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +situs I-EXPLORATION +inversus, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +en I-EXPLORATION +ecografía I-EXPLORATION +abdominal. I-EXPLORATION + I-EXPLORATION +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +Cardiología I-DERIVED_FROM/TO +Infantil I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realizó I-DERIVED_FROM/TO +ecocardiografía I-DERIVED_FROM/TO +evidenciándose I-DERIVED_FROM/TO +dextrocardia I-DERIVED_FROM/TO +especular I-DERIVED_FROM/TO +clásica I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +malformaciones I-DERIVED_FROM/TO +cardíacas I-DERIVED_FROM/TO +asociadas. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +etiología I-TREATMENT +músculo-esquelética, I-TREATMENT +el I-TREATMENT +dolor I-TREATMENT +torácico I-TREATMENT +se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +antiinflamatorios I-TREATMENT +con B-EVOLUTION +mejoría I-EVOLUTION +progresiva, I-EVOLUTION +encontrándose I-EVOLUTION +asintomático I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +acudir I-EVOLUTION +a I-EVOLUTION +control. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tiroiditis I-PAST_MEDICAL_HISTORY +autoinmune I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +pesquisada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +bocio I-PAST_MEDICAL_HISTORY +difuso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antecedente B-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +de I-FAMILY_HISTORY +carcinoma I-FAMILY_HISTORY +papilar I-FAMILY_HISTORY +en I-FAMILY_HISTORY +primo, I-FAMILY_HISTORY +abuela I-FAMILY_HISTORY +y I-FAMILY_HISTORY +bisabuela. I-FAMILY_HISTORY + I-FAMILY_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +ecográfico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +pesquisó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +nódulo I-PRESENT_ILLNESS +tiroideo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1, I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bordes I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +limitados, I-PRESENT_ILLNESS +heterogéneo, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +calcificaciones I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +interior, I-PRESENT_ILLNESS +se B-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +cuya I-EXPLORATION +histología I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +carcinoma I-EXPLORATION +papilar, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +tiroidectomia I-TREATMENT +total I-TREATMENT +con I-TREATMENT +vaciamiento I-TREATMENT +ganglionar I-TREATMENT +cervical I-TREATMENT +anterior. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +confirmó I-EXPLORATION +un I-EXPLORATION +Carcinoma I-EXPLORATION +papilar I-EXPLORATION +de I-EXPLORATION +tiroides I-EXPLORATION +unifocal, I-EXPLORATION +variedad I-EXPLORATION +usual, I-EXPLORATION +sin I-EXPLORATION +infiltración I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +peritiroideo, I-EXPLORATION +sin I-EXPLORATION +permeaciones I-EXPLORATION +linfovasculares I-EXPLORATION +ni I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +linfonodos I-EXPLORATION +evaluados, I-EXPLORATION +bordes I-EXPLORATION +quirúrgicos I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +tiroideo I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +tiroiditis I-EXPLORATION +crónica I-EXPLORATION +difusa. I-EXPLORATION +De B-TREATMENT +acuerdo I-TREATMENT +a I-TREATMENT +protocolo I-TREATMENT +a I-TREATMENT +continuación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tiroidectomía I-TREATMENT +se I-TREATMENT +aplicó I-TREATMENT +Radio I-TREATMENT +yodo I-TREATMENT +100 I-TREATMENT +mCi I-TREATMENT +a I-TREATMENT +los I-TREATMENT +25 I-TREATMENT +días I-TREATMENT +post I-TREATMENT +cirugía I-TREATMENT +con I-TREATMENT +rastreo I-TREATMENT +terapéutico I-TREATMENT +posterior I-TREATMENT +negativo. I-TREATMENT +Permanece B-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +recidiva, I-EVOLUTION +con I-EVOLUTION +Tiroglobulinas I-EVOLUTION +< I-EVOLUTION +0, I-EVOLUTION +2 I-EVOLUTION +ng/ml I-EVOLUTION +en I-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +con I-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +de I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +con I-FAMILY_HISTORY +carcinoma I-FAMILY_HISTORY +papilar I-FAMILY_HISTORY +de I-FAMILY_HISTORY +tiroides I-FAMILY_HISTORY +operado. I-FAMILY_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +ecografía I-PRESENT_ILLNESS +tiroídea I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +bocio I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +describe I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +sugerente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +neoplasia I-PRESENT_ILLNESS +tiroídea I-PRESENT_ILLNESS +extensa I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +parte I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +glándula, I-PRESENT_ILLNESS +nódulo I-PRESENT_ILLNESS +dominante I-PRESENT_ILLNESS +lóbulo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +adenopatías I-PRESENT_ILLNESS +supraclaviculares I-PRESENT_ILLNESS +izquierdas. I-PRESENT_ILLNESS +Teniendo B-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +sus I-TREATMENT +antecedentes I-TREATMENT +familiares, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +tiroidectomía I-TREATMENT +total I-TREATMENT +sin I-TREATMENT +punción I-TREATMENT +tiroídea I-TREATMENT +previa, I-TREATMENT +cuya I-TREATMENT +biopsia I-TREATMENT +contemporánea I-TREATMENT +y I-TREATMENT +definitiva I-TREATMENT +confirmaron I-TREATMENT +carcinoma I-TREATMENT +papilar I-TREATMENT +de I-TREATMENT +tiroides I-TREATMENT +en I-TREATMENT +lóbulo I-TREATMENT +izquierdo, I-TREATMENT +itsmo I-TREATMENT +y I-TREATMENT +lóbulo I-TREATMENT +derecho, I-TREATMENT +variante I-TREATMENT +esclerosante I-TREATMENT +difusa I-TREATMENT +que I-TREATMENT +infiltraba I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +peritiroideo I-TREATMENT +con I-TREATMENT +múltiples I-TREATMENT +permeaciones I-TREATMENT +vasculares I-TREATMENT +y I-TREATMENT +compromiso I-TREATMENT +ganglionar. I-TREATMENT + I-TREATMENT +A I-TREATMENT +continuación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Tiroidectomía I-TREATMENT +se I-TREATMENT +trató I-TREATMENT +a I-TREATMENT +los I-TREATMENT +30 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +radio I-TREATMENT +yodo I-TREATMENT +150 I-TREATMENT +mCi; I-TREATMENT +el B-EXPLORATION +rastreo I-EXPLORATION +sistémico I-EXPLORATION +terapéutico I-EXPLORATION +mostró I-EXPLORATION +sólo I-EXPLORATION +tejido I-EXPLORATION +captante I-EXPLORATION +en I-EXPLORATION +remanente I-EXPLORATION +tiroideo. I-EXPLORATION +Sin I-EXPLORATION +embargo, I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +3 I-EXPLORATION +meses I-EXPLORATION +post I-EXPLORATION +tiroidectomía I-EXPLORATION +se I-EXPLORATION +pesquisó I-EXPLORATION +clínicamente I-EXPLORATION +y I-EXPLORATION +mediante I-EXPLORATION +ecografía, I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +en I-EXPLORATION +lecho I-EXPLORATION +tiroideo I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +recidiva I-EXPLORATION +ganglionar I-EXPLORATION +cervical, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +mediante I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +papilar I-EXPLORATION +en I-EXPLORATION +ganglios I-EXPLORATION +del I-EXPLORATION +grupo I-EXPLORATION +IIA, I-EXPLORATION +II, I-EXPLORATION +IV, I-EXPLORATION +VD, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +reintervención I-TREATMENT +quirúrgica. I-TREATMENT +Evoluciona I-TREATMENT +con I-TREATMENT +persistencia I-TREATMENT +imagenológica B-EVOLUTION +de I-EVOLUTION +lesión I-EVOLUTION +ganglionar I-EVOLUTION +cervical I-EVOLUTION +sospechosa I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +9 I-EVOLUTION +meses I-EVOLUTION +postiroidectomia I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +aplicar I-EVOLUTION +una I-EVOLUTION +segunda I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +radio I-EVOLUTION +yodo I-EVOLUTION +150 I-EVOLUTION +mCi I-EVOLUTION +con I-EVOLUTION +exploración I-EVOLUTION +sistémica I-EVOLUTION +terapéutica I-EVOLUTION +que I-EVOLUTION +mostró I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +captación I-EVOLUTION +en I-EVOLUTION +región I-EVOLUTION +cervical I-EVOLUTION +anterior I-EVOLUTION +compatible I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +nodular I-EVOLUTION +visible I-EVOLUTION +ecográficamente. I-EVOLUTION +Esta I-EVOLUTION +lesión I-EVOLUTION +ha I-EVOLUTION +disminuido I-EVOLUTION +de I-EVOLUTION +tamaño I-EVOLUTION +en I-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +con I-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +y B-TREATMENT +persiste I-TREATMENT +con I-TREATMENT +Tiroglobulinas I-TREATMENT +< I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +ng/ml. I-TREATMENT + I-TREATMENT + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sana, I-PAST_MEDICAL_HISTORY +tercera I-PAST_MEDICAL_HISTORY +hija I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +matrimonio I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +consanguíneo, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +epilepsia I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +AE. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ruido I-PAST_MEDICAL_HISTORY +fuerte, I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +evento I-PAST_MEDICAL_HISTORY +descrito I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +llanto I-PAST_MEDICAL_HISTORY +intenso, I-PAST_MEDICAL_HISTORY +persistente, I-PAST_MEDICAL_HISTORY +apnea I-PAST_MEDICAL_HISTORY +espiratoria, I-PAST_MEDICAL_HISTORY +cianosis, I-PAST_MEDICAL_HISTORY +desviación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mirada I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conciencia I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotonía. I-PAST_MEDICAL_HISTORY +Remitió I-PAST_MEDICAL_HISTORY +espontáneamente I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +unos I-PAST_MEDICAL_HISTORY +segundos I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +vigilia I-PAST_MEDICAL_HISTORY +normal I-PAST_MEDICAL_HISTORY +luego I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +evento. I-PAST_MEDICAL_HISTORY +Estos I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +continuaron I-PAST_MEDICAL_HISTORY +haciéndose I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +frecuentes I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +intensos, I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +3-5 I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +seguidos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conciencia I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotonía, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +consultó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +neurología I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +EEG I-PAST_MEDICAL_HISTORY +estándar I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +informado I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +caída I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +piso, I-PAST_MEDICAL_HISTORY +nuevamente I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +llanto, I-PAST_MEDICAL_HISTORY +apnea I-PAST_MEDICAL_HISTORY +espiratoria, I-PAST_MEDICAL_HISTORY +cianosis I-PAST_MEDICAL_HISTORY +seguida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conciencia, I-PAST_MEDICAL_HISTORY +hipotonía I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +agregó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +tónico I-PAST_MEDICAL_HISTORY +clónica I-PAST_MEDICAL_HISTORY +generalizada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +min I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +duración. I-PAST_MEDICAL_HISTORY +Ingresó B-EXPLORATION +al I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +lactante I-EXPLORATION +vigil, I-EXPLORATION +con I-EXPLORATION +buen I-EXPLORATION +desarrollo I-EXPLORATION +psicomotor. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +hemograma I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +anemia, I-EXPLORATION +sin I-EXPLORATION +microcitosis, I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +cinética I-EXPLORATION +de I-EXPLORATION +fierro I-EXPLORATION +normal, I-EXPLORATION +electroencefalograma I-EXPLORATION +(EEG) I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +normal. I-EXPLORATION +Se B-EVOLUTION +dió I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +apnea I-EVOLUTION +emotiva I-EVOLUTION +cianótica I-EVOLUTION +grave. I-EVOLUTION +Se I-EVOLUTION +solicitó I-EVOLUTION +controles I-EVOLUTION +ambulatorios. I-EVOLUTION + I-EVOLUTION +Posterior I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +persistió I-EVOLUTION +con I-EVOLUTION +AE I-EVOLUTION +de I-EVOLUTION +frecuencia I-EVOLUTION +diaria, I-EVOLUTION +con I-EVOLUTION +intensidades I-EVOLUTION +de I-EVOLUTION +leves I-EVOLUTION +a I-EVOLUTION +graves. I-EVOLUTION +El B-TREATMENT +estudio I-TREATMENT +de I-TREATMENT +cinética I-TREATMENT +de I-TREATMENT +fierro I-TREATMENT +fue I-TREATMENT +normal, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +piracetam I-TREATMENT +dosis I-TREATMENT +40 I-TREATMENT +mg/kg I-TREATMENT +día I-TREATMENT +fraccionado I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +dosis I-TREATMENT +por I-TREATMENT +4 I-TREATMENT +meses. I-TREATMENT +En B-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +verificar I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +frecuencia I-EVOLUTION +e I-EVOLUTION +intensidad I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +crisis, I-EVOLUTION +con I-EVOLUTION +sólo I-EVOLUTION +2 I-EVOLUTION +apneas I-EVOLUTION +emotivas I-EVOLUTION +con I-EVOLUTION +leve I-EVOLUTION +cianosis I-EVOLUTION +y I-EVOLUTION +recuperación I-EVOLUTION +espontánea. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +nacida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +término I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cesárea, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +fisiológico. I-PAST_MEDICAL_HISTORY +Sus B-PRESENT_ILLNESS +padres I-PRESENT_ILLNESS +consultaron I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Ginecología I-PRESENT_ILLNESS +Infantil I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +abertura I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vagina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ano I-PRESENT_ILLNESS +detectada I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +nacimiento I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +evolucionó I-PRESENT_ILLNESS +asintomática. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +general I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +una I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +nutricional I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +dirigida I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +genitales I-EXPLORATION +destacaron I-EXPLORATION +los I-EXPLORATION +labios I-EXPLORATION +mayores I-EXPLORATION +prominentes, I-EXPLORATION +himen I-EXPLORATION +rosado I-EXPLORATION +redundante I-EXPLORATION +y I-EXPLORATION +permeable. I-EXPLORATION +El I-EXPLORATION +periné I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +lineal I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +horquilla I-EXPLORATION +vulvar I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +ano, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cortante I-EXPLORATION +cubierta I-EXPLORATION +por I-EXPLORATION +mucosa I-EXPLORATION +eritematosa I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +anal I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +y I-EXPLORATION +posición I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +palpó I-EXPLORATION +botón I-EXPLORATION +mamario I-EXPLORATION +sin I-EXPLORATION +galactorrea I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +general I-EXPLORATION +estaba I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +aseo I-TREATMENT +con I-TREATMENT +agua I-TREATMENT +y I-TREATMENT +lubricación I-TREATMENT +con I-TREATMENT +vaselina I-TREATMENT +sólida I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +muda. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +la I-EVOLUTION +madre I-EVOLUTION +señaló I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +había I-EVOLUTION +evolucionado I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +y B-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +epitelización I-EXPLORATION +del I-EXPLORATION +surco I-EXPLORATION +perineal. I-EXPLORATION + I-EXPLORATION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ardor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +área I-PRESENT_ILLNESS +genital I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +perineal I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +secreción I-PRESENT_ILLNESS +blanca, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +olor, I-PRESENT_ILLNESS +diariamente I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +aproximadamente. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fisura I-PAST_MEDICAL_HISTORY +anogenital I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +período I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +lactante I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +mantuvo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +observación I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +período I-PAST_MEDICAL_HISTORY +breve I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +completar I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +alta. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +realizaba I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +aseo I-PAST_MEDICAL_HISTORY +genital I-PAST_MEDICAL_HISTORY +diariamente I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +agua I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +sangrado I-PAST_MEDICAL_HISTORY +escaso I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +secar I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +perineal. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +urinaria, I-PAST_MEDICAL_HISTORY +constipación, I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +desarrollo I-PAST_MEDICAL_HISTORY +puberal. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +eutrófica, I-EXPLORATION +con I-EXPLORATION +mamas I-EXPLORATION +y I-EXPLORATION +vello I-EXPLORATION +púbico I-EXPLORATION +en I-EXPLORATION +Tanner I-EXPLORATION +I. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +genital I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +himen I-EXPLORATION +redundante I-EXPLORATION +permeable, I-EXPLORATION +rojo, I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +surco I-EXPLORATION +mucoso I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +horquilla I-EXPLORATION +vulvar I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +ano, I-EXPLORATION +sensible I-EXPLORATION +al I-EXPLORATION +tacto. I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +un I-EXPLORATION +surco I-EXPLORATION +perineal I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +vulvovaginitis I-EXPLORATION +inespecífica. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +cultivo I-EXPLORATION +vaginal I-EXPLORATION +cuyo I-EXPLORATION +resultado I-EXPLORATION +arrojó I-EXPLORATION +flora I-EXPLORATION +comensal. I-EXPLORATION +Se B-TREATMENT +sugirió I-TREATMENT +resección I-TREATMENT +quirúrgica I-TREATMENT +del I-TREATMENT +surco, I-TREATMENT +pero I-TREATMENT +la I-TREATMENT +familia I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +prueba I-TREATMENT +terapéutica I-TREATMENT +con I-TREATMENT +lubricantes I-TREATMENT +tópicos, I-TREATMENT +dado I-TREATMENT +que I-TREATMENT +entendió I-TREATMENT +el I-TREATMENT +carácter I-TREATMENT +benigno I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT + I-TREATMENT + +Recién B-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +cesárea I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +gestacional I-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +cardiopatía I-PRESENT_ILLNESS +compleja; I-PRESENT_ILLNESS +peso B-EXPLORATION +de I-EXPLORATION +nacimiento I-EXPLORATION +2.860 I-EXPLORATION +g I-EXPLORATION +(p15), I-EXPLORATION +longitud I-EXPLORATION +44 I-EXPLORATION +cm I-EXPLORATION +(p3), I-EXPLORATION +perímetro I-EXPLORATION +cefálico I-EXPLORATION +33 I-EXPLORATION +cm I-EXPLORATION +(p I-EXPLORATION +3). I-EXPLORATION +Padres B-FAMILY_HISTORY +no I-FAMILY_HISTORY +consanguíneos I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +personales I-FAMILY_HISTORY +ni I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +importancia, I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +primigesta I-FAMILY_HISTORY +de I-FAMILY_HISTORY +19 I-FAMILY_HISTORY +años. I-FAMILY_HISTORY + I-FAMILY_HISTORY +A B-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontró I-PAST_MEDICAL_HISTORY +translucencia I-PAST_MEDICAL_HISTORY +nucal I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +p95, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cariotipo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vellosidades I-PAST_MEDICAL_HISTORY +coriales I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +resultado I-PAST_MEDICAL_HISTORY +46, I-PAST_MEDICAL_HISTORY +XY; I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +evidenció I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +compleja, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +canal I-PAST_MEDICAL_HISTORY +aurículoventricular I-PAST_MEDICAL_HISTORY +completo, I-PAST_MEDICAL_HISTORY +mientras I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tercer I-PAST_MEDICAL_HISTORY +trimestre I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +huesos I-PAST_MEDICAL_HISTORY +largos I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraban I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +p5. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-DERIVED_FROM/TO +nacimiento I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +hospitalizado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cuidados I-DERIVED_FROM/TO +intensivos I-DERIVED_FROM/TO +neonatal. I-DERIVED_FROM/TO +Evaluado B-EXPLORATION +por I-EXPLORATION +genetista I-EXPLORATION +clínico, I-EXPLORATION +quien I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +dismorfológico I-EXPLORATION +describió: I-EXPLORATION +microcefalia, I-EXPLORATION +orejas I-EXPLORATION +de I-EXPLORATION +implantación I-EXPLORATION +baja I-EXPLORATION +con I-EXPLORATION +rotación I-EXPLORATION +hacia I-EXPLORATION +atrás, I-EXPLORATION +puente I-EXPLORATION +nasal I-EXPLORATION +deprimido, I-EXPLORATION +pliegue I-EXPLORATION +epicántico I-EXPLORATION +interno, I-EXPLORATION +estrabismo I-EXPLORATION +convergente, I-EXPLORATION +en I-EXPLORATION +boca I-EXPLORATION +labio I-EXPLORATION +superior I-EXPLORATION +corto I-EXPLORATION +unido I-EXPLORATION +por I-EXPLORATION +frenillos I-EXPLORATION +al I-EXPLORATION +reborde I-EXPLORATION +alveolar, I-EXPLORATION +extremidades I-EXPLORATION +con I-EXPLORATION +huesos I-EXPLORATION +largos I-EXPLORATION +cortos, I-EXPLORATION +rizomelia, I-EXPLORATION +manos I-EXPLORATION +pequeñas, I-EXPLORATION +braquidactilia, I-EXPLORATION +pliegue I-EXPLORATION +palmar I-EXPLORATION +único, I-EXPLORATION +polidactilia I-EXPLORATION +post I-EXPLORATION +axial I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +superiores, I-EXPLORATION +polisindactilia I-EXPLORATION +preaxial I-EXPLORATION +bilateral I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +uñas I-EXPLORATION +hipoplásicas. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +ecocardiograma I-EXPLORATION +mostró I-EXPLORATION +canal I-EXPLORATION +aurículo-ventricular, I-EXPLORATION +estenosis I-EXPLORATION +aórtica, I-EXPLORATION +hipoplasia I-EXPLORATION +del I-EXPLORATION +arco I-EXPLORATION +aórtico, I-EXPLORATION +ductus I-EXPLORATION +arterioso I-EXPLORATION +e I-EXPLORATION +hipoplasia I-EXPLORATION +leve I-EXPLORATION +de I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +derecha, I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +transfontanelar I-EXPLORATION +y I-EXPLORATION +renal I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +normales; I-EXPLORATION +radiografías I-EXPLORATION +de I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +mostraron I-EXPLORATION +fémur I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tibia I-EXPLORATION +cortos I-EXPLORATION +con I-EXPLORATION +adecuada I-EXPLORATION +osificación, I-EXPLORATION +en I-EXPLORATION +radiografía I-EXPLORATION +toracoabdominal I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +tórax I-EXPLORATION +estrecho I-EXPLORATION +al I-EXPLORATION +comparar I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +silueta I-EXPLORATION +cardíaca I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +al I-EXPLORATION +comparar I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +tórax I-EXPLORATION +; I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +columna I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +alteraciones I-EXPLORATION +vertebrales. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +suma I-EXPLORATION +de I-EXPLORATION +hallazgos I-EXPLORATION +permitió I-EXPLORATION +diagnosticar I-EXPLORATION +el I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Ellis I-EXPLORATION +Van I-EXPLORATION +Creveld. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +tuvo I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +desfavorable I-EVOLUTION +falleciendo I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +8 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +nacido, I-EVOLUTION +por I-EVOLUTION +problemas I-EVOLUTION +secundarios I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +cardiopatía I-EVOLUTION +compleja. I-EVOLUTION + I-EVOLUTION + +Primera B-PRESENT_ILLNESS +hija I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +padres I-PRESENT_ILLNESS +sanos I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +consanguíneos, I-PRESENT_ILLNESS +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +epilepsia I-FAMILY_HISTORY +en I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +primer I-FAMILY_HISTORY +grado, I-FAMILY_HISTORY +debutó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +CF I-PRESENT_ILLNESS +hemiclónica I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +min I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +paresia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Todd I-PRESENT_ILLNESS +posterior. I-PRESENT_ILLNESS +Las I-PRESENT_ILLNESS +recurrencias I-PRESENT_ILLNESS +fueron I-PRESENT_ILLNESS +frecuentes, I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +focal I-PRESENT_ILLNESS +compleja I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hemiclónicas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +min I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +menos I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +SE I-PRESENT_ILLNESS +febriles I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +mes, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +examen I-PRESENT_ILLNESS +normal I-PRESENT_ILLNESS +post I-PRESENT_ILLNESS +crisis. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +RM I-EXPLORATION +cerebral3 I-EXPLORATION +fueron I-EXPLORATION +normal, I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +múltiples I-EXPLORATION +EEG I-EXPLORATION +standard, I-EXPLORATION +la I-EXPLORATION +cuantificación I-EXPLORATION +de I-EXPLORATION +aminoácidos I-EXPLORATION +en I-EXPLORATION +sangre, I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo, I-EXPLORATION +ácidos I-EXPLORATION +orgánicos I-EXPLORATION +y I-EXPLORATION +ultramicroscopía I-EXPLORATION +de I-EXPLORATION +piel. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +6 I-EXPLORATION +meses I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +SCN1A I-EXPLORATION +confirmándose I-EXPLORATION +mutación I-EXPLORATION +c.5347G>A I-EXPLORATION +(p.Ala1783Thr) I-EXPLORATION +en I-EXPLORATION +estado I-EXPLORATION +heterocigoto I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +exón I-EXPLORATION +26 I-EXPLORATION +del I-EXPLORATION +gen. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +padres I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +uso I-TREATMENT +de I-TREATMENT +fenobarbital, I-TREATMENT +clobazam, I-TREATMENT +levetiracetam I-TREATMENT +y I-TREATMENT +topiramato, I-TREATMENT +no I-TREATMENT +logró I-TREATMENT +control I-TREATMENT +de I-TREATMENT +crisis. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +9 I-TREATMENT +meses I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +stiripentol I-TREATMENT +dosis I-TREATMENT +50 I-TREATMENT +mg I-TREATMENT +kp I-TREATMENT +día, I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +topiramato I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +valproico I-TREATMENT +sin I-TREATMENT +resultados. I-TREATMENT +Entre B-EVOLUTION +los I-EVOLUTION +12-18 I-EVOLUTION +meses I-EVOLUTION +los I-EVOLUTION +múltiples I-EVOLUTION +SE I-EVOLUTION +y I-EVOLUTION +crisis I-EVOLUTION +frecuentes I-EVOLUTION +deterioraron I-EVOLUTION +su I-EVOLUTION +desarrollo I-EVOLUTION +perdiendo I-EVOLUTION +marcha, I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +tronco I-EVOLUTION +y I-EVOLUTION +control I-EVOLUTION +cefálico. I-EVOLUTION +Se B-TREATMENT +inició I-TREATMENT +dieta I-TREATMENT +cetogénica I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +asoció I-TREATMENT +a I-TREATMENT +una I-TREATMENT +pancreatitis I-TREATMENT +grave I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +discontinuó. I-TREATMENT + I-TREATMENT +La I-TREATMENT +certificación I-TREATMENT +de I-TREATMENT +alteración I-TREATMENT +deglución I-TREATMENT +y I-TREATMENT +cuadros I-TREATMENT +respiratorios I-TREATMENT +recurrentes I-TREATMENT +febriles I-TREATMENT +que I-TREATMENT +precipitaban I-TREATMENT +los I-TREATMENT +SE I-TREATMENT +plantearon I-TREATMENT +gastrostomía I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +logró I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +episodios I-TREATMENT +febriles I-TREATMENT +y I-TREATMENT +mejor I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +las I-TREATMENT +crisis. I-TREATMENT + I-TREATMENT +Posterior I-TREATMENT +a I-TREATMENT +una I-TREATMENT +serie I-TREATMENT +de I-TREATMENT +adecuaciones I-TREATMENT +de I-TREATMENT +fármacos I-TREATMENT +antiepilépticos I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +triasociado I-TREATMENT +con I-TREATMENT +clobazam, I-TREATMENT +topiramato I-TREATMENT +y I-TREATMENT +lacosamida I-TREATMENT +permitió I-TREATMENT +un I-TREATMENT +control I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +crisis, I-TREATMENT +sin I-TREATMENT +SE I-TREATMENT +en I-TREATMENT +18 I-TREATMENT +meses, I-TREATMENT +con I-TREATMENT +crisis I-TREATMENT +de I-TREATMENT +corta I-TREATMENT +duración I-TREATMENT +(segundos) I-TREATMENT +3-5 I-TREATMENT +por I-TREATMENT +semana I-TREATMENT +que I-TREATMENT +no I-TREATMENT +requerían I-TREATMENT +uso I-TREATMENT +diazepam I-TREATMENT +ni I-TREATMENT +provocaban I-TREATMENT +alteración I-TREATMENT +en I-TREATMENT +actividades I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +diaria. I-TREATMENT + I-TREATMENT + +Tercera B-PRESENT_ILLNESS +hija, I-PRESENT_ILLNESS +embarazo B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +normal, I-PAST_MEDICAL_HISTORY +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +epilepsia I-FAMILY_HISTORY +en I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +primer I-FAMILY_HISTORY +grado. I-FAMILY_HISTORY +Inició B-PRESENT_ILLNESS +CF I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +prolongadas, I-PRESENT_ILLNESS +focales, I-PRESENT_ILLNESS +clonías I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hemicara I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +SE I-PRESENT_ILLNESS +febriles I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mulitples I-PRESENT_ILLNESS +EEG I-PRESENT_ILLNESS +standard I-PRESENT_ILLNESS +normales. I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +agregan I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +afebriles I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +gatilladas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadros I-PRESENT_ILLNESS +infecciosos. I-PRESENT_ILLNESS +Posterior I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +persistió I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +afebriles I-PRESENT_ILLNESS +hemigeneralizadas, I-PRESENT_ILLNESS +mioclónicas, I-PRESENT_ILLNESS +ausencias I-PRESENT_ILLNESS +atípicas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tónicas I-PRESENT_ILLNESS +clónicas I-PRESENT_ILLNESS +generalizadas I-PRESENT_ILLNESS +precipitadas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +foto I-PRESENT_ILLNESS +estimulación. I-PRESENT_ILLNESS +Entre I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +primer I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +SE I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +requirieron I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuidados I-PRESENT_ILLNESS +intensivos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +hospitalizaciones I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +prolongadas. I-PRESENT_ILLNESS +La B-TREATMENT +triasociación I-TREATMENT +de I-TREATMENT +fenobarbital, I-TREATMENT +ácido I-TREATMENT +valproico I-TREATMENT +y I-TREATMENT +levetiracetam I-TREATMENT +no I-TREATMENT +logró I-TREATMENT +control I-TREATMENT +de I-TREATMENT +crisis. I-TREATMENT +La B-EXPLORATION +RM I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +estudios I-EXPLORATION +metabólicos I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +retraso I-EVOLUTION +de I-EVOLUTION +lenguaje, I-EVOLUTION +compromiso I-EVOLUTION +motor I-EVOLUTION +de I-EVOLUTION +menor I-EVOLUTION +cuantía I-EVOLUTION +y I-EVOLUTION +microcefalia. I-EVOLUTION +A B-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +años I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +SCN1A I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +c.3311C>A I-EXPLORATION +(p.Ser1104X) I-EXPLORATION +exón I-EXPLORATION +16 I-EXPLORATION +en I-EXPLORATION +estado I-EXPLORATION +heterocigoto I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +gen. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +padres I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +topiramato, I-TREATMENT +clobazam I-TREATMENT +y I-TREATMENT +Levetiracetam I-TREATMENT +permitió I-TREATMENT +controlar I-TREATMENT +crisis I-TREATMENT +prolongadas. I-TREATMENT +Sin B-EVOLUTION +SE I-EVOLUTION +desde I-EVOLUTION +9 I-EVOLUTION +meses I-EVOLUTION +pero I-EVOLUTION +ha I-EVOLUTION +persistido I-EVOLUTION +con I-EVOLUTION +5-7 I-EVOLUTION +crisis I-EVOLUTION +semanales I-EVOLUTION +de I-EVOLUTION +corta I-EVOLUTION +duración I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +requieren I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +benzodiacepinas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +sano, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +controlado, I-PAST_MEDICAL_HISTORY +nacido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +término I-PAST_MEDICAL_HISTORY +38 I-PAST_MEDICAL_HISTORY +semanas, I-PAST_MEDICAL_HISTORY +pequeña I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +gestacional I-PAST_MEDICAL_HISTORY +(2.670 I-PAST_MEDICAL_HISTORY +kg). I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +coluria, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +buen I-PRESENT_ILLNESS +incremento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +derivada I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +regional I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +estudio. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Exámenes B-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +colestásico, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +destacaba I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +(BT), I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bilirrubina I-EXPLORATION +directa I-EXPLORATION +(BD) I-EXPLORATION +(12, I-EXPLORATION +75 I-EXPLORATION +mg/dl-10, I-EXPLORATION +18 I-EXPLORATION +mg/dl) I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +elevadas, I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +la I-EXPLORATION +gamma I-EXPLORATION +glutamil I-EXPLORATION +transpeptidasa I-EXPLORATION +(GGT) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +(FA). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +Hospital I-EXPLORATION +regional I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +hepatitis I-EXPLORATION +viral, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +tomó I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +hepatitis I-EXPLORATION +A, I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +negativas. I-EXPLORATION +Evolucionó B-EVOLUTION +favorablemente I-EVOLUTION +pero I-EVOLUTION +se I-EVOLUTION +constataron I-EVOLUTION +deposiciones I-EVOLUTION +acólicas. I-EVOLUTION +Se B-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +gastroenterología I-DERIVED_FROM/TO +previos B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +que I-EXPLORATION +mantenían I-EXPLORATION +patrón I-EXPLORATION +colestásico I-EXPLORATION +con I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +BD I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +transaminasas: I-EXPLORATION +BT I-EXPLORATION +10, I-EXPLORATION +58, I-EXPLORATION +BD I-EXPLORATION +7, I-EXPLORATION +88, I-EXPLORATION +GOT I-EXPLORATION +204, I-EXPLORATION +GPT I-EXPLORATION +109, I-EXPLORATION +GGT I-EXPLORATION +550. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +52 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +vida I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +dilatación I-EXPLORATION +arrosariada I-EXPLORATION +de I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +y I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +presente I-EXPLORATION +pero I-EXPLORATION +colapsada I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +del I-EXPLORATION +ayuno. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +gran I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +diferir I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +colangio-resonancia. I-EXPLORATION +Esta I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +hígado I-EXPLORATION +normal I-EXPLORATION +con I-EXPLORATION +parénquima I-EXPLORATION +conservado, I-EXPLORATION +leve I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +ductos I-EXPLORATION +biliares I-EXPLORATION +intrahepáticos I-EXPLORATION +hasta I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +confluencia, I-EXPLORATION +hacia I-EXPLORATION +distal I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +logró I-EXPLORATION +visualizar I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extrahepática. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +colangio-resonancia I-TREATMENT +se I-TREATMENT +sospechó I-TREATMENT +atresia I-TREATMENT +de I-TREATMENT +vía I-TREATMENT +biliar I-TREATMENT +y I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +derivación I-TREATMENT +bilio-digestiva I-TREATMENT +(Kasai). I-TREATMENT +Llamaba B-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +exámenes I-EXPLORATION +seriados I-EXPLORATION +la I-EXPLORATION +bilirrubina I-EXPLORATION +había I-EXPLORATION +ido I-EXPLORATION +en I-EXPLORATION +disminución I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +ictericia. I-EXPLORATION +Por I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +deposiciones I-EXPLORATION +acólicas I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +exploración I-EXPLORATION +quirúrgica. I-EXPLORATION + I-EXPLORATION +Durante I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +superficie I-EXPLORATION +hepática I-EXPLORATION +lisa, I-EXPLORATION +hígado I-EXPLORATION +congestivo I-EXPLORATION +(confirmado I-EXPLORATION +por I-EXPLORATION +biopsia), I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +presente, I-EXPLORATION +con I-EXPLORATION +lumen I-EXPLORATION +y I-EXPLORATION +bilis I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +colangiografía I-EXPLORATION +intraoperatoria I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +estenótica I-EXPLORATION +crítica I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +hepático I-EXPLORATION +común I-EXPLORATION +logrando I-EXPLORATION +paso I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +hacia I-EXPLORATION +proximal I-EXPLORATION +y I-EXPLORATION +distal I-EXPLORATION +(intra I-EXPLORATION +y I-EXPLORATION +extra I-EXPLORATION +hepático), I-EXPLORATION +con I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +dilatada. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +colecistectomía I-TREATMENT +y I-TREATMENT +disección I-TREATMENT +de I-TREATMENT +conducto I-TREATMENT +hepático I-TREATMENT +común I-TREATMENT +demostrando I-TREATMENT +una I-TREATMENT +estenosis I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +éste, I-TREATMENT +causado I-TREATMENT +por I-TREATMENT +un I-TREATMENT +anillo I-TREATMENT +vascular I-TREATMENT +proveniente I-TREATMENT +de I-TREATMENT +arteria I-TREATMENT +hepática I-TREATMENT +derecha. I-TREATMENT +Se I-TREATMENT +seccionó I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +biliar I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +proximal I-TREATMENT +de I-TREATMENT +la I-TREATMENT +estenosis I-TREATMENT +realizando I-TREATMENT +una I-TREATMENT +hepático-duodeno I-TREATMENT +anastomosis. I-TREATMENT +Se I-TREATMENT +dejó I-TREATMENT +drenaje I-TREATMENT +abdominal I-TREATMENT +y I-TREATMENT +sonda I-TREATMENT +nasogástrica I-TREATMENT +instalada. I-TREATMENT + B-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +con I-EVOLUTION +débito I-EVOLUTION +en I-EVOLUTION +disminución I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +retirándose I-EVOLUTION +al I-EVOLUTION +6 I-EVOLUTION +día I-EVOLUTION +y I-EVOLUTION +alimentándose I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +días. I-EVOLUTION +Se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +días I-EVOLUTION +post I-EVOLUTION +operatorio I-EVOLUTION +con I-EVOLUTION +pruebas I-EVOLUTION +hepáticas I-EVOLUTION +en I-EVOLUTION +disminución I-EVOLUTION +(BT I-EVOLUTION +3, I-EVOLUTION +98, I-EVOLUTION +BD I-EVOLUTION +3, I-EVOLUTION +46, I-EVOLUTION +GOT I-EVOLUTION +266, I-EVOLUTION +GPT I-EVOLUTION +134, I-EVOLUTION +FA I-EVOLUTION +431, I-EVOLUTION +GGT I-EVOLUTION +586). I-EVOLUTION +En I-EVOLUTION +controles I-EVOLUTION +ambulatorios I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +asintomática, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +tolerancia I-EVOLUTION +oral, I-EVOLUTION +deposiciones I-EVOLUTION +teñidas I-EVOLUTION +y I-EVOLUTION +exámenes I-EVOLUTION +hepáticos I-EVOLUTION +y I-EVOLUTION +generales I-EVOLUTION +normalizados. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +mejilla I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +asimetría I-PRESENT_ILLNESS +facial, I-PRESENT_ILLNESS +descenso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +comisura I-PRESENT_ILLNESS +oral I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +esqueletal, I-PRESENT_ILLNESS +cuya I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +radiología I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ML. I-PRESENT_ILLNESS +La B-EXPLORATION +ecografía I-EXPLORATION +facial, I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +18 I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +edad, I-EXPLORATION +realizada I-EXPLORATION +con I-EXPLORATION +transductor I-EXPLORATION +lineal I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +resolución, I-EXPLORATION +mostraba I-EXPLORATION +lesión I-EXPLORATION +predominantemente I-EXPLORATION +micro I-EXPLORATION +quística, I-EXPLORATION +con I-EXPLORATION +algunos I-EXPLORATION +quistes I-EXPLORATION +que I-EXPLORATION +superaban I-EXPLORATION +los I-EXPLORATION +15 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +planificó I-TREATMENT +realizar I-TREATMENT +esclerosis I-TREATMENT +seriada I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +para I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +en I-TREATMENT +2 I-TREATMENT +ocasiones I-TREATMENT ++ I-TREATMENT +OK-432 I-TREATMENT +y I-TREATMENT +en I-TREATMENT +las I-TREATMENT +2 I-TREATMENT +siguientes I-TREATMENT +Bleomicina. I-TREATMENT +Todas I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +con I-TREATMENT +6-8 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +intervalo I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general. I-TREATMENT +El I-TREATMENT +procedimiento I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +el I-TREATMENT +aspirado I-TREATMENT +del I-TREATMENT +contenido I-TREATMENT +de I-TREATMENT +los I-TREATMENT +quistes I-TREATMENT +de I-TREATMENT +mayor I-TREATMENT +tamaño I-TREATMENT +e I-TREATMENT +inyección I-TREATMENT +de I-TREATMENT +OK I-TREATMENT +432, I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +1 I-TREATMENT +mg I-TREATMENT +disueltos I-TREATMENT +en I-TREATMENT +10 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +volumen I-TREATMENT +total. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +procedimiento, I-EVOLUTION +al I-EVOLUTION +4° I-EVOLUTION +día I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +importante I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +e I-EVOLUTION +inició I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +escarlatina, I-EVOLUTION +evolucionando I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +proyección I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mejilla I-EVOLUTION +e I-EVOLUTION +induración I-EVOLUTION +local. I-EVOLUTION +Similar B-TREATMENT +procedimiento I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +con I-TREATMENT +la I-TREATMENT +Bleomicina I-TREATMENT +cuyas I-TREATMENT +dosis I-TREATMENT +no I-TREATMENT +sobrepasaban I-TREATMENT +0, I-TREATMENT +3-1 I-TREATMENT +mg/kg I-TREATMENT +por I-TREATMENT +sesión. I-TREATMENT +En I-TREATMENT +las I-TREATMENT +posteriores I-TREATMENT +infiltraciones, I-TREATMENT +presentó I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +volumen I-TREATMENT +más I-TREATMENT +discreto I-TREATMENT +y I-TREATMENT +con I-TREATMENT +menor I-TREATMENT +reacción I-TREATMENT +local. I-TREATMENT + I-TREATMENT +A I-TREATMENT +la I-TREATMENT +edad I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +años I-TREATMENT +4 I-TREATMENT +meses, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +más I-TREATMENT +circunscrita, I-TREATMENT +se I-TREATMENT +consideró I-TREATMENT +que I-TREATMENT +no I-TREATMENT +tenía I-TREATMENT +mayor I-TREATMENT +beneficio I-TREATMENT +continuar I-TREATMENT +con I-TREATMENT +las I-TREATMENT +esclerosis I-TREATMENT +y I-TREATMENT +se I-TREATMENT +planificó I-TREATMENT +extirpación I-TREATMENT +quirúrgica I-TREATMENT +intralesional. I-TREATMENT +Se I-TREATMENT +utilizó I-TREATMENT +abordaje I-TREATMENT +externo I-TREATMENT +submandibular I-TREATMENT +derecho, I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +la I-TREATMENT +que I-TREATMENT +comprometía I-TREATMENT +espesor I-TREATMENT +completo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mejilla I-TREATMENT +incluyendo I-TREATMENT +musculatura I-TREATMENT +facial I-TREATMENT +y I-TREATMENT +mucosa I-TREATMENT +vestibular. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +post I-TREATMENT +operatorio I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +compresivo I-TREATMENT +elástico I-TREATMENT +y I-TREATMENT +masoterapia, I-TREATMENT +intentándose I-TREATMENT +compresión I-TREATMENT +externa I-TREATMENT +con I-TREATMENT +máscara I-TREATMENT +de I-TREATMENT +acrílico I-TREATMENT +pero I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +mal I-TREATMENT +tolerada I-TREATMENT +por I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +ML I-EXPLORATION +microquístico I-EXPLORATION +con I-EXPLORATION +intersticio I-EXPLORATION +fibroso I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +inflamatoria I-EXPLORATION +linfocitaria. I-EXPLORATION +Seis B-TREATMENT +meses I-TREATMENT +después I-TREATMENT +se I-TREATMENT +planificó I-TREATMENT +nueva I-TREATMENT +resección I-TREATMENT +utilizando I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +abordaje I-TREATMENT +y I-TREATMENT +extirpando I-TREATMENT +lesión I-TREATMENT +remanente I-TREATMENT +hacia I-TREATMENT +cefálico. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +post I-EVOLUTION +operatorio I-EVOLUTION +se I-EVOLUTION +mantuvieron I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +de I-EVOLUTION +compresión I-EVOLUTION +facial I-EVOLUTION +previas I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION +Después I-EVOLUTION +de I-EVOLUTION +varios I-EVOLUTION +años I-EVOLUTION +comenzó I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +molestias I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +lesiones I-EVOLUTION +vesiculares I-EVOLUTION +en I-EVOLUTION +vestíbulo I-EVOLUTION +oral I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +mordía I-EVOLUTION +con I-EVOLUTION +frecuencia, I-EVOLUTION +siendo I-EVOLUTION +interpretadas I-EVOLUTION +como I-EVOLUTION +recidiva I-EVOLUTION +local I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ML. I-EVOLUTION +A B-TREATMENT +los I-TREATMENT +9 I-TREATMENT +años I-TREATMENT +de I-TREATMENT +edad, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +con I-TREATMENT +abordaje I-TREATMENT +intraoral, I-TREATMENT +cuya I-TREATMENT +biopsia I-TREATMENT +mostraba I-TREATMENT +ML I-TREATMENT +con I-TREATMENT +fibrosis I-TREATMENT +difusa. I-TREATMENT +Dado B-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +difícil I-DERIVED_FROM/TO +manejo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +cicatrización I-DERIVED_FROM/TO +intraoral I-DERIVED_FROM/TO +ya I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +mordía I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +frecuencia I-DERIVED_FROM/TO +presentando I-DERIVED_FROM/TO +sangramiento I-DERIVED_FROM/TO +e I-DERIVED_FROM/TO +inflamación I-DERIVED_FROM/TO +local, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +ortodoncia I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +manejo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +anomalía I-DERIVED_FROM/TO +dentomaxilar I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +confección I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +plano I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +apoyo I-DERIVED_FROM/TO +intraoral. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-TREATMENT +diseñó I-TREATMENT +un I-TREATMENT +aparato I-TREATMENT +intraoral I-TREATMENT +con I-TREATMENT +prolongación I-TREATMENT +vestibular I-TREATMENT +completa I-TREATMENT +que I-TREATMENT +proporcionaba I-TREATMENT +un I-TREATMENT +buen I-TREATMENT +plano I-TREATMENT +de I-TREATMENT +apoyo I-TREATMENT +intraoral I-TREATMENT +que I-TREATMENT +potenciaba I-TREATMENT +la I-TREATMENT +compresión I-TREATMENT +externa, I-TREATMENT +Además I-TREATMENT +se I-TREATMENT +instaló I-TREATMENT +aparatología I-TREATMENT +ortodóncica I-TREATMENT +fija I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +dentaria I-TREATMENT +anterosuperior I-TREATMENT +para I-TREATMENT +alinear I-TREATMENT +y I-TREATMENT +nivelar I-TREATMENT +el I-TREATMENT +sector I-TREATMENT +incisivo. I-TREATMENT +La I-TREATMENT +compresión I-TREATMENT +interna/externa I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +por I-TREATMENT +15 I-TREATMENT +h I-TREATMENT +diarias, I-TREATMENT +con I-TREATMENT +controles I-TREATMENT +del I-TREATMENT +aparato I-TREATMENT +y I-TREATMENT +rebasado I-TREATMENT +de I-TREATMENT +acrílico I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +al I-TREATMENT +espacio I-TREATMENT +que I-TREATMENT +se I-TREATMENT +iba I-TREATMENT +produciendo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +vestíbulo. I-TREATMENT + I-TREATMENT +Dado I-TREATMENT +que I-TREATMENT +el I-TREATMENT +seguimiento I-TREATMENT +de I-TREATMENT +los I-TREATMENT +últimos I-TREATMENT +4 I-TREATMENT +años I-TREATMENT +no I-TREATMENT +mostró I-TREATMENT +recidiva I-TREATMENT +local I-TREATMENT +y I-TREATMENT +la I-TREATMENT +comisura I-TREATMENT +oral I-TREATMENT +derecha I-TREATMENT +se I-TREATMENT +encontraba I-TREATMENT +descendida I-TREATMENT +e I-TREATMENT +inanimada, I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +cirugía I-TREATMENT +para I-TREATMENT +suspender I-TREATMENT +la I-TREATMENT +comisura I-TREATMENT +derecha, I-TREATMENT +ayudado I-TREATMENT +por I-TREATMENT +el I-TREATMENT +soporte I-TREATMENT +intraoral I-TREATMENT +al I-TREATMENT +que I-TREATMENT +se I-TREATMENT +le I-TREATMENT +rebasa I-TREATMENT +material I-TREATMENT +semanalmente I-TREATMENT +agregando I-TREATMENT +una I-TREATMENT +zona I-TREATMENT +más I-TREATMENT +alta I-TREATMENT +que I-TREATMENT +levanta I-TREATMENT +y I-TREATMENT +da I-TREATMENT +soporte I-TREATMENT +a I-TREATMENT +la I-TREATMENT +comisura. I-TREATMENT + I-TREATMENT + +Lactante B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +proteína I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +leche I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vaca, I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +compatible I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +contrapruebas I-PAST_MEDICAL_HISTORY +positivas, I-PAST_MEDICAL_HISTORY +alimentada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lactancia I-PAST_MEDICAL_HISTORY +materna I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dieta I-PAST_MEDICAL_HISTORY +hipoalergénica. I-PAST_MEDICAL_HISTORY +Tuvo I-PAST_MEDICAL_HISTORY +adecuado I-PAST_MEDICAL_HISTORY +incremento I-PAST_MEDICAL_HISTORY +pondoestatural I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +(P/T I-PAST_MEDICAL_HISTORY +–0, I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +DS I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +T/E I-PAST_MEDICAL_HISTORY +–0, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +DS), I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +evolucionó I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +estacionario I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +caída I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +curva I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +talla I-PAST_MEDICAL_HISTORY +(P/T I-PAST_MEDICAL_HISTORY +–0, I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +DS I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +T/E I-PAST_MEDICAL_HISTORY +–0, I-PAST_MEDICAL_HISTORY +8). I-PAST_MEDICAL_HISTORY +Por B-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +modo I-PRESENT_ILLNESS +intercurrente I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +alta I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +solicitaron I-PRESENT_ILLNESS +exámenes I-PRESENT_ILLNESS +generales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +orina, I-PRESENT_ILLNESS +compatibles I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tracto I-PRESENT_ILLNESS +urinario. I-PRESENT_ILLNESS +Los B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +mostraron I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +severa I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +FA I-EXPLORATION +(4.552 I-EXPLORATION +UI/l), I-EXPLORATION +calcio, I-EXPLORATION +fósforo I-EXPLORATION +y I-EXPLORATION +enzimas I-EXPLORATION +hepáticas I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +isoenzimas I-EXPLORATION +que I-EXPLORATION +revelaron I-EXPLORATION +predominio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fracción I-EXPLORATION +ósea I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +hepática I-EXPLORATION +de I-EXPLORATION +96, I-EXPLORATION +3% I-EXPLORATION +a I-EXPLORATION +3, I-EXPLORATION +7% I-EXPLORATION +respectivamente. I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +FA I-EVOLUTION +a I-EVOLUTION +269 I-EVOLUTION +UI/l I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +y I-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +curva I-EVOLUTION +pondoestatural. I-EVOLUTION + I-EVOLUTION + +Lactante B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +sana, I-PRESENT_ILLNESS +buen I-PRESENT_ILLNESS +incremento I-PRESENT_ILLNESS +pondoestatural I-PRESENT_ILLNESS +(P/T I-PRESENT_ILLNESS +–0, I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +DS I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +T/E I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +DS), I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +curso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +prolongado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +inapetencia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +se B-EXPLORATION +solicitaron I-EXPLORATION +exámenes I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +elevación I-EXPLORATION +severa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +FA I-EXPLORATION +(5.553 I-EXPLORATION +UI/l), I-EXPLORATION +la I-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +isoenzimas I-EXPLORATION +evidenció I-EXPLORATION +predominio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fracción I-EXPLORATION +ósea I-EXPLORATION +—75%— I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +hepática I-EXPLORATION +—24%—. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +alteración I-EXPLORATION +hepática, I-EXPLORATION +ni I-EXPLORATION +ósea, I-EXPLORATION +con I-EXPLORATION +hemograma, I-EXPLORATION +VHS, I-EXPLORATION +transaminasas, I-EXPLORATION +calcio, I-EXPLORATION +fósforo, I-EXPLORATION +hormona I-EXPLORATION +paratiroidea I-EXPLORATION +(PTH), I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +25-OH I-EXPLORATION +vit. I-EXPLORATION +D3 I-EXPLORATION +y I-EXPLORATION +cintigrafía I-EXPLORATION +ósea I-EXPLORATION +normales. I-EXPLORATION +El B-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +FA I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +mostraron I-EVOLUTION +un I-EVOLUTION +leve I-EVOLUTION +ascenso I-EVOLUTION +con I-EVOLUTION +respecto I-EVOLUTION +al I-EVOLUTION +valor I-EVOLUTION +previo I-EVOLUTION +(5.857 I-EVOLUTION +UI/l), I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +recuperación I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +cuadro I-EVOLUTION +febril I-EVOLUTION +intercurrente; I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +disminuyeron I-EVOLUTION +a I-EVOLUTION +631 I-EVOLUTION +UI/l, I-EVOLUTION +normalizándose I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +valor I-EVOLUTION +de I-EVOLUTION +297 I-EVOLUTION +U/l. I-EVOLUTION + I-EVOLUTION + +Prees B-PAST_MEDICAL_HISTORY +colar I-PAST_MEDICAL_HISTORY +femenino B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +portador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cromosomopatia I-PAST_MEDICAL_HISTORY +compleja I-PAST_MEDICAL_HISTORY +46XX I-PAST_MEDICAL_HISTORY +add I-PAST_MEDICAL_HISTORY +(8). I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +placas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ampollas I-PRESENT_ILLNESS +localizadas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +mente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +extremidades, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +alta, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +antibiótico I-PRESENT_ILLNESS +indicado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +sospecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +impetigo I-PRESENT_ILLNESS +ampollar. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +múltiples I-EXPLORATION +placas I-EXPLORATION +eritemato-violáceas, I-EXPLORATION +con I-EXPLORATION +centro I-EXPLORATION +ampollar I-EXPLORATION +en I-EXPLORATION +dorso, I-EXPLORATION +extremidades I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores, I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +placas I-EXPLORATION +y I-EXPLORATION +nódulos I-EXPLORATION +eritematosos I-EXPLORATION +en I-EXPLORATION +brazo I-EXPLORATION +y I-EXPLORATION +muslo I-EXPLORATION +izquierdo. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacó I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(RAN I-EXPLORATION +45954/mm3) I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +elevada I-EXPLORATION +(347 I-EXPLORATION +mg/L). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +cutáneas I-EXPLORATION +con I-EXPLORATION +hallazgos I-EXPLORATION +histopatológicos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +Síndrome I-EXPLORATION +de I-EXPLORATION +Sweet. I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +1 I-TREATMENT +mg/ I-TREATMENT +kg/día, I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínica. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +presentaba I-EVOLUTION +placas I-EVOLUTION +costrosas I-EVOLUTION +de I-EVOLUTION +menor I-EVOLUTION +tamaño, I-EVOLUTION +sin I-EVOLUTION +lesiones I-EVOLUTION +ampollares. I-EVOLUTION + I-EVOLUTION + +Recién B-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +gestacional, I-PRESENT_ILLNESS +nacido B-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sepsis I-PAST_MEDICAL_HISTORY +materna. I-PAST_MEDICAL_HISTORY +Madre B-FAMILY_HISTORY +de I-FAMILY_HISTORY +19 I-FAMILY_HISTORY +años I-FAMILY_HISTORY +de I-FAMILY_HISTORY +edad I-FAMILY_HISTORY +falleció I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +puerperio I-FAMILY_HISTORY +inme I-FAMILY_HISTORY +diato I-FAMILY_HISTORY +por I-FAMILY_HISTORY +sepsis I-FAMILY_HISTORY +grave, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +consanguinidad, I-FAMILY_HISTORY +el B-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +controlado, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +reporte I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +ultrasonidos I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +signos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hidrops I-PAST_MEDICAL_HISTORY +(derrame I-PAST_MEDICAL_HISTORY +pleural, I-PAST_MEDICAL_HISTORY +derrame I-PAST_MEDICAL_HISTORY +pericárdico I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +asci I-PAST_MEDICAL_HISTORY +tis). I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2090g, I-PAST_MEDICAL_HISTORY +APGAR I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +minuto I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +minutos. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +examen I-PAST_MEDICAL_HISTORY +clínico I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +fenotipo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +sugiera I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +genético. I-PAST_MEDICAL_HISTORY +Dos B-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +nacimiento I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +taquipnea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cianosis I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +grave. I-PRESENT_ILLNESS +Fue B-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +surfactante I-TREATMENT +exógeno I-TREATMENT +de I-TREATMENT +rescate I-TREATMENT +por I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +signos I-TREATMENT +y I-TREATMENT +síntomas I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +dificultad I-TREATMENT +respiratoria, I-TREATMENT +catecolaminas, I-TREATMENT +antibióticos I-TREATMENT +y I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +por I-TREATMENT +22 I-TREATMENT +días; I-TREATMENT +la I-TREATMENT +ventilación I-TREATMENT +convencional I-TREATMENT +con I-TREATMENT +presión I-TREATMENT +media I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +aérea I-TREATMENT +máxima I-TREATMENT +de I-TREATMENT +16 I-TREATMENT +cm I-TREATMENT +H2O, I-TREATMENT +seguida I-TREATMENT +de I-TREATMENT +VAFO I-TREATMENT +por I-TREATMENT +acidosis I-TREATMENT +respiratoria I-TREATMENT +e I-TREATMENT +hipoxemia I-TREATMENT +refrac I-TREATMENT +taria I-TREATMENT +(pCO2 I-TREATMENT +75 I-TREATMENT +mmHg I-TREATMENT +y I-TREATMENT +pO2 I-TREATMENT +45 I-TREATMENT +mmHg). I-TREATMENT + I-TREATMENT +La B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +infiltración I-EXPLORATION +reticular I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +pulmones I-EXPLORATION +y I-EXPLORATION +sobre I-EXPLORATION +distención I-EXPLORATION +pulmonar I-EXPLORATION +sin I-EXPLORATION +consolidaciones. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +describió I-EXPLORATION +cambios I-EXPLORATION +reticulares I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +zonas, I-EXPLORATION +engrosamiento I-EXPLORATION +intersticial, I-EXPLORATION +múltiples I-EXPLORATION +bullas I-EXPLORATION +y I-EXPLORATION +atrapamiento I-EXPLORATION +de I-EXPLORATION +aire I-EXPLORATION +en I-EXPLORATION +pulmón I-EXPLORATION +izquierdo, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +neumonía I-EXPLORATION +derecha I-EXPLORATION +(Fi I-EXPLORATION +gura I-EXPLORATION +2). I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +linfangiectasia I-EXPLORATION +en I-EXPLORATION +otros I-EXPLORATION +órganos I-EXPLORATION +por I-EXPLORATION +TAC I-EXPLORATION +abdominal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +indicación I-EXPLORATION +de I-EXPLORATION +cirugía I-EXPLORATION +pediátrica I-EXPLORATION +lobectomía I-EXPLORATION +inferior I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +dilatación I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +canales I-EXPLORATION +linfáti I-EXPLORATION +cos I-EXPLORATION +broncovasculares,. I-EXPLORATION +Por I-EXPLORATION +ecocardiografía I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +comunicación I-EXPLORATION +interauricular I-EXPLORATION +(CIA) I-EXPLORATION +y I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +conducto I-EXPLORATION +arterioso I-EXPLORATION +(PCA) I-EXPLORATION +y I-EXPLORATION +fueron I-EXPLORATION +corregidas I-EXPLORATION +quirúrgicamente I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +30 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +vida I-EXPLORATION +extra I-EXPLORATION +uterina. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +satisfactoria, I-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +pediátrico I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +19 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +edad I-EVOLUTION +reportó I-EVOLUTION +peso I-EVOLUTION +y I-EVOLUTION +talla I-EVOLUTION +adecuados I-EVOLUTION +para I-EVOLUTION +su I-EVOLUTION +edad, I-EVOLUTION +desarrollo I-EVOLUTION +psicomotor I-EVOLUTION +nor I-EVOLUTION +mal, I-EVOLUTION +sin I-EVOLUTION +cuadros I-EVOLUTION +infecciosos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +vía I-EVOLUTION +respiratoria I-EVOLUTION +in I-EVOLUTION +ferior, I-EVOLUTION +no I-EVOLUTION +requirió I-EVOLUTION +oxigeno I-EVOLUTION +suplementario; I-EVOLUTION +la I-EVOLUTION +TAC I-EVOLUTION +de I-EVOLUTION +tórax I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +informó I-EVOLUTION +con I-EVOLUTION +engrosamiento I-EVOLUTION +intersti I-EVOLUTION +cial, I-EVOLUTION +bullas I-EVOLUTION +enfisematosas I-EVOLUTION +difusas I-EVOLUTION +pequeñas I-EVOLUTION +y I-EVOLUTION +mejoría I-EVOLUTION +con I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +TAC I-EVOLUTION +inicial,. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +cursando B-PAST_MEDICAL_HISTORY +escarlatina, I-PAST_MEDICAL_HISTORY +quien B-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ictericia, I-PRESENT_ILLNESS +coluria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +apetito. I-PRESENT_ILLNESS +Los B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +revelaron I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +transaminasas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +y I-EXPLORATION +directa, I-EXPLORATION +y I-EXPLORATION +estudios I-EXPLORATION +vira I-EXPLORATION +les I-EXPLORATION +negativos I-EXPLORATION +para I-EXPLORATION +Hepatitis I-EXPLORATION +A, I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +Virus I-EXPLORATION +de I-EXPLORATION +Epstein I-EXPLORATION +Barr, I-EXPLORATION +Parvovirus I-EXPLORATION +B19, I-EXPLORATION +Citomegalovirus, I-EXPLORATION +Virus I-EXPLORATION +Herpes I-EXPLORATION +6 I-EXPLORATION +y I-EXPLORATION +Herpes I-EXPLORATION +simplex I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +2. I-EXPLORATION +Ecografía I-EXPLORATION +abdominal I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sano. I-PAST_MEDICAL_HISTORY +Comenzó B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dermato I-PRESENT_ILLNESS +sis I-PRESENT_ILLNESS +generalizada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +máximo I-PRESENT_ILLNESS +lesional I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +umbilical, I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +genitales, I-PRESENT_ILLNESS +caracterizada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ampollas, I-PRESENT_ILLNESS +algunas I-PRESENT_ILLNESS +denudadas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sangrado I-PRESENT_ILLNESS +fácil, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +mucoso I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Se B-TREATMENT +diagnosticó I-TREATMENT +impétigo I-TREATMENT +bulloso I-TREATMENT +y I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +antibioticoterapia I-TREATMENT +tópica I-TREATMENT +y I-TREATMENT +sistémica I-TREATMENT +sin I-TREATMENT +mejoría I-TREATMENT +clínica. I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +extensión I-EVOLUTION +lesional, I-EVOLUTION +con I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +mucosas I-EVOLUTION +oral I-EVOLUTION +y I-EVOLUTION +anal. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +e I-EXPLORATION +inmunohistoquí- I-EXPLORATION +mico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +perilesional I-EXPLORATION +confirmó I-EXPLORATION +pénfigo I-EXPLORATION +vulgar. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +corticoideo I-TREATMENT +e I-TREATMENT +inmunomodulador I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT + I-TREATMENT + +Recién B-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +término I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +semanas, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +mascu I-PRESENT_ILLNESS +lino, I-PRESENT_ILLNESS +embarazo B-PAST_MEDICAL_HISTORY +controlado, I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +eutócico, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +perinatales. I-PAST_MEDICAL_HISTORY +Derivado B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +dermatología I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +placa I-DERIVED_FROM/TO +eritematosa I-DERIVED_FROM/TO +levemente I-DERIVED_FROM/TO +infiltrada I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +región I-DERIVED_FROM/TO +peri I-DERIVED_FROM/TO +e I-DERIVED_FROM/TO +infraumbilical I-DERIVED_FROM/TO +presente I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +nacimiento, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +bordes I-DERIVED_FROM/TO +bien I-DERIVED_FROM/TO +definidos I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +descamación I-DERIVED_FROM/TO +amarillenta I-DERIVED_FROM/TO +superficial I-DERIVED_FROM/TO +adherente I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +polo I-DERIVED_FROM/TO +inferior, I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +otros I-DERIVED_FROM/TO +signos I-DERIVED_FROM/TO +inflamatorios I-DERIVED_FROM/TO +locales. I-DERIVED_FROM/TO +Estudio B-EXPLORATION +ecográfico I-EXPLORATION +cutáneo I-EXPLORATION +reveló I-EXPLORATION +lesión I-EXPLORATION +dermoepidérmica I-EXPLORATION +hipoecogénica I-EXPLORATION +homogénea, I-EXPLORATION +con I-EXPLORATION +extensión I-EXPLORATION +leve I-EXPLORATION +a I-EXPLORATION +tejido I-EXPLORATION +subcutáneo I-EXPLORATION +y I-EXPLORATION +escasos I-EXPLORATION +vasos I-EXPLORATION +sinuosos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +segmento I-EXPLORATION +más I-EXPLORATION +profundo. I-EXPLORATION + I-EXPLORATION +Dado I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +clínicas, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +profunda I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +fusiformes I-EXPLORATION +delgadas I-EXPLORATION +en I-EXPLORATION +dermis I-EXPLORATION +e I-EXPLORATION +hipodermis, I-EXPLORATION +de I-EXPLORATION +morfología I-EXPLORATION +bifásica I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +segmento I-EXPLORATION +dispuesto I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +arremolinado I-EXPLORATION +infiltrante I-EXPLORATION +y I-EXPLORATION +otro I-EXPLORATION +con I-EXPLORATION +bandas I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +fusadas I-EXPLORATION +con I-EXPLORATION +hábitos I-EXPLORATION +fibroblástico I-EXPLORATION +y I-EXPLORATION +miofibroblástico, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +Grenz. I-EXPLORATION +En I-EXPLORATION +profundidad, I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +componente I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +maduro, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +atipía. I-EXPLORATION +Epidermis I-EXPLORATION +madura, I-EXPLORATION +parcialmente I-EXPLORATION +atrófica. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +necrosis I-EXPLORATION +ni I-EXPLORATION +mitosis I-EXPLORATION +atípicas. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +mos I-EXPLORATION +tró I-EXPLORATION +positividad I-EXPLORATION +intensa I-EXPLORATION +y I-EXPLORATION +difusa I-EXPLORATION +a I-EXPLORATION +CD34 I-EXPLORATION +y I-EXPLORATION +focal I-EXPLORATION +para I-EXPLORATION +FXIIIa, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +inmunoreactividad I-EXPLORATION +a I-EXPLORATION +actina, I-EXPLORATION +desmina, I-EXPLORATION +MyoD1, I-EXPLORATION +S100, I-EXPLORATION +HMB45, I-EXPLORATION +MelanA I-EXPLORATION +y I-EXPLORATION +EMA. I-EXPLORATION +Índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +con I-EXPLORATION +Ki67 I-EXPLORATION +moderado, I-EXPLORATION +con I-EXPLORATION +positividad I-EXPLORATION +en I-EXPLORATION +aproximadamente I-EXPLORATION +el I-EXPLORATION +20% I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células. I-EXPLORATION +Se I-EXPLORATION +complementó I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +FISH I-EXPLORATION +para I-EXPLORATION +PDGF I-EXPLORATION +beta I-EXPLORATION +y I-EXPLORATION +ETV6, I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +negativos, I-EXPLORATION +excluyendo I-EXPLORATION +los I-EXPLORATION +diagnósticos I-EXPLORATION +diferenciales I-EXPLORATION +de I-EXPLORATION +dermatofobrosarcoma I-EXPLORATION +protuberans I-EXPLORATION +congénito I-EXPLORATION +y I-EXPLORATION +fibrosarcoma I-EXPLORATION +infantil, I-EXPLORATION +respec I-EXPLORATION +tivamente. I-EXPLORATION +Estos I-EXPLORATION +antecedentes, I-EXPLORATION +sumados I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +histológicos, I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +HFI. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +extirpación I-TREATMENT +quirúrgica I-TREATMENT +por I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +ci I-TREATMENT +rugía I-TREATMENT +pediátrica, I-TREATMENT +con I-TREATMENT +readecuación I-TREATMENT +umbilical I-TREATMENT +mediante I-TREATMENT +colgajos I-TREATMENT +de I-TREATMENT +rotación I-TREATMENT +laterales. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +e I-EXPLORATION +inmunohistoquímico I-EXPLORATION +sostuvo I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +descritos I-EXPLORATION +previamente, I-EXPLORATION +comprometiendo I-EXPLORATION +márgenes I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +quirúrgica. I-EXPLORATION +Evolucionó B-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +joven I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +lograr I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mejoría I-PRESENT_ILLNESS +estético I-PRESENT_ILLNESS +funcional I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +dedo I-PRESENT_ILLNESS +pulgar I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Había B-PAST_MEDICAL_HISTORY +nacido I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +dedo I-PAST_MEDICAL_HISTORY +pulgar I-PAST_MEDICAL_HISTORY +pequeño I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +función, I-PAST_MEDICAL_HISTORY +unido I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +resto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mano I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +través I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +pequeño I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +delgado I-PAST_MEDICAL_HISTORY +tubo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +piel; I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +lactancia, I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +Hospital I-PAST_MEDICAL_HISTORY +Infantil I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +habían I-PAST_MEDICAL_HISTORY +únicamente I-PAST_MEDICAL_HISTORY +extirpado I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +área I-PAST_MEDICAL_HISTORY +cutánea I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +pequeño I-PAST_MEDICAL_HISTORY +tubo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +unión I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +fin I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +lograr I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +implantación I-PAST_MEDICAL_HISTORY +directa I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +apéndice I-PAST_MEDICAL_HISTORY +pulgar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mano. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Cuando B-EXPLORATION +acude I-EXPLORATION +a I-EXPLORATION +nuestra I-EXPLORATION +consulta I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +pulgar I-EXPLORATION +con I-EXPLORATION +implantación I-EXPLORATION +distal I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +metacarpofalangica I-EXPLORATION +del I-EXPLORATION +índice, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +primer I-EXPLORATION +espacio I-EXPLORATION +estrecho, I-EXPLORATION +sin I-EXPLORATION +capacidad I-EXPLORATION +motora I-EXPLORATION +de I-EXPLORATION +oposición I-EXPLORATION +ni I-EXPLORATION +flexo-extensión, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +sensibilidad I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +bordes I-EXPLORATION +del I-EXPLORATION +mismo. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +eminencia I-EXPLORATION +tenar I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +palpaba I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +metacarpiano; I-EXPLORATION +además I-EXPLORATION +tenía I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulso I-EXPLORATION +radial I-EXPLORATION +pero I-EXPLORATION +sí I-EXPLORATION +se I-EXPLORATION +palpaba I-EXPLORATION +adecuadamente I-EXPLORATION +el I-EXPLORATION +pulso I-EXPLORATION +cubital. I-EXPLORATION +La I-EXPLORATION +parte I-EXPLORATION +funcional I-EXPLORATION +compensatoria I-EXPLORATION +la I-EXPLORATION +realizaba I-EXPLORATION +con I-EXPLORATION +alguna I-EXPLORATION +dificultad I-EXPLORATION +mediante I-EXPLORATION +una I-EXPLORATION +pinza I-EXPLORATION +dígito-digital I-EXPLORATION +lateral I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +índice I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +medio. I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +estudios I-EXPLORATION +radiológicos I-EXPLORATION +que I-EXPLORATION +evidenciaron I-EXPLORATION +hipoplasia I-EXPLORATION +y I-EXPLORATION +fusión I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +falanges, I-EXPLORATION +agenesia I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +metacarpiano, I-EXPLORATION +atrofia I-EXPLORATION +del I-EXPLORATION +trapecio I-EXPLORATION +y I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +huesos I-EXPLORATION +del I-EXPLORATION +carpo, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +también I-EXPLORATION +atrofia I-EXPLORATION +del I-EXPLORATION +radio; I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +doppler I-EXPLORATION +color I-EXPLORATION +revelo I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +radial I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +compensatoria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +ulnar. I-EXPLORATION +Con I-EXPLORATION +este I-EXPLORATION +examen I-EXPLORATION +clínico I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +un I-EXPLORATION +típico I-EXPLORATION +pulgar I-EXPLORATION +flotante I-EXPLORATION +izquierdo I-EXPLORATION +parcialmente I-EXPLORATION +tratado. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +su I-EXPLORATION +mano I-EXPLORATION +derecha I-EXPLORATION +dominante I-EXPLORATION +presentaba I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pulgar I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +anomalías: I-EXPLORATION +primer I-EXPLORATION +espacio I-EXPLORATION +estrecho, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pliegues I-EXPLORATION +de I-EXPLORATION +flexión, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +eminencia I-EXPLORATION +tenar, I-EXPLORATION +imposibilidad I-EXPLORATION +para I-EXPLORATION +flexionar I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +metacarpofalángica I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +movilidad I-EXPLORATION +pasiva I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma, I-EXPLORATION +anquílosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +interfalángica; I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +esto I-EXPLORATION +había I-EXPLORATION +buena I-EXPLORATION +función I-EXPLORATION +del I-EXPLORATION +mismo. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +doppler I-EXPLORATION +color I-EXPLORATION +no I-EXPLORATION +evidenciaron I-EXPLORATION +anomalías I-EXPLORATION +óseas I-EXPLORATION +o I-EXPLORATION +vasculares. I-EXPLORATION +Con I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +podríamos I-EXPLORATION +clasificar I-EXPLORATION +el I-EXPLORATION +pulgar I-EXPLORATION +derecho I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +grupo I-EXPLORATION +I I-EXPLORATION +de I-EXPLORATION +Blauth. I-EXPLORATION + I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectaron I-EXPLORATION +otras I-EXPLORATION +anomalías I-EXPLORATION +corporales I-EXPLORATION +congénitas. I-EXPLORATION + I-EXPLORATION +Tratamiento B-TREATMENT +y I-TREATMENT +resultados I-TREATMENT + I-TREATMENT +Al I-TREATMENT +reconstruir I-TREATMENT +un I-TREATMENT +pulgar I-TREATMENT +se I-TREATMENT +deben I-TREATMENT +tener I-TREATMENT +bien I-TREATMENT +claros I-TREATMENT +algunos I-TREATMENT +objetivos I-TREATMENT +generales I-TREATMENT +que I-TREATMENT +ayudarán I-TREATMENT +a I-TREATMENT +la I-TREATMENT +funcionabilidad I-TREATMENT +del I-TREATMENT +mismo, I-TREATMENT +como I-TREATMENT +son I-TREATMENT +lograr I-TREATMENT +estabilidad, I-TREATMENT +oposición, I-TREATMENT +sensibilidad, I-TREATMENT +darle I-TREATMENT +una I-TREATMENT +longitud I-TREATMENT +adecuada, I-TREATMENT +darle I-TREATMENT +movilidad I-TREATMENT +en I-TREATMENT +lo I-TREATMENT +posible I-TREATMENT +y I-TREATMENT +un I-TREATMENT +buen I-TREATMENT +aspecto I-TREATMENT +estético. I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +de I-TREATMENT +un I-TREATMENT +pulgar I-TREATMENT +flotante I-TREATMENT +existen I-TREATMENT +dos I-TREATMENT +conductas I-TREATMENT +básicamente I-TREATMENT +opuestas, I-TREATMENT +que I-TREATMENT +deben I-TREATMENT +discutirse I-TREATMENT +ampliamente I-TREATMENT +con I-TREATMENT +los I-TREATMENT +padres I-TREATMENT +y I-TREATMENT +con I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +si I-TREATMENT +éste I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +en I-TREATMENT +una I-TREATMENT +edad I-TREATMENT +de I-TREATMENT +comprender. I-TREATMENT + I-TREATMENT +Desde I-TREATMENT +el I-TREATMENT +punto I-TREATMENT +de I-TREATMENT +vista I-TREATMENT +práctico I-TREATMENT +se I-TREATMENT +trata I-TREATMENT +de I-TREATMENT +decidir I-TREATMENT +entre I-TREATMENT +una I-TREATMENT +de I-TREATMENT +las I-TREATMENT +siguientes I-TREATMENT +actitudes I-TREATMENT +terapéuticas: I-TREATMENT + I-TREATMENT +Amputación I-TREATMENT +y I-TREATMENT +reconstrucción: I-TREATMENT + I-TREATMENT +La I-TREATMENT +amputación I-TREATMENT +del I-TREATMENT +pulgar I-TREATMENT +flotante I-TREATMENT +conducirá I-TREATMENT +a I-TREATMENT +una I-TREATMENT +aplasia I-TREATMENT +que I-TREATMENT +necesitará I-TREATMENT +una I-TREATMENT +reconstrucción I-TREATMENT +con I-TREATMENT +técnicas I-TREATMENT +microquirúrgicas I-TREATMENT +tales I-TREATMENT +como I-TREATMENT +pulgarización I-TREATMENT +del I-TREATMENT +índice I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +con I-TREATMENT +buenos I-TREATMENT +resultados I-TREATMENT +desde I-TREATMENT +1964 I-TREATMENT +( I-TREATMENT +3, I-TREATMENT +4), I-TREATMENT +o I-TREATMENT +la I-TREATMENT +transferencia I-TREATMENT +de I-TREATMENT +un I-TREATMENT +ortejo, I-TREATMENT +técnica I-TREATMENT +que I-TREATMENT +conlleva I-TREATMENT +muchos I-TREATMENT +riesgos I-TREATMENT +sobre I-TREATMENT +todo I-TREATMENT +cuando I-TREATMENT +no I-TREATMENT +se I-TREATMENT +tiene I-TREATMENT +un I-TREATMENT +buen I-TREATMENT +entrenamiento I-TREATMENT +en I-TREATMENT +microcirugía I-TREATMENT +(5,6) I-TREATMENT +o I-TREATMENT +no I-TREATMENT +se I-TREATMENT +cuenta I-TREATMENT +con I-TREATMENT +la I-TREATMENT +infraestructura I-TREATMENT +idonea. I-TREATMENT +En I-TREATMENT +teoría, I-TREATMENT +son I-TREATMENT +las I-TREATMENT +técnicas I-TREATMENT +que I-TREATMENT +mejor I-TREATMENT +resultado I-TREATMENT +estético-funcional I-TREATMENT +producen. I-TREATMENT + I-TREATMENT +Conservación I-TREATMENT +y I-TREATMENT +estabilización: I-TREATMENT + I-TREATMENT +Son I-TREATMENT +posibles I-TREATMENT +tres I-TREATMENT +tipos I-TREATMENT +de I-TREATMENT +conducta I-TREATMENT +dependiendo I-TREATMENT +del I-TREATMENT +tipo I-TREATMENT +de I-TREATMENT +patología I-TREATMENT +según I-TREATMENT +la I-TREATMENT +clasificación I-TREATMENT +de I-TREATMENT +Blauth I-TREATMENT + I-TREATMENT +-Estabilización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +articulación I-TREATMENT +metacarpofalángica. I-TREATMENT +-Estabilización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +metacarpofalángica I-TREATMENT +más I-TREATMENT +una I-TREATMENT +transferencia I-TREATMENT +de I-TREATMENT +oposición. I-TREATMENT +- I-TREATMENT +Reconstrucción I-TREATMENT +del I-TREATMENT +metacarpiano I-TREATMENT +con I-TREATMENT +una I-TREATMENT +transferencia I-TREATMENT +ósea I-TREATMENT +vascularizada I-TREATMENT +o I-TREATMENT +no. I-TREATMENT + I-TREATMENT +En I-TREATMENT +nuestra I-TREATMENT +paciente, I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +hecho I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +e I-TREATMENT +identificados I-TREATMENT +los I-TREATMENT +problemas, I-TREATMENT +se I-TREATMENT +plantearon I-TREATMENT +a I-TREATMENT +la I-TREATMENT +madre I-TREATMENT +y I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +las I-TREATMENT +conductas I-TREATMENT +quirúrgicas I-TREATMENT +presentadas I-TREATMENT +anteriormente, I-TREATMENT +pero I-TREATMENT +en I-TREATMENT +definitiva I-TREATMENT +fue I-TREATMENT +sumamente I-TREATMENT +difícil I-TREATMENT +convencerlas I-TREATMENT +de I-TREATMENT +amputar I-TREATMENT +el I-TREATMENT +pulgar I-TREATMENT +vestigial I-TREATMENT +y I-TREATMENT +reconstruirlo I-TREATMENT +con I-TREATMENT +una I-TREATMENT +pulgarización I-TREATMENT +del I-TREATMENT +índice, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +tomó I-TREATMENT +la I-TREATMENT +decisión I-TREATMENT +de I-TREATMENT +reconstrucción I-TREATMENT +y I-TREATMENT +estabilización I-TREATMENT +del I-TREATMENT +metacarpiano. I-TREATMENT + I-TREATMENT +Debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +efectuar, I-TREATMENT +por I-TREATMENT +ejemplo, I-TREATMENT +una I-TREATMENT +transferencia I-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +óseo I-TREATMENT +del I-TREATMENT +tercio I-TREATMENT +distal I-TREATMENT +del I-TREATMENT +radio I-TREATMENT +nutrido I-TREATMENT +por I-TREATMENT +la I-TREATMENT +rama I-TREATMENT +perforante I-TREATMENT +superior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +ínterósea I-TREATMENT +anterior I-TREATMENT +a I-TREATMENT +flujo I-TREATMENT +retrogrado I-TREATMENT +(7), I-TREATMENT +no I-TREATMENT +era I-TREATMENT +viable I-TREATMENT +por I-TREATMENT +las I-TREATMENT +anomalías I-TREATMENT +vasculares I-TREATMENT +observadas I-TREATMENT +con I-TREATMENT +el I-TREATMENT +doppler, I-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +la I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +un I-TREATMENT +injerto I-TREATMENT +óseo I-TREATMENT +convencional I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +del I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +reabsorción I-TREATMENT +que I-TREATMENT +puede I-TREATMENT +presentarse I-TREATMENT +a I-TREATMENT +largo I-TREATMENT +plazo. I-TREATMENT +Para I-TREATMENT +no I-TREATMENT +cambiar I-TREATMENT +de I-TREATMENT +campo I-TREATMENT +operatorio I-TREATMENT +se I-TREATMENT +cosechó I-TREATMENT +el I-TREATMENT +injerto I-TREATMENT +óseo I-TREATMENT +del I-TREATMENT +olécranon I-TREATMENT +ipsilateral; I-TREATMENT +después I-TREATMENT +se I-TREATMENT +estabilizó I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +trapecio I-TREATMENT +vestigial I-TREATMENT +con I-TREATMENT +una I-TREATMENT +miniplaca I-TREATMENT +y I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +las I-TREATMENT +falanges I-TREATMENT +con I-TREATMENT +alambre, I-TREATMENT +logrando I-TREATMENT +darle I-TREATMENT +al I-TREATMENT +neo-pulgar I-TREATMENT +orientación I-TREATMENT +en I-TREATMENT +oposición. I-TREATMENT +Para I-TREATMENT +mantener I-TREATMENT +estable I-TREATMENT +esta I-TREATMENT +posición I-TREATMENT +y I-TREATMENT +evitar I-TREATMENT +futuros I-TREATMENT +desplazamientos I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +efectuar I-TREATMENT +la I-TREATMENT +transferencia I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +abductor I-TREATMENT +del I-TREATMENT +meñique I-TREATMENT +para I-TREATMENT +fijarlo I-TREATMENT +al I-TREATMENT +neo-metacarpiano I-TREATMENT +y I-TREATMENT +reforzar I-TREATMENT +o I-TREATMENT +estabilizar I-TREATMENT +la I-TREATMENT +oposición I-TREATMENT +del I-TREATMENT +pulgar, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +para I-TREATMENT +tratar I-TREATMENT +de I-TREATMENT +aumentar I-TREATMENT +el I-TREATMENT +volumen I-TREATMENT +y I-TREATMENT +por I-TREATMENT +ende I-TREATMENT +la I-TREATMENT +estética I-TREATMENT +del I-TREATMENT +área I-TREATMENT +tenar. I-TREATMENT +La I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +con I-TREATMENT +un I-TREATMENT +bloqueo I-TREATMENT +regional I-TREATMENT +bajo I-TREATMENT +torniquete I-TREATMENT +neumático. I-TREATMENT + I-TREATMENT +No B-EVOLUTION +se I-EVOLUTION +presentaron I-EVOLUTION +complicaciones I-EVOLUTION +postoperatorias I-EVOLUTION + I-EVOLUTION +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Fisioterapia I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diseño I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +ortesis I-DERIVED_FROM/TO +funcional I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +posteriormente, I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +inicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +reeducación I-DERIVED_FROM/TO +funcional. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Psicológicamente B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +respondido I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +positiva I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +ha I-EVOLUTION +logrado I-EVOLUTION +darle I-EVOLUTION +utilidad I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +nuevo I-EVOLUTION +pulgar I-EVOLUTION +y I-EVOLUTION +éste I-EVOLUTION +ha I-EVOLUTION +mejorado I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +aspecto I-EVOLUTION +estético, I-EVOLUTION +aunque I-EVOLUTION +no I-EVOLUTION +es I-EVOLUTION +el I-EVOLUTION +aspecto I-EVOLUTION +que I-EVOLUTION +sus I-EVOLUTION +expectativas, I-EVOLUTION +normales I-EVOLUTION +o I-EVOLUTION +no, I-EVOLUTION +le I-EVOLUTION +hicieron I-EVOLUTION +desear. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +85 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +basocelular I-PRESENT_ILLNESS +recidivado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pabellón I-PRESENT_ILLNESS +auricular I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-TREATMENT +tratamiento I-TREATMENT +inicial, I-TREATMENT +realizado I-TREATMENT +en I-TREATMENT +mayo I-TREATMENT +de I-TREATMENT +2001, I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +una I-TREATMENT +extirpación I-TREATMENT +local I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +siguió I-EVOLUTION +revisiones I-EVOLUTION +periódicas I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +recidiva I-EVOLUTION +local I-EVOLUTION +más I-EVOLUTION +una I-EVOLUTION +tumoración I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +submandibular I-EVOLUTION +derecho. I-EVOLUTION +Se B-EXPLORATION +solicitó I-EXPLORATION +citología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +mediante I-EXPLORATION +punción I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +células I-EXPLORATION +malignas, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +basocelular. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Tomografía I-EXPLORATION +Axial I-EXPLORATION +Computerizada I-EXPLORATION +(TAC) I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tejidos I-EXPLORATION +blandos I-EXPLORATION +del I-EXPLORATION +pabellón I-EXPLORATION +auricular I-EXPLORATION +derecho I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +antecedente I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +previa. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +de I-EXPLORATION +1.5 I-EXPLORATION +cm. I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +situada I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +infraparotídeo, I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +central I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +impresiona I-EXPLORATION +de I-EXPLORATION +adenopatía I-EXPLORATION +locoregional. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +En B-TREATMENT +junio I-TREATMENT +del I-TREATMENT +2003 I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +resección I-TREATMENT +parcial I-TREATMENT +del I-TREATMENT +lóbulo I-TREATMENT +superficial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +parótida, I-TREATMENT +un I-TREATMENT +vaciamiento I-TREATMENT +cervical I-TREATMENT +derecho I-TREATMENT +selectivo I-TREATMENT +confinado I-TREATMENT +a I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +3 I-TREATMENT +y I-TREATMENT +extirpación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mitad I-TREATMENT +inferior I-TREATMENT +del I-TREATMENT +pabellón I-TREATMENT +auricular I-TREATMENT +que I-TREATMENT +incluía I-TREATMENT +la I-TREATMENT +recidiva I-TREATMENT +local. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +final I-EXPLORATION +informó I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +basocelular I-EXPLORATION +de I-EXPLORATION +subtipo I-EXPLORATION +infiltrante I-EXPLORATION +que I-EXPLORATION +afectaba I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +parótida I-EXPLORATION +con I-EXPLORATION +márgenes I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +libres. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +del I-EXPLORATION +vaciamiento I-EXPLORATION +cervical, I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +10 I-EXPLORATION +ganglios I-EXPLORATION +cervicales I-EXPLORATION +aislados, I-EXPLORATION +2 I-EXPLORATION +estaban I-EXPLORATION +afectados. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +recidiva I-EXPLORATION +local I-EXPLORATION +del I-EXPLORATION +pabellón I-EXPLORATION +auricular I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +epitelioma I-EXPLORATION +basocelular I-EXPLORATION +infiltrante I-EXPLORATION +con I-EXPLORATION +márgenes I-EXPLORATION +libres. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +remitida I-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +complementario I-TREATMENT +con I-TREATMENT +radioterapia, I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +negó. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +publicación I-EVOLUTION +no I-EVOLUTION +existe I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +recurrencia I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +sigue I-EVOLUTION +viva. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +artritis I-PAST_MEDICAL_HISTORY +reumatoide I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +corticoides I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +tumefacción I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +largo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +2º I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +3er. I-PRESENT_ILLNESS +radios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +punción I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +aguja I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +palma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +trayecto I-EXPLORATION +flexor I-EXPLORATION +del I-EXPLORATION +2º I-EXPLORATION +y I-EXPLORATION +3er. I-EXPLORATION +radios I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +actitud I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dedos I-EXPLORATION +en I-EXPLORATION +hiperextensión, I-EXPLORATION +por I-EXPLORATION +probable I-EXPLORATION +rotura I-EXPLORATION +tendinosa. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +ecográficos I-EXPLORATION +revelaron I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +hipoecogénica I-EXPLORATION +rodeando I-EXPLORATION +los I-EXPLORATION +tendones I-EXPLORATION +flexores I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +del I-EXPLORATION +2º I-EXPLORATION +y I-EXPLORATION +3er. I-EXPLORATION +radio I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +metacarpofalángica I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +distal, I-EXPLORATION +una I-EXPLORATION +desestructuración I-EXPLORATION +del I-EXPLORATION +flexor I-EXPLORATION +profundo I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +sinovial I-EXPLORATION +engrosada I-EXPLORATION +hipervascularizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +doppler I-EXPLORATION +color. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +drenaje I-TREATMENT +abierto I-TREATMENT +de I-TREATMENT +gran I-TREATMENT +cantidad I-TREATMENT +de I-TREATMENT +pus I-TREATMENT +mediante I-TREATMENT +incisiones I-TREATMENT +volares I-TREATMENT +tipo I-TREATMENT +Brunner. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +cuyo I-PRESENT_ILLNESS +aspecto I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +muestra I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Figura I-PRESENT_ILLNESS +1; I-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +dermatológicas, I-PRESENT_ILLNESS +marcado I-PRESENT_ILLNESS +plexo I-PRESENT_ILLNESS +venoso I-PRESENT_ILLNESS +subdérmico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +asimetría I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +físicas, I-PRESENT_ILLNESS +psíquicas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dificultades I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +vestirse I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +ejercicios I-PRESENT_ILLNESS +físicos, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +hacían I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +situación I-PRESENT_ILLNESS +insostenible I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +desarrollo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +cotidiana. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-EXPLORATION +practicó I-EXPLORATION +examen I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +biopsia I-EXPLORATION +obtenida I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +aspiración, I-EXPLORATION +encontrando I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +mamaria I-EXPLORATION +tisular I-EXPLORATION +tanto I-EXPLORATION +del I-EXPLORATION +estroma I-EXPLORATION +como I-EXPLORATION +del I-EXPLORATION +epitelio, I-EXPLORATION +con I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +diferenciarla I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +patrones I-EXPLORATION +de I-EXPLORATION +fibroadenoma I-EXPLORATION +filoides I-EXPLORATION +Las B-TREATMENT +propuestas I-TREATMENT +terapéuticas I-TREATMENT +hormonales I-TREATMENT +se I-TREATMENT +excluyeron, I-TREATMENT +como I-TREATMENT +ya I-TREATMENT +hemos I-TREATMENT +explicado, I-TREATMENT +por I-TREATMENT +sus I-TREATMENT +posibles I-TREATMENT +efectos I-TREATMENT +secundarios. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +realizado I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +una I-TREATMENT +mamoplastia I-TREATMENT +reductora I-TREATMENT +siguiendo I-TREATMENT +el I-TREATMENT +patrón I-TREATMENT +de I-TREATMENT +Wise I-TREATMENT +en I-TREATMENT +el I-TREATMENT +marcaje I-TREATMENT +dérmico; I-TREATMENT +tallamos I-TREATMENT +un I-TREATMENT +amplio I-TREATMENT +colgajo I-TREATMENT +horizontal I-TREATMENT +bipediculado I-TREATMENT +cuya I-TREATMENT +desepidermización I-TREATMENT +se I-TREATMENT +aprovechó I-TREATMENT +para I-TREATMENT +disminuir I-TREATMENT +el I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +las I-TREATMENT +areolas, I-TREATMENT +que I-TREATMENT +trasladamos I-TREATMENT +a I-TREATMENT +su I-TREATMENT +nueva I-TREATMENT +ubicación I-TREATMENT +conservando I-TREATMENT +la I-TREATMENT +sensibilidad I-TREATMENT +y I-TREATMENT +evitando I-TREATMENT +así I-TREATMENT +el I-TREATMENT +injerto I-TREATMENT +libre I-TREATMENT +tipo I-TREATMENT +Thoreck. I-TREATMENT + I-TREATMENT +Empleamos I-TREATMENT +el I-TREATMENT +material I-TREATMENT +autólogo I-TREATMENT +de I-TREATMENT +los I-TREATMENT +colgajos I-TREATMENT +a I-TREATMENT +modo I-TREATMENT +de I-TREATMENT +relleno, I-TREATMENT +evitando I-TREATMENT +de I-TREATMENT +esta I-TREATMENT +manera I-TREATMENT +también I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +prótesis. I-TREATMENT + I-TREATMENT +La I-TREATMENT +resección I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mama I-TREATMENT +derecha I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +1.050 I-TREATMENT +gr. I-TREATMENT +de I-TREATMENT +peso I-TREATMENT +y I-TREATMENT +en I-TREATMENT +la I-TREATMENT +izquierda I-TREATMENT +llegó I-TREATMENT +a I-TREATMENT +los I-TREATMENT +1.800 I-TREATMENT +gr. I-TREATMENT + I-TREATMENT +Colocamos I-TREATMENT +drenajes I-TREATMENT +en I-TREATMENT +ambas I-TREATMENT +mamas I-TREATMENT +que I-TREATMENT +fueron I-TREATMENT +retirados I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48h. I-TREATMENT +y B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +evolución, I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +mismo I-EVOLUTION +diagnóstico I-EVOLUTION +anatomopatológico I-EVOLUTION +de I-EVOLUTION +hipertrofia I-EVOLUTION +con I-EVOLUTION +patrón I-EVOLUTION +proliferativo I-EVOLUTION +del I-EVOLUTION +estroma I-EVOLUTION +y I-EVOLUTION +epitelio I-EVOLUTION +a I-EVOLUTION +modo I-EVOLUTION +de I-EVOLUTION +fibroadenoma I-EVOLUTION +filoides. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +aspecto I-EVOLUTION +del I-EVOLUTION +resultado I-EVOLUTION +reciente, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +pocos I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +podemos I-EVOLUTION +verlo I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +Figuras I-EVOLUTION +3: I-EVOLUTION +en I-EVOLUTION +él I-EVOLUTION +se I-EVOLUTION +aprecian I-EVOLUTION +unas I-EVOLUTION +mamas I-EVOLUTION +voluminosas I-EVOLUTION +aun I-EVOLUTION +para I-EVOLUTION +el I-EVOLUTION +tamaño I-EVOLUTION +y I-EVOLUTION +edad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +diferencia I-EVOLUTION +notable I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +situación I-EVOLUTION +previa. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +resultado I-EVOLUTION +más I-EVOLUTION +tardío, I-EVOLUTION +ya I-EVOLUTION +con I-EVOLUTION +17 I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +edad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente, I-EVOLUTION +presenta I-EVOLUTION +un I-EVOLUTION +tamaño I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +forma I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +mamas I-EVOLUTION +más I-EVOLUTION +proporcionados I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +edad I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +circunstancias I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente; I-EVOLUTION +ha I-EVOLUTION +mejorado I-EVOLUTION +el I-EVOLUTION +aspecto I-EVOLUTION +dérmico I-EVOLUTION +y I-EVOLUTION +vascular I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +mamas I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +habido I-EVOLUTION +recurrencia I-EVOLUTION +del I-EVOLUTION +cuadro, I-EVOLUTION +mantiene I-EVOLUTION +la I-EVOLUTION +sensibilidad I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +complejos I-EVOLUTION +areolares, I-EVOLUTION +las I-EVOLUTION +cicatrices I-EVOLUTION +son I-EVOLUTION +muy I-EVOLUTION +aceptables I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +discreción I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +satisfacción I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +le I-EVOLUTION +lleva I-EVOLUTION +a I-EVOLUTION +rechazar I-EVOLUTION +cualquier I-EVOLUTION +retoque I-EVOLUTION +de I-EVOLUTION +mejora. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +35 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +abuso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +patología I-PAST_MEDICAL_HISTORY +asociada. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cirugía I-PRESENT_ILLNESS +Plástica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Reparadora I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Carlos I-PRESENT_ILLNESS +Haya I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Málaga I-PRESENT_ILLNESS +(España) I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +masas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hombros, I-PRESENT_ILLNESS +mamas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +flancos I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +habían I-PRESENT_ILLNESS +aumentado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rápida I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +medio, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +dificultaban I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +movilidad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +tanto I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +actividad I-PRESENT_ILLNESS +laboral. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +reveló I-EXPLORATION +masas I-EXPLORATION +no I-EXPLORATION +dolorosas I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +blanda, I-EXPLORATION +sin I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +definidos, I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +hombros, I-EXPLORATION +mamas, I-EXPLORATION +fosas I-EXPLORATION +lumbares I-EXPLORATION +y I-EXPLORATION +flancos I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +cervical I-EXPLORATION +(Collar I-EXPLORATION +de I-EXPLORATION +Madelung). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +mediante I-EXPLORATION +secuencias I-EXPLORATION +axiales I-EXPLORATION +de I-EXPLORATION +Tomografía I-EXPLORATION +Axial I-EXPLORATION +Computerizada I-EXPLORATION +(TAC) I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +un I-EXPLORATION +exceso I-EXPLORATION +de I-EXPLORATION +depósito I-EXPLORATION +graso I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +homogénea I-EXPLORATION +no I-EXPLORATION +encapsulada I-EXPLORATION +(difusa) I-EXPLORATION +sobre I-EXPLORATION +los I-EXPLORATION +hombros, I-EXPLORATION +mamas I-EXPLORATION +y I-EXPLORATION +cintura I-EXPLORATION +abdominal, I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +estructuras I-EXPLORATION +profundas. I-EXPLORATION +Asimismo, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +depósitos I-EXPLORATION +grasos I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +mesentérica I-EXPLORATION +o I-EXPLORATION +mediastínica, I-EXPLORATION +ni I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cervical I-EXPLORATION +anterior I-EXPLORATION +o I-EXPLORATION +posterior. I-EXPLORATION +Dado I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +había I-EXPLORATION +sido I-EXPLORATION +intervenido I-EXPLORATION +de I-EXPLORATION +hernia I-EXPLORATION +inguinal I-EXPLORATION +y I-EXPLORATION +eventración I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +Resonancia I-EXPLORATION +Magnética I-EXPLORATION +Nuclear I-EXPLORATION +(RMN) I-EXPLORATION +abdominal I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +integridad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +cortes I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +planos I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +con I-EXPLORATION +secuencias I-EXPLORATION +potenciadas I-EXPLORATION +en I-EXPLORATION +SE I-EXPLORATION +T1, I-EXPLORATION +TSE I-EXPLORATION +T2 I-EXPLORATION +y I-EXPLORATION +Stir, I-EXPLORATION +visualizándose I-EXPLORATION +una I-EXPLORATION +correcta I-EXPLORATION +disposición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +abdominal, I-EXPLORATION +un I-EXPLORATION +importante I-EXPLORATION +aumento I-EXPLORATION +difuso I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +adiposo I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +grasa I-EXPLORATION +intrabdominal. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +depósitos I-EXPLORATION +grasos I-EXPLORATION +no I-EXPLORATION +encapsulados I-EXPLORATION +con I-EXPLORATION +adipocitos I-EXPLORATION +no I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +completar I-EXPLORATION +estos I-EXPLORATION +datos I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +anamnesis I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +Enfermedad I-EXPLORATION +de I-EXPLORATION +Madelung I-EXPLORATION +o I-EXPLORATION +Lipomatosis I-EXPLORATION +Simétrica I-EXPLORATION +Benigna I-EXPLORATION +tipo I-EXPLORATION +II. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +propuesto I-TREATMENT +fue I-TREATMENT +la I-TREATMENT +liposucción I-TREATMENT +de I-TREATMENT +los I-TREATMENT +cúmulos I-TREATMENT +grasos I-TREATMENT +localizados I-TREATMENT +en I-TREATMENT +abdomen, I-TREATMENT +área I-TREATMENT +lumbar I-TREATMENT +y I-TREATMENT +hombros I-TREATMENT +y I-TREATMENT +la I-TREATMENT +dermolipectomía I-TREATMENT +en I-TREATMENT +ambas I-TREATMENT +mamas. I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +rehusó I-TREATMENT +ambos I-TREATMENT +procedimientos, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +le I-TREATMENT +aconsejó I-TREATMENT +entonces I-TREATMENT +la I-TREATMENT +pérdida I-TREATMENT +de I-TREATMENT +peso I-TREATMENT +y I-TREATMENT +la I-TREATMENT +abstinencia I-TREATMENT +alcohólica, I-TREATMENT +aún I-TREATMENT +conociendo I-TREATMENT +sus I-TREATMENT +limitados I-TREATMENT +beneficios. I-TREATMENT + I-TREATMENT + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +hospitalario I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +pérdida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +sustancia I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +dorso I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +mano I-DERIVED_FROM/TO +izquierda I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +sufrir I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +accidente I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tráfico. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +pérdida I-EXPLORATION +cutánea I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +muy I-EXPLORATION +contundidos I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +sobrepasaba I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +metacarpofalangica I-EXPLORATION +del I-EXPLORATION +2º I-EXPLORATION +dedo. I-EXPLORATION +Asimismo, I-EXPLORATION +encontramos I-EXPLORATION +una I-EXPLORATION +exposición I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tendones I-EXPLORATION +extensores I-EXPLORATION +del I-EXPLORATION +2º I-EXPLORATION +y I-EXPLORATION +3º I-EXPLORATION +dedos I-EXPLORATION +con I-EXPLORATION +ruptura I-EXPLORATION +del I-EXPLORATION +extensor I-EXPLORATION +del I-EXPLORATION +2º, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +exposición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +interósea I-EXPLORATION +dorsal I-EXPLORATION +de I-EXPLORATION +1º I-EXPLORATION +y I-EXPLORATION +2º I-EXPLORATION +dedos. I-EXPLORATION +No I-EXPLORATION +había I-EXPLORATION +déficit I-EXPLORATION +neurovascular I-EXPLORATION +ni I-EXPLORATION +fracturas I-EXPLORATION +asociadas. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +una I-TREATMENT +primera I-TREATMENT +cura I-TREATMENT +realizada I-TREATMENT +a I-TREATMENT +su I-TREATMENT +ingreso, I-TREATMENT +con I-TREATMENT +retirada I-TREATMENT +de I-TREATMENT +tejidos I-TREATMENT +desvitalizados I-TREATMENT +y I-TREATMENT +reparación I-TREATMENT +del I-TREATMENT +tendón I-TREATMENT +extensor I-TREATMENT +del I-TREATMENT +2º I-TREATMENT +dedo, I-TREATMENT +nos I-TREATMENT +planteamos I-TREATMENT +cómo I-TREATMENT +realizar I-TREATMENT +la I-TREATMENT +cobertura I-TREATMENT +del I-TREATMENT +defecto, I-TREATMENT +optando I-TREATMENT +por I-TREATMENT +una I-TREATMENT +reconstrucción I-TREATMENT +mediante I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +interóseo I-TREATMENT +posterior I-TREATMENT +de I-TREATMENT +transferencia I-TREATMENT +libre. I-TREATMENT +Los I-TREATMENT +motivos I-TREATMENT +de I-TREATMENT +esta I-TREATMENT +elección I-TREATMENT +los I-TREATMENT +presentamos I-TREATMENT +en I-TREATMENT +el I-TREATMENT +apartado I-TREATMENT +de I-TREATMENT +Discusión. I-TREATMENT + I-TREATMENT + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +fumadora, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mielomelingocele I-PAST_MEDICAL_HISTORY +congénito I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +paraplejia I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +nefrostomía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +operada I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +úlcera I-PAST_MEDICAL_HISTORY +sacra, I-PAST_MEDICAL_HISTORY +realizándose I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +colgajo I-PAST_MEDICAL_HISTORY +glúteo. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +ninguna I-PAST_MEDICAL_HISTORY +recidiva I-PAST_MEDICAL_HISTORY +debido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +higiene I-PAST_MEDICAL_HISTORY +postural I-PAST_MEDICAL_HISTORY +domiciliaria. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Seis B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +acudir I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Servicio, I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fémur, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tuvo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +portar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +férula I-PRESENT_ILLNESS +pelvi-pédica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +yeso. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +imposibilidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +movilización I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cambios I-PRESENT_ILLNESS +posturales I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +realizaba I-PRESENT_ILLNESS +habitualmente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +domicilio, I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +ocasionaron I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +úlcera I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +sacra, I-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +remitida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +valoración. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +en I-EXPLORATION +ese I-EXPLORATION +momento I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +úlcera I-EXPLORATION +isquiotroncantéreo-sacra I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +20 I-EXPLORATION +x I-EXPLORATION +25 I-EXPLORATION +cm, I-EXPLORATION +con I-EXPLORATION +trayecto I-EXPLORATION +fistuloso I-EXPLORATION +hacia I-EXPLORATION +pala I-EXPLORATION +iliaca I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +algunas I-EXPLORATION +zonas I-EXPLORATION +profundizaba I-EXPLORATION +hasta I-EXPLORATION +plano I-EXPLORATION +óseo I-EXPLORATION +con I-EXPLORATION +exposición I-EXPLORATION +del I-EXPLORATION +sacro. I-EXPLORATION +Se B-EVOLUTION +recomendó I-EVOLUTION +ingreso I-EVOLUTION +hospitalario I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +rechazó I-EVOLUTION +por I-EVOLUTION +motivos I-EVOLUTION +personales, I-EVOLUTION +acudiendo I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +3 I-EVOLUTION +semanas, I-EVOLUTION +momento I-EVOLUTION +en I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +úlcera I-EVOLUTION +medía I-EVOLUTION +ya I-EVOLUTION +24 I-EVOLUTION +x I-EVOLUTION +30 I-EVOLUTION +cm. I-EVOLUTION + I-EVOLUTION +Durante B-TREATMENT +el I-TREATMENT +ingreso I-TREATMENT +y I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +gran I-TREATMENT +úlcera I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +colostomía. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +tenía I-EVOLUTION +un I-EVOLUTION +mal I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +con I-EVOLUTION +alteraciones I-EVOLUTION +analíticas I-EVOLUTION +importantes I-EVOLUTION +tanto I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +hematocrito I-EVOLUTION +como I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +de I-EVOLUTION +proteínas I-EVOLUTION +totales, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +tuvo I-EVOLUTION +que I-EVOLUTION +iniciar I-EVOLUTION +nutrición I-EVOLUTION +parenteral I-EVOLUTION +para I-EVOLUTION +remontar I-EVOLUTION +su I-EVOLUTION +estado I-EVOLUTION +general. I-EVOLUTION + I-EVOLUTION +Para B-TREATMENT +cerrar I-TREATMENT +el I-TREATMENT +gran I-TREATMENT +defecto I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +fue I-TREATMENT +intervenida I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +póstero-medial I-TREATMENT +de I-TREATMENT +muslo, I-TREATMENT +para I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +procedimos I-TREATMENT +a I-TREATMENT +desbridar I-TREATMENT +la I-TREATMENT +úlcera I-TREATMENT +y I-TREATMENT +cubrirla I-TREATMENT +posteriormente I-TREATMENT +mediante I-TREATMENT +el I-TREATMENT +colgajo I-TREATMENT +anteriormente I-TREATMENT +descrito I-TREATMENT +como I-TREATMENT +alternativa I-TREATMENT +a I-TREATMENT +la I-TREATMENT +desarticulación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cadera. I-TREATMENT + I-TREATMENT +La I-TREATMENT +intervención I-TREATMENT +duró I-TREATMENT +unas I-TREATMENT +5 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +se I-TREATMENT +desarrolló I-TREATMENT +sin I-TREATMENT +contratiempos. I-TREATMENT +La I-TREATMENT +zona I-TREATMENT +donante I-TREATMENT +del I-TREATMENT +colgajo I-TREATMENT +se I-TREATMENT +cerró I-TREATMENT +directamente I-TREATMENT +en I-TREATMENT +su I-TREATMENT +mayor I-TREATMENT +parte, I-TREATMENT +teniendo I-TREATMENT +que I-TREATMENT +cubrir I-TREATMENT +solo I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +distal I-TREATMENT +con I-TREATMENT +un I-TREATMENT +injerto I-TREATMENT +de I-TREATMENT +piel I-TREATMENT +parcial I-TREATMENT +tomado I-TREATMENT +del I-TREATMENT +muslo I-TREATMENT +contralateral. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +2 I-EVOLUTION +días I-EVOLUTION +para I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +situación I-EVOLUTION +metabólica, I-EVOLUTION +tras I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +trasladada I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +a I-EVOLUTION +planta I-EVOLUTION +hospitalaria. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días, I-EVOLUTION +el I-EVOLUTION +colgajo I-EVOLUTION +presentaba I-EVOLUTION +buen I-EVOLUTION +estado, I-EVOLUTION +con I-EVOLUTION +adecuado I-EVOLUTION +relleno I-EVOLUTION +capilar. I-EVOLUTION +A I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +ello, I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +empezó I-EVOLUTION +a I-EVOLUTION +deteriorarse. I-EVOLUTION +Comenzó I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +insuficiencia I-EVOLUTION +hepato-renal I-EVOLUTION +progresiva I-EVOLUTION +que I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +diagnóstico I-EVOLUTION +exhaustivo I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Medicina I-EVOLUTION +Interna I-EVOLUTION +se I-EVOLUTION +catalogó I-EVOLUTION +como I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +alteraciones I-EVOLUTION +biliopancreáticas I-EVOLUTION +derivadas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +nutrición I-EVOLUTION +parenteral. I-EVOLUTION +Tras B-TREATMENT +valoración I-TREATMENT +por I-TREATMENT +el I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Nefrología, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +diálisis, I-TREATMENT +que I-TREATMENT +mejoró I-TREATMENT +las I-TREATMENT +cifras I-TREATMENT +de I-TREATMENT +creatinina I-TREATMENT +aunque I-TREATMENT +se I-TREATMENT +manifestó I-TREATMENT +una I-TREATMENT +hipoproteinemia I-TREATMENT +severa I-TREATMENT +que I-TREATMENT +no I-TREATMENT +se I-TREATMENT +consiguió I-TREATMENT +remontar. I-TREATMENT +A B-EVOLUTION +la I-EVOLUTION +cuarta I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +postoperatorio, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +fiebre I-EVOLUTION +alta I-EVOLUTION +de I-EVOLUTION +origen I-EVOLUTION +desconocido I-EVOLUTION +que I-EVOLUTION +evolucionó I-EVOLUTION +a I-EVOLUTION +sepsis I-EVOLUTION +y I-EVOLUTION +fracaso I-EVOLUTION +multiorgánico I-EVOLUTION +que I-EVOLUTION +provocaron I-EVOLUTION +el I-EVOLUTION +fallecimiento. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +tumoral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aspecto I-PRESENT_ILLNESS +esclerodermiforme I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +central I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +párpado I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +deja I-PRESENT_ILLNESS +libre I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +borde I-PRESENT_ILLNESS +palpebral. I-PRESENT_ILLNESS +Bajo B-TREATMENT +anestesia I-TREATMENT +local I-TREATMENT +y I-TREATMENT +sedación I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +exéresis I-TREATMENT +amplia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +cutánea I-TREATMENT +respetando I-TREATMENT +la I-TREATMENT +lamela I-TREATMENT +interna I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +mediante I-TREATMENT +colgajo I-TREATMENT +miocutáneo I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +orbicular I-TREATMENT +en I-TREATMENT +isla I-TREATMENT +con I-TREATMENT +unas I-TREATMENT +dimensiones I-TREATMENT +de I-TREATMENT +25 I-TREATMENT +x I-TREATMENT +17 I-TREATMENT +mm. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +basocelular. I-EXPLORATION +En B-EVOLUTION +las I-EVOLUTION +Fig. I-EVOLUTION +4 I-EVOLUTION +y I-EVOLUTION +5 I-EVOLUTION +presentamos I-EVOLUTION +el I-EVOLUTION +resultado I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Diez B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +indolora I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuarto I-PRESENT_ILLNESS +dedo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +dio I-PRESENT_ILLNESS +lugar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +déficit I-PRESENT_ILLNESS +funcional, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +imposibilidad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +flexoextensión I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dedo I-PRESENT_ILLNESS +afectado. I-PRESENT_ILLNESS +El B-EXPLORATION +estudio I-EXPLORATION +radiográfico I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +definición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cortical I-EXPLORATION +anterior I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +proximal I-EXPLORATION +del I-EXPLORATION +cuarto I-EXPLORATION +dedo, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +presentar I-EXPLORATION +una I-EXPLORATION +incipiente I-EXPLORATION +calcificación I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +distalmente I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +palmar I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +vio I-EXPLORATION +lesión I-EXPLORATION +intramedular. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +biopsia I-EXPLORATION +incisional, I-EXPLORATION +cuyo I-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +periostitis I-EXPLORATION +reactiva I-EXPLORATION +florida. I-EXPLORATION + I-EXPLORATION +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +comprobó I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +existencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +masa I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +falange I-DERIVED_FROM/TO +proximal I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +cuarto I-DERIVED_FROM/TO +dedo I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +inflamación I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +tumefacción. I-DERIVED_FROM/TO +No B-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +signos I-EXPLORATION +locorregionales I-EXPLORATION +de I-EXPLORATION +infección. I-EXPLORATION +La I-EXPLORATION +movilidad I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +articulaciones I-EXPLORATION +del I-EXPLORATION +dedo I-EXPLORATION +estaba I-EXPLORATION +afectada, I-EXPLORATION +existiendo I-EXPLORATION +una I-EXPLORATION +impotencia I-EXPLORATION +funcional I-EXPLORATION +absoluta. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +refería I-EXPLORATION +dolor I-EXPLORATION +con I-EXPLORATION +parestesias I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +territorio I-EXPLORATION +del I-EXPLORATION +nervio I-EXPLORATION +colateral I-EXPLORATION +cubital. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +radiográfico I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +estadio I-EXPLORATION +evolutivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +primer I-EXPLORATION +estudio, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +calcificación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +palmar I-EXPLORATION +de I-EXPLORATION +falange I-EXPLORATION +proximal I-EXPLORATION +se I-EXPLORATION +había I-EXPLORATION +hecho I-EXPLORATION +más I-EXPLORATION +ostensible, I-EXPLORATION +extendiéndose I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange. I-EXPLORATION +Aparecía I-EXPLORATION +una I-EXPLORATION +clara I-EXPLORATION +reacción I-EXPLORATION +perióstica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +conectar I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +calcificación I-EXPLORATION +pero I-EXPLORATION +que I-EXPLORATION +además, I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +al I-EXPLORATION +lado I-EXPLORATION +opuesto. I-EXPLORATION +Es I-EXPLORATION +interesante I-EXPLORATION +señalar I-EXPLORATION +también I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +reacción I-EXPLORATION +perióstica I-EXPLORATION +sólida I-EXPLORATION +de I-EXPLORATION +borde I-EXPLORATION +irregular I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +radiográfico I-EXPLORATION +preoperatorio I-EXPLORATION +la I-EXPLORATION +calcificación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +se I-EXPLORATION +volvió I-EXPLORATION +más I-EXPLORATION +definida I-EXPLORATION +y I-EXPLORATION +grande, I-EXPLORATION +abarcando I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +mediante I-EXPLORATION +Resonancia I-EXPLORATION +Magnética I-EXPLORATION +(RM) I-EXPLORATION +permitió I-EXPLORATION +apreciar I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +que I-EXPLORATION +englobaba I-EXPLORATION +los I-EXPLORATION +tendones I-EXPLORATION +flexores I-EXPLORATION +y I-EXPLORATION +contactaba I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +periostio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +proximal. I-EXPLORATION +Era I-EXPLORATION +hipointensa I-EXPLORATION +en I-EXPLORATION +T1, I-EXPLORATION +hiperintensa I-EXPLORATION +en I-EXPLORATION +T2 I-EXPLORATION +y I-EXPLORATION +realzaba I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +homogénea I-EXPLORATION +con I-EXPLORATION +Gadolinio. I-EXPLORATION +En I-EXPLORATION +su I-EXPLORATION +margen I-EXPLORATION +palmar I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +reborde I-EXPLORATION +hipointenso I-EXPLORATION +que I-EXPLORATION +pudiera I-EXPLORATION +representar I-EXPLORATION +calcificación. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +vacíos I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +internos, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +calcificación I-EXPLORATION +debería I-EXPLORATION +ir I-EXPLORATION +unido I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +matriz I-EXPLORATION +celular I-EXPLORATION +(lo I-EXPLORATION +que I-EXPLORATION +sugiere I-EXPLORATION +tumor I-EXPLORATION +o I-EXPLORATION +psedotumor). I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +márgenes I-EXPLORATION +laterales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +levantamientos I-EXPLORATION +periostios, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +componente I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +que I-EXPLORATION +desplazaba I-EXPLORATION +al I-EXPLORATION +tendón I-EXPLORATION +extensor. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +cortes I-EXPLORATION +sagitales I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +medular I-EXPLORATION +ósea I-EXPLORATION +estaba I-EXPLORATION +respetada I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +cortical I-EXPLORATION +anterior I-EXPLORATION +no I-EXPLORATION +estaba I-EXPLORATION +infiltrada I-EXPLORATION +pero I-EXPLORATION +si I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +ligero I-EXPLORATION +festoneado I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +superficie I-EXPLORATION +externa. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +lesión I-TREATMENT +fue I-TREATMENT +extirpada I-TREATMENT +realizando I-TREATMENT +una I-TREATMENT +amputación I-TREATMENT +estética I-TREATMENT +del I-TREATMENT +4º I-TREATMENT +radio I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mano I-TREATMENT +derecha I-TREATMENT +por I-TREATMENT +el I-TREATMENT +déficit I-TREATMENT +funcional I-TREATMENT +del I-TREATMENT +dedo. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +de I-EXPLORATION +amputación I-EXPLORATION +señaló I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +tendón I-EXPLORATION +flexor I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +falange, I-EXPLORATION +de I-EXPLORATION +hueso I-EXPLORATION +maduro I-EXPLORATION +con I-EXPLORATION +intensos I-EXPLORATION +fenómenos I-EXPLORATION +de I-EXPLORATION +remodelación. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +centro I-EXPLORATION +del I-EXPLORATION +mencionado I-EXPLORATION +hueso I-EXPLORATION +existía I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +fibroblástica I-EXPLORATION +con I-EXPLORATION +casi I-EXPLORATION +total I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +mitosis, I-EXPLORATION +que I-EXPLORATION +diferenciaba I-EXPLORATION +pequeñas I-EXPLORATION +cantidades I-EXPLORATION +de I-EXPLORATION +osteoide. I-EXPLORATION +Al I-EXPLORATION +comparar I-EXPLORATION +esta I-EXPLORATION +biopsia I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +previa I-EXPLORATION +o I-EXPLORATION +diagnóstica, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +mayor I-EXPLORATION +celularidad, I-EXPLORATION +con I-EXPLORATION +discreta I-EXPLORATION +atipia I-EXPLORATION +celular I-EXPLORATION +y I-EXPLORATION +mayor I-EXPLORATION +actividad I-EXPLORATION +mitótica. I-EXPLORATION + B-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +satisfactoria I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +recidivado I-EVOLUTION +tras I-EVOLUTION +8 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +conservando I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +función I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mano. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +basocelular I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +canto I-PRESENT_ILLNESS +interno I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +La B-TREATMENT +resección I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +con I-TREATMENT +margen I-TREATMENT +sano I-TREATMENT +de I-TREATMENT +0.5 I-TREATMENT +cm I-TREATMENT +también I-TREATMENT +confirmado I-TREATMENT +mediante I-TREATMENT +biopsia I-TREATMENT +por I-TREATMENT +congelación. I-TREATMENT +Cobertura I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +con I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +descrita. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tumor I-PRESENT_ILLNESS +parietal I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +costillas I-PRESENT_ILLNESS +cuarta, I-PRESENT_ILLNESS +quinta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sexta, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +línea I-PRESENT_ILLNESS +media I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hemitórax I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +margen I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +esternón I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +recidiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mama, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mastectomía I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +El B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Realizamos B-TREATMENT +resección I-TREATMENT +de I-TREATMENT +las I-TREATMENT +costillas I-TREATMENT +afectadas I-TREATMENT +con I-TREATMENT +margen I-TREATMENT +de I-TREATMENT +seguridad I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +cm. I-TREATMENT +Realizamos I-TREATMENT +la I-TREATMENT +restitución I-TREATMENT +parietal I-TREATMENT +con I-TREATMENT +una I-TREATMENT +membrana I-TREATMENT +de I-TREATMENT +Gore-tex® I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +repusieron I-TREATMENT +dos I-TREATMENT +arcos I-TREATMENT +costales I-TREATMENT +realizados I-TREATMENT +son I-TREATMENT +tubos I-TREATMENT +de I-TREATMENT +Gore-tex® I-TREATMENT +rellenos I-TREATMENT +de I-TREATMENT +Craneoplastic® I-TREATMENT +para I-TREATMENT +reconstrucción I-TREATMENT +costal. I-TREATMENT +Finalmente I-TREATMENT +efectuamos I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +con I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +músculo I-TREATMENT +recto I-TREATMENT +abdominal I-TREATMENT +pediculado, I-TREATMENT +contralateral. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +Permanece I-EVOLUTION +asintomática I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +después, I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +64 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +intervenida B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +centro I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sarcoma I-PAST_MEDICAL_HISTORY +esternal; I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +esternectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +reconstrucción I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +placa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +metacrilato I-PAST_MEDICAL_HISTORY +colocada I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +arcos I-PAST_MEDICAL_HISTORY +costales I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +sutura I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +labrar I-PAST_MEDICAL_HISTORY +orificios I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +bordes. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +intermitente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +La B-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TAC) I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +líquido I-EXPLORATION +bajo I-EXPLORATION +la I-EXPLORATION +placa I-EXPLORATION +de I-EXPLORATION +metacrilato, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +empiema. I-EXPLORATION + I-EXPLORATION +Decidimos B-TREATMENT +intervenir I-TREATMENT +y I-TREATMENT +retirar I-TREATMENT +la I-TREATMENT +placa I-TREATMENT +de I-TREATMENT +material I-TREATMENT +aloplástico. I-TREATMENT +Bajo I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +encontramos I-TREATMENT +abundante I-TREATMENT +material I-TREATMENT +purulento, I-TREATMENT +en I-TREATMENT +cuyo I-TREATMENT +cultivo I-TREATMENT +se I-TREATMENT +aisló I-TREATMENT +un I-TREATMENT +microorganismo I-TREATMENT +anaerobio. I-TREATMENT +La I-TREATMENT +reconstrucción I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +epiplon I-TREATMENT +basado I-TREATMENT +en I-TREATMENT +los I-TREATMENT +vasos I-TREATMENT +gastroepiploicos I-TREATMENT +derecho I-TREATMENT +e I-TREATMENT +izquierdo I-TREATMENT +cubierto I-TREATMENT +con I-TREATMENT +un I-TREATMENT +injerto I-TREATMENT +de I-TREATMENT +piel I-TREATMENT +mallada. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +sin I-EVOLUTION +incidencias I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION +No I-EVOLUTION +hubo I-EVOLUTION +recidiva I-EVOLUTION +tumoral I-EVOLUTION +local I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +biopsias I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +bordes I-EVOLUTION +fueron I-EVOLUTION +negativas. I-EVOLUTION +Las I-EVOLUTION +revisiones I-EVOLUTION +son I-EVOLUTION +satisfactorias I-EVOLUTION +desde I-EVOLUTION +entonces, I-EVOLUTION +cumpliendo I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +redactar I-EVOLUTION +este I-EVOLUTION +trabajo. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +basocelular I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ceja I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +defecto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7x5 I-PRESENT_ILLNESS +cm. I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +resección I-PRESENT_ILLNESS +tumoral. I-PRESENT_ILLNESS +Realizamos B-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +en I-TREATMENT +isla I-TREATMENT +de I-TREATMENT +arteria I-TREATMENT +temporal I-TREATMENT +para I-TREATMENT +reconstrucción I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ceja I-TREATMENT +con I-TREATMENT +piel I-TREATMENT +con I-TREATMENT +pelo. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +depilación I-TREATMENT +con I-TREATMENT +láser I-TREATMENT +para I-TREATMENT +lograr I-TREATMENT +simetría I-TREATMENT +con I-TREATMENT +la I-TREATMENT +ceja I-TREATMENT +contralateral. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +abierta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tibia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +peroné I-PRESENT_ILLNESS +tratada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +placa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fijador I-PRESENT_ILLNESS +externo, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sustancia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +exposición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +material I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +osteosíntesis. I-PRESENT_ILLNESS +Se B-TREATMENT +practica I-TREATMENT +desbridamiento I-TREATMENT +y I-TREATMENT +limpieza I-TREATMENT +y I-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +sistema I-TREATMENT +Renasys® I-TREATMENT +a-125 I-TREATMENT +mm I-TREATMENT +Hg. I-TREATMENT +Tras B-EVOLUTION +12 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +aplicación, I-EVOLUTION +se I-EVOLUTION +consigue I-EVOLUTION +un I-EVOLUTION +lecho I-EVOLUTION +limpio I-EVOLUTION +con I-EVOLUTION +tejido I-EVOLUTION +de I-EVOLUTION +granulación I-EVOLUTION +sano. I-EVOLUTION +Finalmente B-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +cobertura I-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +anterolateral I-TREATMENT +de I-TREATMENT +muslo. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +afecto B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +leucemia I-PAST_MEDICAL_HISTORY +linfática I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +epidermoide I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo. I-PRESENT_ILLNESS +El B-TREATMENT +tumor I-TREATMENT +infiltra I-TREATMENT +localmente I-TREATMENT +sin I-TREATMENT +llegar I-TREATMENT +a I-TREATMENT +afectar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +duramadre. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +y I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +periostio I-TREATMENT +que I-TREATMENT +se I-TREATMENT +complica I-TREATMENT +con I-TREATMENT +necrosis. I-TREATMENT +Se I-TREATMENT +decide I-TREATMENT +entonces I-TREATMENT +colocar I-TREATMENT +sistema I-TREATMENT +de I-TREATMENT +terapia I-TREATMENT +Renasys® I-TREATMENT +a I-TREATMENT +-50 I-TREATMENT +mm I-TREATMENT +Hg. I-TREATMENT +Tras I-TREATMENT +3 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +observa I-TREATMENT +reducción I-TREATMENT +del I-TREATMENT +diámetro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +y I-TREATMENT +granulación I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +duramadre. I-TREATMENT +Posteriormente, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +cierre I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +con I-TREATMENT +triple I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +Guillis. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cirugía I-PRESENT_ILLNESS +Plástica I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Octubre I-PRESENT_ILLNESS +(Madrid, I-PRESENT_ILLNESS +España) I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +sufrido I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +penectomía I-PRESENT_ILLNESS +subtotal I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +epidermoide I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +precisó I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +oncológico I-PRESENT_ILLNESS +coadyuvante I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +solicita I-PRESENT_ILLNESS +reconstrucción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pene. I-PRESENT_ILLNESS +Tras B-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +historia I-EXPLORATION +clínica, I-EXPLORATION +exploración I-EXPLORATION +y I-EXPLORATION +documentación I-EXPLORATION +fotográfica I-EXPLORATION +pertinentes I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +estudio, I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +demorar I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +hasta I-EXPLORATION +transcurridos I-EXPLORATION +al I-EXPLORATION +menos I-EXPLORATION +6 I-EXPLORATION +meses I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +extirpación I-EXPLORATION +tumoral I-EXPLORATION +para I-EXPLORATION +confirmar I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +recurrencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +local. I-EXPLORATION +Se I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +arcos I-EXPLORATION +vasculares I-EXPLORATION +palmares I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +profundo I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +del I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Allen I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +con I-EXPLORATION +sonda I-EXPLORATION +doppler I-EXPLORATION +de I-EXPLORATION +8Mhz, I-EXPLORATION +que I-EXPLORATION +permiten I-EXPLORATION +la I-EXPLORATION +elección I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +colgajo I-EXPLORATION +libre I-EXPLORATION +radial I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +reconstrucción I-EXPLORATION +peneana, I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +vascular I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +superior I-EXPLORATION +derecho. I-EXPLORATION +El B-TREATMENT +día I-TREATMENT +previo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +intervención, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +cistostomía I-TREATMENT +suprapúbica. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tumoración I-PAST_MEDICAL_HISTORY +(osteosarcoma) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +rodilla I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +Tras B-TREATMENT +recibir I-TREATMENT +múltiples I-TREATMENT +tratamientos I-TREATMENT +de I-TREATMENT +elongación I-TREATMENT +ósea, I-TREATMENT +fue I-TREATMENT +necesario I-TREATMENT +colocar I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +total I-TREATMENT +de I-TREATMENT +rodilla. I-TREATMENT +Debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +múltiples I-TREATMENT +cicatrices, I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +se I-TREATMENT +necrosó I-TREATMENT +y I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +resultó I-TREATMENT +expuesta, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +necesario I-TREATMENT +cubrirla I-TREATMENT +con I-TREATMENT +2 I-TREATMENT +colgajos I-TREATMENT +de I-TREATMENT +gemelos I-TREATMENT +según I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +que I-TREATMENT +hemos I-TREATMENT +descrito. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +queja I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +aspecto I-PRESENT_ILLNESS +inestético I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +labio I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +notar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +social, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pareja. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-FAMILY_HISTORY +historia I-FAMILY_HISTORY +clínica I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +no I-FAMILY_HISTORY +reveló I-FAMILY_HISTORY +la I-FAMILY_HISTORY +existencia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +casos I-FAMILY_HISTORY +semejantes. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Presentaba B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +pronunciado I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +labio I-PRESENT_ILLNESS +superior, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +mucho I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +evidente I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +sonreía, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +retracción I-PRESENT_ILLNESS +central. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +bajo I-TREATMENT +bloqueo I-TREATMENT +anestésico I-TREATMENT +de I-TREATMENT +ambos I-TREATMENT +nervios I-TREATMENT +infraorbitarios. I-TREATMENT +Marcamos I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +azul I-TREATMENT +de I-TREATMENT +metileno I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +de I-TREATMENT +dos I-TREATMENT +elipses I-TREATMENT +tranversas I-TREATMENT +con I-TREATMENT +una I-TREATMENT +"z" I-TREATMENT +central. I-TREATMENT +Resecamos I-TREATMENT +el I-TREATMENT +exceso I-TREATMENT +de I-TREATMENT +tejido I-TREATMENT +mucoso I-TREATMENT +y I-TREATMENT +submucoso I-TREATMENT +labial I-TREATMENT +con I-TREATMENT +excisiones I-TREATMENT +elípticas I-TREATMENT +y I-TREATMENT +la I-TREATMENT +brida I-TREATMENT +central I-TREATMENT +se I-TREATMENT +corrigió I-TREATMENT +con I-TREATMENT +una I-TREATMENT +z-plastia I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +con I-TREATMENT +el I-TREATMENT +marcaje I-TREATMENT +realizado. I-TREATMENT +La I-TREATMENT +cirugía I-TREATMENT +finalizó I-TREATMENT +con I-TREATMENT +el I-TREATMENT +cierre I-TREATMENT +mediante I-TREATMENT +suturas I-TREATMENT +simples I-TREATMENT +con I-TREATMENT +hilo I-TREATMENT +sintético I-TREATMENT +reabsorbible I-TREATMENT +de I-TREATMENT +poliglactin I-TREATMENT +6-0. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +herida I-EVOLUTION +quirúrgica I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +edema I-EVOLUTION +local I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +resolvió I-EVOLUTION +al I-EVOLUTION +final I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +postoperatorio. I-EVOLUTION +Dos I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +en I-EVOLUTION +revisión I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +ambulatoria, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +estaba I-EVOLUTION +plenamente I-EVOLUTION +satisfecha I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +resultado I-EVOLUTION +obtenido, I-EVOLUTION +contando I-EVOLUTION +incluso I-EVOLUTION +que I-EVOLUTION +había I-EVOLUTION +vuelto I-EVOLUTION +a I-EVOLUTION +frecuentar I-EVOLUTION +relaciones I-EVOLUTION +sociales I-EVOLUTION +en I-EVOLUTION +compañía I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +pareja. I-EVOLUTION +Tras I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +no I-EVOLUTION +hay I-EVOLUTION +señales I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +o I-EVOLUTION +complicaciones I-EVOLUTION +tardías. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +pediátrica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +púrpura I-PRESENT_ILLNESS +fulminans I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +meningocóccica I-PRESENT_ILLNESS +grave I-PRESENT_ILLNESS +complicada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fallo I-PRESENT_ILLNESS +multiorgánico, I-PRESENT_ILLNESS +shock I-PRESENT_ILLNESS +séptico, I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pulmón I-PRESENT_ILLNESS +complicado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +neumonía I-PRESENT_ILLNESS +nosocomial I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +requirió I-PRESENT_ILLNESS +soporte I-PRESENT_ILLNESS +ventilatorio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +grave I-PRESENT_ILLNESS +necrosis I-PRESENT_ILLNESS +isquémica I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +CID I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +4 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +ingreso I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cuidados I-DERIVED_FROM/TO +Intensivos I-DERIVED_FROM/TO +(UCI) I-DERIVED_FROM/TO +pediátrica, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +pide I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +cutáneas. I-DERIVED_FROM/TO +Apreciamos B-EXPLORATION +flictenas I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sufrimiento I-EXPLORATION +cutáneo I-EXPLORATION +en I-EXPLORATION +miembro I-EXPLORATION +superior I-EXPLORATION +derecho I-EXPLORATION +(MSD) I-EXPLORATION +y I-EXPLORATION +principalmente, I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +(MMII), I-EXPLORATION +acompañados I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +purpúricas I-EXPLORATION +y I-EXPLORATION +necrosis I-EXPLORATION +irreversibles I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dedos I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +pies. I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +tórpida I-TREATMENT +y I-TREATMENT +la I-TREATMENT +extensión I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +17 I-TREATMENT +días I-TREATMENT +después. I-TREATMENT + I-TREATMENT +Realizamos I-TREATMENT +desbridamiento I-TREATMENT +superficial I-TREATMENT +para I-TREATMENT +demarcar I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +de I-TREATMENT +necrosis I-TREATMENT +profunda I-TREATMENT +y I-TREATMENT +colocamos I-TREATMENT +Biobrane® I-TREATMENT +(Biobrane, I-TREATMENT +Smith I-TREATMENT +& I-TREATMENT +Nephew I-TREATMENT +B.V., I-TREATMENT +Barcelona, I-TREATMENT +España). I-TREATMENT +Las B-EVOLUTION +zonas I-EVOLUTION +intervenidas I-EVOLUTION +se I-EVOLUTION +curaron I-EVOLUTION +con I-EVOLUTION +sulfadiazina I-EVOLUTION +argéntica I-EVOLUTION +antes I-EVOLUTION +y I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION +Ante B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +mala I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +heridas, I-DERIVED_FROM/TO +contactamos I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Traumatología I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +nueva I-DERIVED_FROM/TO +valoración. I-DERIVED_FROM/TO +Se B-EXPLORATION +realizaron I-EXPLORATION +2 I-EXPLORATION +gammagrafías I-EXPLORATION +óseas I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +intervalo I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +días I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +el I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +MMII I-EXPLORATION +y I-EXPLORATION +ambas I-EXPLORATION +informaron I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +óseo I-EXPLORATION +sin I-EXPLORATION +captación I-EXPLORATION +desde I-EXPLORATION +aproximadamente I-EXPLORATION +el I-EXPLORATION +1/3 I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tibia. I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +gangrena I-TREATMENT +establecida, I-TREATMENT +con I-TREATMENT +necrosis I-TREATMENT +irreversible I-TREATMENT +evidente I-TREATMENT +y I-TREATMENT +mal I-TREATMENT +olor, I-TREATMENT +los I-TREATMENT +traumatólogos I-TREATMENT +pediátricos I-TREATMENT +deciden, I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +con I-TREATMENT +la I-TREATMENT +familia, I-TREATMENT +proceder I-TREATMENT +a I-TREATMENT +practicar I-TREATMENT +amputación I-TREATMENT +infrarrotuliana I-TREATMENT +bilateral I-TREATMENT +para I-TREATMENT +conservar I-TREATMENT +la I-TREATMENT +máxima I-TREATMENT +movilidad I-TREATMENT +ulterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +diferido I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +vascular I-EXPLORATION +múltiple I-EXPLORATION +y I-EXPLORATION +necrosis I-EXPLORATION +abscesificante I-EXPLORATION +en I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +tejidos I-EXPLORATION +blandos. I-EXPLORATION + I-EXPLORATION +Durante B-EVOLUTION +el I-EVOLUTION +postoperatorio, I-EVOLUTION +se I-EVOLUTION +delimitó I-EVOLUTION +aún I-EVOLUTION +más I-EVOLUTION +la I-EVOLUTION +necrosis I-EVOLUTION +de I-EVOLUTION +tejidos I-EVOLUTION +blandos I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +de I-EVOLUTION +cobertura I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +muñones I-EVOLUTION +de I-EVOLUTION +amputación, I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +produjo I-EVOLUTION +una I-EVOLUTION +exposición I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +segmentos I-EVOLUTION +tibial I-EVOLUTION +y I-EVOLUTION +peroneo I-EVOLUTION +de I-EVOLUTION +ambas I-EVOLUTION +extremidades. I-EVOLUTION +Debido I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +corta I-EVOLUTION +longitud I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +muñones, I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +podía I-EVOLUTION +proceder I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +amputación I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +segmentos I-EVOLUTION +y I-EVOLUTION +cobertura I-EVOLUTION +con I-EVOLUTION +tejido I-EVOLUTION +proximal, I-EVOLUTION +pues I-EVOLUTION +no I-EVOLUTION +garantizaría I-EVOLUTION +la I-EVOLUTION +posible I-EVOLUTION +colocación I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +futuro I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +prótesis. I-EVOLUTION +Por B-TREATMENT +tanto, I-TREATMENT +optamos I-TREATMENT +por I-TREATMENT +iniciar I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +presión I-TREATMENT +negativa I-TREATMENT +con I-TREATMENT +sistema I-TREATMENT +VAC® I-TREATMENT +para I-TREATMENT +favorecer I-TREATMENT +el I-TREATMENT +crecimiento I-TREATMENT +tisular I-TREATMENT +y I-TREATMENT +la I-TREATMENT +eliminación I-TREATMENT +del I-TREATMENT +exudado I-TREATMENT +de I-TREATMENT +las I-TREATMENT +heridas. I-TREATMENT + I-TREATMENT +Procedimos I-TREATMENT +en I-TREATMENT +primer I-TREATMENT +lugar I-TREATMENT +a I-TREATMENT +lavar I-TREATMENT +las I-TREATMENT +extremidades I-TREATMENT +con I-TREATMENT +una I-TREATMENT +solución I-TREATMENT +de I-TREATMENT +clorhexidina I-TREATMENT +jabonosa I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +4% I-TREATMENT +y I-TREATMENT +suero I-TREATMENT +fisiológico. I-TREATMENT +Luego I-TREATMENT +colocamos I-TREATMENT +los I-TREATMENT +apósitos I-TREATMENT +VAC-Granufoam I-TREATMENT +® I-TREATMENT +según I-TREATMENT +la I-TREATMENT +guía I-TREATMENT +clínica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +VAC®. I-TREATMENT +Al I-TREATMENT +principio I-TREATMENT +utilizamos I-TREATMENT +los I-TREATMENT +apósitos I-TREATMENT +medianos I-TREATMENT +según I-TREATMENT +el I-TREATMENT +modelo I-TREATMENT +Pitta-VAC® I-TREATMENT +(10,11), I-TREATMENT +dividiendo I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +mitades I-TREATMENT +el I-TREATMENT +apósito, I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +que I-TREATMENT +cada I-TREATMENT +una I-TREATMENT +de I-TREATMENT +ellas I-TREATMENT +es I-TREATMENT +separada I-TREATMENT +parcialmente I-TREATMENT +para I-TREATMENT +ser I-TREATMENT +colocada I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +a I-TREATMENT +tratar, I-TREATMENT +como I-TREATMENT +si I-TREATMENT +fuera I-TREATMENT +un I-TREATMENT +guante. I-TREATMENT +Esta B-EVOLUTION +técnica I-EVOLUTION +está I-EVOLUTION +descrita I-EVOLUTION +como I-EVOLUTION +rápida I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +diseño I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +ejecución. I-EVOLUTION +No I-EVOLUTION +obstante, I-EVOLUTION +en I-EVOLUTION +zonas I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +necrosis I-EVOLUTION +es I-EVOLUTION +parcheada, I-EVOLUTION +hemos I-EVOLUTION +notado I-EVOLUTION +que I-EVOLUTION +este I-EVOLUTION +sistema I-EVOLUTION +macera I-EVOLUTION +la I-EVOLUTION +piel I-EVOLUTION +sana I-EVOLUTION +si I-EVOLUTION +ésta I-EVOLUTION +entra I-EVOLUTION +en I-EVOLUTION +contacto I-EVOLUTION +directo I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +apósito I-EVOLUTION +de I-EVOLUTION +poliuretano I-EVOLUTION +reticulado, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +es I-EVOLUTION +necesario I-EVOLUTION +colocar I-EVOLUTION +apósitos I-EVOLUTION +hidrocoloides I-EVOLUTION +recortados I-EVOLUTION +bajo I-EVOLUTION +la I-EVOLUTION +esponja I-EVOLUTION +para I-EVOLUTION +evitarlo, I-EVOLUTION +lo I-EVOLUTION +cual I-EVOLUTION +hace I-EVOLUTION +más I-EVOLUTION +engorrosa I-EVOLUTION +la I-EVOLUTION +cura. I-EVOLUTION +Decidimos B-TREATMENT +por I-TREATMENT +tanto I-TREATMENT +volver I-TREATMENT +a I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +clásica I-TREATMENT +de I-TREATMENT +los I-TREATMENT +apósitos: I-TREATMENT +pequeños I-TREATMENT +fragmentos I-TREATMENT +recortados I-TREATMENT +sobre I-TREATMENT +las I-TREATMENT +pérdidas I-TREATMENT +de I-TREATMENT +sustancia I-TREATMENT +conectados I-TREATMENT +entre I-TREATMENT +sí I-TREATMENT +mediante I-TREATMENT +íntimo I-TREATMENT +contacto I-TREATMENT +en I-TREATMENT +alguna I-TREATMENT +de I-TREATMENT +sus I-TREATMENT +partes. I-TREATMENT +La I-TREATMENT +presión I-TREATMENT +utilizada I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +-125 I-TREATMENT +mmHg I-TREATMENT +y I-TREATMENT +en I-TREATMENT +modo I-TREATMENT +continuo. I-TREATMENT +La B-EVOLUTION +granulación I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +lecho I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +fueron I-EVOLUTION +evidentes. I-EVOLUTION + I-EVOLUTION +Tras I-EVOLUTION +40 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +terapia, I-EVOLUTION +conseguimos I-EVOLUTION +el I-EVOLUTION +recubrimiento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +segmentos I-EVOLUTION +óseos I-EVOLUTION +expuestos I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +colocación I-EVOLUTION +de I-EVOLUTION +láminas I-EVOLUTION +regeneradoras I-EVOLUTION +dérmicas I-EVOLUTION +Integra® I-EVOLUTION +(Integra, I-EVOLUTION +San I-EVOLUTION +Priest, I-EVOLUTION +Francia) I-EVOLUTION +durante I-EVOLUTION +1 I-EVOLUTION +mes, I-EVOLUTION +logramos I-EVOLUTION +la I-EVOLUTION +cobertura I-EVOLUTION +definitiva I-EVOLUTION +mediante I-EVOLUTION +injertos I-EVOLUTION +de I-EVOLUTION +piel I-EVOLUTION +parcial I-EVOLUTION +mallados I-EVOLUTION +1: I-EVOLUTION +1, I-EVOLUTION +5 I-EVOLUTION +tomados I-EVOLUTION +del I-EVOLUTION +muslo I-EVOLUTION +izquierdo. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +satisfactoria, I-EVOLUTION +con I-EVOLUTION +epitelización I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +muñones I-EVOLUTION +de I-EVOLUTION +amputación, I-EVOLUTION +procediéndose I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +tras I-EVOLUTION +exactamente I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +hospitalario. I-EVOLUTION +Mantuvimos I-EVOLUTION +seguimiento I-EVOLUTION +ambulatorio I-EVOLUTION +durante I-EVOLUTION +3 I-EVOLUTION +semanas I-EVOLUTION +más. I-EVOLUTION +Tras I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +del I-EVOLUTION +suceso, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +proceso I-EVOLUTION +de I-EVOLUTION +rehabilitación I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +secuelas I-EVOLUTION +neurológicas, I-EVOLUTION +control I-EVOLUTION +del I-EVOLUTION +tronco I-EVOLUTION +y I-EVOLUTION +adaptación I-EVOLUTION +a I-EVOLUTION +prótesis I-EVOLUTION +infracondíleas. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +valorar I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +mamario I-PRESENT_ILLNESS +bilateral. I-PRESENT_ILLNESS +Presenta B-EXPLORATION +atrofia I-EXPLORATION +mamaria I-EXPLORATION +moderada I-EXPLORATION +con I-EXPLORATION +ptosis I-EXPLORATION +muy I-EXPLORATION +leve. I-EXPLORATION +La I-EXPLORATION +piel I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +buena I-EXPLORATION +calidad, I-EXPLORATION +hidratada I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +estrías. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpan I-EXPLORATION +nódulos I-EXPLORATION +mamarios I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +refiere I-EXPLORATION +ningún I-EXPLORATION +antecedente I-EXPLORATION +patológico I-EXPLORATION +mamario I-EXPLORATION +de I-EXPLORATION +relevancia. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +mamografías I-EXPLORATION +recientes I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +ninguna I-EXPLORATION +patología. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +la I-TREATMENT +consulta I-TREATMENT +y I-TREATMENT +exploración I-TREATMENT +clínica I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +una I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +aumento I-TREATMENT +mamario I-TREATMENT +bilateral I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +periareolar I-TREATMENT +inferior, I-TREATMENT +con I-TREATMENT +disección I-TREATMENT +de I-TREATMENT +bolsillo I-TREATMENT +subpectoral I-TREATMENT +y I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +prótesis I-TREATMENT +anatómicas I-TREATMENT +de I-TREATMENT +gel I-TREATMENT +de I-TREATMENT +silicona I-TREATMENT +(McGhan® I-TREATMENT +Style I-TREATMENT +140 I-TREATMENT +MM I-TREATMENT +de I-TREATMENT +320 I-TREATMENT +cc.). I-TREATMENT + I-TREATMENT +La I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +y I-TREATMENT +transcurrió I-TREATMENT +sin I-TREATMENT +incidencias; I-TREATMENT +la B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +siguiente. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +postoperatorio I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +bien, I-EVOLUTION +el I-EVOLUTION +aspecto I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +mamas I-EVOLUTION +es I-EVOLUTION +normal, I-EVOLUTION +la I-EVOLUTION +simetría I-EVOLUTION +es I-EVOLUTION +adecuada I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +molestias I-EVOLUTION +son I-EVOLUTION +de I-EVOLUTION +escasa I-EVOLUTION +relevancia. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +que I-EVOLUTION +nota I-EVOLUTION +tensión I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +mamas, I-EVOLUTION +pero I-EVOLUTION +sin I-EVOLUTION +dolor I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +palpación. I-EVOLUTION +La B-EXPLORATION +cicatrización I-EXPLORATION +es I-EXPLORATION +correcta. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +postoperatorio I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +consulta I-EVOLUTION +presentando I-EVOLUTION +aumento I-EVOLUTION +simétrico I-EVOLUTION +del I-EVOLUTION +volumen I-EVOLUTION +mamario I-EVOLUTION +y I-EVOLUTION +drenaje I-EVOLUTION +espontáneo I-EVOLUTION +de I-EVOLUTION +material I-EVOLUTION +líquido I-EVOLUTION +de I-EVOLUTION +coloración I-EVOLUTION +blanquecina I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +pequeña I-EVOLUTION +dehiscencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +herida I-EVOLUTION +periareolar I-EVOLUTION +derecha. I-EVOLUTION +No B-EXPLORATION +ha I-EXPLORATION +presentado I-EXPLORATION +fiebre I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +mamas I-EXPLORATION +no I-EXPLORATION +muestran I-EXPLORATION +signos I-EXPLORATION +inflamatorios. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +margen I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cicatriz I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +pequeño I-EXPLORATION +de I-EXPLORATION +fecto I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +mm. I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +drena I-EXPLORATION +material, I-EXPLORATION +que I-EXPLORATION +al I-EXPLORATION +exprimir I-EXPLORATION +la I-EXPLORATION +mama I-EXPLORATION +aumenta I-EXPLORATION +su I-EXPLORATION +caudal. I-EXPLORATION +Sospechando B-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +un I-TREATMENT +absceso I-TREATMENT +retroareolar I-TREATMENT +y I-TREATMENT +decidimos I-TREATMENT +dilatar I-TREATMENT +dicho I-TREATMENT +defecto I-TREATMENT +usando I-TREATMENT +una I-TREATMENT +pinza I-TREATMENT +de I-TREATMENT +hemostasia, I-TREATMENT +momento I-TREATMENT +en I-TREATMENT +el I-TREATMENT +que I-TREATMENT +se I-TREATMENT +produce I-TREATMENT +el I-TREATMENT +drenaje I-TREATMENT +espontáneo I-TREATMENT +de I-TREATMENT +una I-TREATMENT +gran I-TREATMENT +cantidad I-TREATMENT +del I-TREATMENT +citado I-TREATMENT +material. I-TREATMENT +Al I-TREATMENT +proceder I-TREATMENT +a I-TREATMENT +la I-TREATMENT +expresión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mama I-TREATMENT +se I-TREATMENT +aprecia I-TREATMENT +igualmente I-TREATMENT +que I-TREATMENT +el I-TREATMENT +material I-TREATMENT +drena I-TREATMENT +por I-TREATMENT +el I-TREATMENT +pezón I-TREATMENT +y I-TREATMENT +al I-TREATMENT +hacer I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +maniobra I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mama I-TREATMENT +izquierda, I-TREATMENT +se I-TREATMENT +aprecia I-TREATMENT +también I-TREATMENT +este I-TREATMENT +drenaje I-TREATMENT +por I-TREATMENT +el I-TREATMENT +pezón. I-TREATMENT +Tomamos B-EXPLORATION +muestra I-EXPLORATION +para I-EXPLORATION +cultivo, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +negativo. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +pensamos I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +tumefacción I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mamas I-EXPLORATION +se I-EXPLORATION +debe I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +producción I-EXPLORATION +de I-EXPLORATION +leche. I-EXPLORATION + I-EXPLORATION +Recomendamos I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +para I-EXPLORATION +estudiar I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +prolactina I-EXPLORATION +(PRL) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +consulta I-EXPLORATION +con I-EXPLORATION +Ginecología I-EXPLORATION +que I-EXPLORATION +recomienda I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +mamaria I-EXPLORATION +bilateral, I-EXPLORATION +TAC I-EXPLORATION +craneal I-EXPLORATION +y I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +hormonas I-EXPLORATION +tiroideas I-EXPLORATION +y I-EXPLORATION +suprarrenales. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +todas I-EXPLORATION +estas I-EXPLORATION +pruebas I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +signos I-EXPLORATION +patológicos. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +mamaria I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +densidad I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +mamario I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +líquido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +bolsillo I-EXPLORATION +que I-EXPLORATION +alojaba I-EXPLORATION +la I-EXPLORATION +prótesis. I-EXPLORATION +Aún B-TREATMENT +así I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +instaurar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +bromocriptina I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +empírica, I-TREATMENT +a I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +inicial I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +25 I-TREATMENT +mg., I-TREATMENT +3 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Después I-TREATMENT +de I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +al I-TREATMENT +no I-TREATMENT +obtener I-TREATMENT +respuesta, I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +hasta I-TREATMENT +2, I-TREATMENT +5 I-TREATMENT +mg. I-TREATMENT +3 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +mantendría I-TREATMENT +hasta I-TREATMENT +2 I-TREATMENT +semanas I-TREATMENT +después I-TREATMENT +del I-TREATMENT +cese I-TREATMENT +de I-TREATMENT +la I-TREATMENT +secreción. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +pesar I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +tórpida I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +galactorrea I-EVOLUTION +no I-EVOLUTION +cesó, I-EVOLUTION +continuando I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +de I-EVOLUTION +leche I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +herida I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +derecha. I-EVOLUTION +Ambas I-EVOLUTION +mamas I-EVOLUTION +continuaban I-EVOLUTION +turgentes. I-EVOLUTION +Se B-TREATMENT +mantiene I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +con I-TREATMENT +vendajes I-TREATMENT +moderadamente I-TREATMENT +compresivos I-TREATMENT +considerando I-TREATMENT +que I-TREATMENT +el I-TREATMENT +drenaje I-TREATMENT +continuo I-TREATMENT +de I-TREATMENT +leche I-TREATMENT +por I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +puede I-TREATMENT +ser I-TREATMENT +un I-TREATMENT +estímulo I-TREATMENT +mantenido I-TREATMENT +para I-TREATMENT +la I-TREATMENT +lactancia, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +para I-TREATMENT +sellar I-TREATMENT +posibles I-TREATMENT +espacios I-TREATMENT +muertos I-TREATMENT +en I-TREATMENT +el I-TREATMENT +bolsillo I-TREATMENT +o I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +mamario. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +sometida I-EVOLUTION +a I-EVOLUTION +revisiones I-EVOLUTION +y I-EVOLUTION +curas I-EVOLUTION +semanales, I-EVOLUTION +el I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +galactorrea I-EVOLUTION +cesó, I-EVOLUTION +deteniéndose I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +de I-EVOLUTION +leche I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +herida I-EVOLUTION +y I-EVOLUTION +disminuyendo I-EVOLUTION +la I-EVOLUTION +turgencia I-EVOLUTION +en I-EVOLUTION +ambas I-EVOLUTION +mamas. I-EVOLUTION + I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +después I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +acude I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +presentando I-EVOLUTION +en I-EVOLUTION +esta I-EVOLUTION +ocasión I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +mamario I-EVOLUTION +unilateral I-EVOLUTION +derecho. I-EVOLUTION +Se B-EXPLORATION +realiza I-EXPLORATION +nueva I-EXPLORATION +ecografía I-EXPLORATION +mamaria I-EXPLORATION +que I-EXPLORATION +revela I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +seroma I-EXPLORATION +intracapsular I-EXPLORATION +derecho. I-EXPLORATION +Se B-TREATMENT +procede I-TREATMENT +al I-TREATMENT +drenaje I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +bajo I-TREATMENT +condiciones I-TREATMENT +de I-TREATMENT +asepsia I-TREATMENT +y I-TREATMENT +éste I-TREATMENT +se I-TREATMENT +resuelve I-TREATMENT +en I-TREATMENT +7 I-TREATMENT +días; I-TREATMENT +pero B-EVOLUTION +la I-EVOLUTION +morfología I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +comienza I-EVOLUTION +a I-EVOLUTION +verse I-EVOLUTION +afectada I-EVOLUTION +de I-EVOLUTION +tal I-EVOLUTION +forma I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +trayecto I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +del I-EVOLUTION +cual I-EVOLUTION +drenaba I-EVOLUTION +la I-EVOLUTION +leche I-EVOLUTION +se I-EVOLUTION +retrae I-EVOLUTION +deformando I-EVOLUTION +la I-EVOLUTION +areola. I-EVOLUTION +Se I-EVOLUTION +constata I-EVOLUTION +también I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +desarrolla I-EVOLUTION +un I-EVOLUTION +grado I-EVOLUTION +incipiente I-EVOLUTION +de I-EVOLUTION +contractura I-EVOLUTION +capsular. I-EVOLUTION +Optamos B-TREATMENT +por I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +revisión I-TREATMENT +quirúrgica I-TREATMENT +debido I-TREATMENT +sobre I-TREATMENT +todo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +deformidad I-TREATMENT +provocada I-TREATMENT +por I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +areolar. I-TREATMENT + I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +intervenida I-TREATMENT +procediendo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +revisión I-TREATMENT +del I-TREATMENT +bolsillo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +que I-TREATMENT +no I-TREATMENT +se I-TREATMENT +aprecia I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +ninguna I-TREATMENT +colección I-TREATMENT +líquida, I-TREATMENT +tan I-TREATMENT +solo I-TREATMENT +escasos I-TREATMENT +depósitos I-TREATMENT +blanquecinos I-TREATMENT +que I-TREATMENT +se I-TREATMENT +analizan I-TREATMENT +Practicamos I-TREATMENT +capsulotomías, I-TREATMENT +recolocación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +que I-TREATMENT +permanecía I-TREATMENT +intacta I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +depósitos I-TREATMENT +en I-TREATMENT +su I-TREATMENT +superficie I-TREATMENT +y I-TREATMENT +reparación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +retracción I-TREATMENT +areolar. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +depósitos I-EXPLORATION +blanquecinos I-EXPLORATION +hallados I-EXPLORATION +describe I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +hialinizada I-EXPLORATION +con I-EXPLORATION +infiltración I-EXPLORATION +crónica I-EXPLORATION +granulomatosa I-EXPLORATION +e I-EXPLORATION +infiltrado I-EXPLORATION +de I-EXPLORATION +histiocitos. I-EXPLORATION + I-EXPLORATION +Durante B-EVOLUTION +este I-EVOLUTION +segundo I-EVOLUTION +postoperatorio I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +desarrolla I-EVOLUTION +galactorrea I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +recupera I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +derecha I-EVOLUTION +desarrolla I-EVOLUTION +contractura I-EVOLUTION +capsular I-EVOLUTION +grado I-EVOLUTION +III I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +reintervenir I-TREATMENT +nuevamente, I-TREATMENT +realizando I-TREATMENT +capsulectomía I-TREATMENT +parcial I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +los I-TREATMENT +tegumentos I-TREATMENT +se I-TREATMENT +han I-TREATMENT +adelgazado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +considera I-TREATMENT +el I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +afectar I-TREATMENT +la I-TREATMENT +integridad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +una I-TREATMENT +capsulectomia I-TREATMENT +total, I-TREATMENT +y I-TREATMENT +capsulorrafia I-TREATMENT +medial I-TREATMENT +por I-TREATMENT +ser I-TREATMENT +esta I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +el I-TREATMENT +adelgazamiento I-TREATMENT +de I-TREATMENT +los I-TREATMENT +tejidos I-TREATMENT +es I-TREATMENT +mayor. I-TREATMENT +Cambiamos I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +por I-TREATMENT +otra I-TREATMENT +de I-TREATMENT +idénticas I-TREATMENT +carácterísticas. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +nueva I-EVOLUTION +intervención I-EVOLUTION +detectamos I-EVOLUTION +como I-EVOLUTION +única I-EVOLUTION +complicación I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +Mondor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +derecha. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +postoperatorio I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +nuevamente I-EVOLUTION +signos I-EVOLUTION +compatibles I-EVOLUTION +con I-EVOLUTION +contractura I-EVOLUTION +capsular I-EVOLUTION +recidivada I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +derecha, I-EVOLUTION +con I-EVOLUTION +notable I-EVOLUTION +afectación I-EVOLUTION +estética I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +aparición I-EVOLUTION +más I-EVOLUTION +lenta I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +izquierda. I-EVOLUTION +El B-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +que I-TREATMENT +podría I-TREATMENT +plantearse I-TREATMENT +en I-TREATMENT +esta I-TREATMENT +ocasión I-TREATMENT +sería: I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mama I-TREATMENT +derecha I-TREATMENT +nueva I-TREATMENT +capsulectomía, I-TREATMENT +si I-TREATMENT +los I-TREATMENT +tegumentos I-TREATMENT +lo I-TREATMENT +permiten, I-TREATMENT +pudiendo I-TREATMENT +precisar I-TREATMENT +de I-TREATMENT +refuerzo I-TREATMENT +mediante I-TREATMENT +malla I-TREATMENT +de I-TREATMENT +material I-TREATMENT +sintético I-TREATMENT +o I-TREATMENT +biológico I-TREATMENT +en I-TREATMENT +la I-TREATMENT +región I-TREATMENT +ínferomedial, I-TREATMENT +y I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mama I-TREATMENT +izquierda I-TREATMENT +capsulectomía I-TREATMENT +y I-TREATMENT +recambio I-TREATMENT +de I-TREATMENT +prótesis. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +descarta I-TREATMENT +la I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +añadir I-TREATMENT +procedimientos I-TREATMENT +de I-TREATMENT +mastopexia I-TREATMENT +para I-TREATMENT +corregir I-TREATMENT +la I-TREATMENT +posición I-TREATMENT +del I-TREATMENT +complejo I-TREATMENT +teloareolar. I-TREATMENT + I-TREATMENT + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +maseterina I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +músculo I-PRESENT_ILLNESS +masetero I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +motivó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +estar I-PAST_MEDICAL_HISTORY +asintomático, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +patologías I-PAST_MEDICAL_HISTORY +agregadas, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +malos I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +dietéticos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +bruxismo I-PAST_MEDICAL_HISTORY +diurno I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +nocturno. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +en I-EXPLORATION +marzo I-EXPLORATION +del I-EXPLORATION +2008 I-EXPLORATION +mediante I-EXPLORATION +Tomografía I-EXPLORATION +Axial I-EXPLORATION +Computerizada I-EXPLORATION +(TAC) I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +contrastada I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +patología I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos I-EXPLORATION +y I-EXPLORATION +duros I-EXPLORATION +tipo I-EXPLORATION +neoplasia, I-EXPLORATION +proceso I-EXPLORATION +infeccioso I-EXPLORATION +crónico I-EXPLORATION +o I-EXPLORATION +crecimiento I-EXPLORATION +óseo. I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +finalmente I-EXPLORATION +como I-EXPLORATION +hipertrofia I-EXPLORATION +del I-EXPLORATION +músculo I-EXPLORATION +masetero I-EXPLORATION +bilateral, I-EXPLORATION +mayor I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +Tomamos I-EXPLORATION +medidas I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +maseteros I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +cortes I-EXPLORATION +tomográficos, I-EXPLORATION +de I-EXPLORATION +anterior I-EXPLORATION +a I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +músculos I-EXPLORATION +maseteros I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +diámetro I-EXPLORATION +transverso I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +resultados: I-EXPLORATION +1.40 I-EXPLORATION +cm, I-EXPLORATION +1.60 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +0.95 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +masetero I-EXPLORATION +derecho; I-EXPLORATION +1.83 I-EXPLORATION +cm, I-EXPLORATION +1.53 I-EXPLORATION +y I-EXPLORATION +1.13 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +músculo I-EXPLORATION +masetero I-EXPLORATION +izquierdo, I-EXPLORATION +ambos I-EXPLORATION +mayores I-EXPLORATION +de I-EXPLORATION +lo I-EXPLORATION +normal. I-EXPLORATION +Iniciamos B-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +base I-TREATMENT +de I-TREATMENT +guarda I-TREATMENT +oclusal I-TREATMENT +nocturna I-TREATMENT +y I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +en I-TREATMENT +noviembre I-TREATMENT +del I-TREATMENT +2009, I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +al I-TREATMENT +protocolo I-TREATMENT +seleccionado. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +propuso I-TREATMENT +la I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +toxina I-TREATMENT +botulínica. I-TREATMENT +La I-TREATMENT +Primera I-TREATMENT +aplicación I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +50 I-TREATMENT +U, I-TREATMENT +25 I-TREATMENT +de I-TREATMENT +las I-TREATMENT +cuales I-TREATMENT +se I-TREATMENT +aplicaron I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +de I-TREATMENT +mayor I-TREATMENT +hipertrofia I-TREATMENT +(zona I-TREATMENT +IV I-TREATMENT +descrita I-TREATMENT +por I-TREATMENT +Da-Hye I-TREATMENT +Kim), I-TREATMENT +15 I-TREATMENT +U I-TREATMENT +en I-TREATMENT +dirección I-TREATMENT +al I-TREATMENT +borde I-TREATMENT +inferior I-TREATMENT +mandibular I-TREATMENT +y I-TREATMENT +10 I-TREATMENT +U I-TREATMENT +por I-TREATMENT +encima I-TREATMENT +de I-TREATMENT +la I-TREATMENT +aplicación I-TREATMENT +previa I-TREATMENT +(correspondiente I-TREATMENT +a I-TREATMENT +zona I-TREATMENT +V I-TREATMENT +de I-TREATMENT +Da-Hye I-TREATMENT +Kim). I-TREATMENT +Con I-TREATMENT +esta I-TREATMENT +distribución I-TREATMENT +de I-TREATMENT +aplicación I-TREATMENT +en I-TREATMENT +los I-TREATMENT +puntos I-TREATMENT +propuestos I-TREATMENT +por I-TREATMENT +Nam-Ho I-TREATMENT +Kim I-TREATMENT +que I-TREATMENT +mejoran I-TREATMENT +el I-TREATMENT +contorno I-TREATMENT +mandibular, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +marcaje I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +ambos I-TREATMENT +músculos I-TREATMENT +maseteros I-TREATMENT +(5). I-TREATMENT +Para I-TREATMENT +la I-TREATMENT +preparación I-TREATMENT +del I-TREATMENT +producto I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +una I-TREATMENT +aguja I-TREATMENT +gruesa I-TREATMENT +(18G) I-TREATMENT +con I-TREATMENT +el I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +evitar I-TREATMENT +la I-TREATMENT +formación I-TREATMENT +de I-TREATMENT +turbulencias. I-TREATMENT +El I-TREATMENT +alcohol, I-TREATMENT +usado I-TREATMENT +ya I-TREATMENT +sea I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tapón I-TREATMENT +del I-TREATMENT +vial I-TREATMENT +o I-TREATMENT +bien I-TREATMENT +en I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +debe I-TREATMENT +evaporarse I-TREATMENT +completamente I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +aplicar I-TREATMENT +la I-TREATMENT +toxina I-TREATMENT +dado I-TREATMENT +que I-TREATMENT +también I-TREATMENT +puede I-TREATMENT +inactivarla. I-TREATMENT +A I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +que I-TREATMENT +el I-TREATMENT +vial I-TREATMENT +puede I-TREATMENT +reconstituirse I-TREATMENT +a I-TREATMENT +una I-TREATMENT +dilución I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +cc/100 I-TREATMENT +U, I-TREATMENT +preferimos I-TREATMENT +la I-TREATMENT +dilución I-TREATMENT +en I-TREATMENT +4 I-TREATMENT +cc. I-TREATMENT +a I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +conseguir I-TREATMENT +una I-TREATMENT +dosificación I-TREATMENT +de I-TREATMENT +2.5 I-TREATMENT +U/0.1 I-TREATMENT +cc. I-TREATMENT +El I-TREATMENT +obtener I-TREATMENT +de I-TREATMENT +esta I-TREATMENT +forma I-TREATMENT +un I-TREATMENT +volumen I-TREATMENT +menor, I-TREATMENT +limitará I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +que I-TREATMENT +la I-TREATMENT +toxina I-TREATMENT +difunda I-TREATMENT +hacia I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +adyacentes. I-TREATMENT +Es I-TREATMENT +importante I-TREATMENT +recordar I-TREATMENT +que I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +realizada I-TREATMENT +la I-TREATMENT +reconstitución, I-TREATMENT +el I-TREATMENT +producto I-TREATMENT +deberá I-TREATMENT +utilizarse I-TREATMENT +en I-TREATMENT +el I-TREATMENT +plazo I-TREATMENT +de I-TREATMENT +las I-TREATMENT +4 I-TREATMENT +horas I-TREATMENT +siguientes I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +pérdida I-TREATMENT +de I-TREATMENT +eficacia, I-TREATMENT +aunque I-TREATMENT +algunos I-TREATMENT +autores I-TREATMENT +señalan I-TREATMENT +que I-TREATMENT +se I-TREATMENT +puede I-TREATMENT +utilizar I-TREATMENT +sin I-TREATMENT +disminuir I-TREATMENT +su I-TREATMENT +eficacia I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +los I-TREATMENT +3 I-TREATMENT +a I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +posteriores. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +disminuir I-TREATMENT +las I-TREATMENT +molestias I-TREATMENT +y I-TREATMENT +que I-TREATMENT +la I-TREATMENT +aplicación I-TREATMENT +sea I-TREATMENT +segura I-TREATMENT +utilizamos I-TREATMENT +una I-TREATMENT +aguja I-TREATMENT +fina I-TREATMENT +(30G). I-TREATMENT +Es I-TREATMENT +importante I-TREATMENT +insistir I-TREATMENT +en I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +debe I-TREATMENT +tomar I-TREATMENT +medicamentos I-TREATMENT +que I-TREATMENT +interfieran I-TREATMENT +con I-TREATMENT +la I-TREATMENT +coagulación I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +a I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +inyección I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +equímosis. I-TREATMENT +También I-TREATMENT +solicitamos I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +la I-TREATMENT +correspondiente I-TREATMENT +autorización I-TREATMENT +para I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +mediante I-TREATMENT +un I-TREATMENT +consentimiento I-TREATMENT +informado I-TREATMENT +específico, I-TREATMENT +tal I-TREATMENT +y I-TREATMENT +como I-TREATMENT +habitualmente I-TREATMENT +hacemos I-TREATMENT +con I-TREATMENT +cualquier I-TREATMENT +procedimiento I-TREATMENT +invasivo. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +las I-TREATMENT +aplicaciones I-TREATMENT +posteriores I-TREATMENT +citamos I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +semanas I-TREATMENT +(3 I-TREATMENT +meses), I-TREATMENT +utilizando I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +técnica I-TREATMENT +y I-TREATMENT +completando I-TREATMENT +hasta I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +aplicaciones. I-TREATMENT +Se I-TREATMENT +sabe I-TREATMENT +que I-TREATMENT +al I-TREATMENT +utilizar I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +repetitiva I-TREATMENT +se I-TREATMENT +causa I-TREATMENT +atrofia I-TREATMENT +en I-TREATMENT +los I-TREATMENT +grupos I-TREATMENT +musculares I-TREATMENT +infiltrados, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +hace I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +presente I-TREATMENT +mejoría I-TREATMENT +clínica. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +continuar I-TREATMENT +con I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +guarda I-TREATMENT +oclusal I-TREATMENT +nocturna I-TREATMENT +para I-TREATMENT +controlar I-TREATMENT +el I-TREATMENT +bruxismo. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +sufre I-PRESENT_ILLNESS +herida I-PRESENT_ILLNESS +traumática I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +quedar I-PRESENT_ILLNESS +atrapada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +cinta I-PRESENT_ILLNESS +transportadora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +empresa I-PRESENT_ILLNESS +cárnica, I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +arrancamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +tendones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +músculo I-PRESENT_ILLNESS +extensor I-PRESENT_ILLNESS +común I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +unión I-PRESENT_ILLNESS +miotendinosa. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-TREATMENT +un I-TREATMENT +primer I-TREATMENT +acto I-TREATMENT +quirúrgico I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +limpieza I-TREATMENT +exhaustiva, I-TREATMENT +cierre I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +y I-TREATMENT +cobertura I-TREATMENT +antibiótica, I-TREATMENT +postponiendo I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +reconstructiva I-TREATMENT +dado I-TREATMENT +el I-TREATMENT +alto I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +infección. I-TREATMENT +Tras B-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +profilácticas, I-EVOLUTION +la I-EVOLUTION +herida I-EVOLUTION +sufrió I-EVOLUTION +una I-EVOLUTION +infección I-EVOLUTION +por I-EVOLUTION +microorganismos I-EVOLUTION +anaerobios I-EVOLUTION +que B-TREATMENT +se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +desbridamiento I-TREATMENT +quirúrgico, I-TREATMENT +antibiotepia I-TREATMENT +y I-TREATMENT +cámara I-TREATMENT +hiperbárica I-TREATMENT +durante I-TREATMENT +3 I-TREATMENT +semanas. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +resuelta I-TREATMENT +la I-TREATMENT +infección I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +para I-TREATMENT +transferencia I-TREATMENT +tendinosa, I-TREATMENT +pero I-TREATMENT +en I-TREATMENT +el I-TREATMENT +acto I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +necrosis I-TREATMENT +de I-TREATMENT +los I-TREATMENT +tendones I-TREATMENT +extensores I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +resecar I-TREATMENT +hasta I-TREATMENT +tejido I-TREATMENT +viable I-TREATMENT +y I-TREATMENT +utilizar I-TREATMENT +varillas I-TREATMENT +de I-TREATMENT +silicona I-TREATMENT +en I-TREATMENT +un I-TREATMENT +primer I-TREATMENT +tiempo I-TREATMENT +con I-TREATMENT +vistas I-TREATMENT +a I-TREATMENT +un I-TREATMENT +posterior I-TREATMENT +injerto I-TREATMENT +tendinoso. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +implantación I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +varillas, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentaba I-EVOLUTION +una I-EVOLUTION +severa I-EVOLUTION +limitación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +movilidad I-EVOLUTION +que I-EVOLUTION +contraindicaba I-EVOLUTION +el I-EVOLUTION +injerto I-EVOLUTION +tendinoso, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +tras I-TREATMENT +confirmar I-TREATMENT +mediante I-TREATMENT +doppler I-TREATMENT +la I-TREATMENT +permeabilidad I-TREATMENT +tanto I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +tibial I-TREATMENT +posterior I-TREATMENT +como I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tibial I-TREATMENT +anterior, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +utilizar I-TREATMENT +el I-TREATMENT +colgajo I-TREATMENT +vascularizado I-TREATMENT +de I-TREATMENT +dorsalis I-TREATMENT +pedis I-TREATMENT +para I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +funcional I-TREATMENT +completa. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +anastomosis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +dorsal I-TREATMENT +del I-TREATMENT +pie I-TREATMENT +a I-TREATMENT +la I-TREATMENT +radial, I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +safena I-TREATMENT +a I-TREATMENT +una I-TREATMENT +vena I-TREATMENT +superficial I-TREATMENT +del I-TREATMENT +antebrazo, I-TREATMENT +y I-TREATMENT +la I-TREATMENT +correspondiente I-TREATMENT +sutura I-TREATMENT +tendinosa. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +inmovilizó I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +donante I-TREATMENT +durante I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +férula I-TREATMENT +de I-TREATMENT +yeso, I-TREATMENT +lo I-TREATMENT +suficiente I-TREATMENT +para I-TREATMENT +que I-TREATMENT +el I-TREATMENT +injerto I-TREATMENT +prendiera. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +comenzó I-EVOLUTION +entonces I-EVOLUTION +a I-EVOLUTION +deambular I-EVOLUTION +libremente I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +vendaje I-EVOLUTION +simple I-EVOLUTION +del I-EVOLUTION +área I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +sufrió I-EVOLUTION +complicaciones. I-EVOLUTION +Tras I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +postoperatorio, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +refería I-EVOLUTION +anestesia I-EVOLUTION +exclusivamente I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +área I-EVOLUTION +donante I-EVOLUTION +del I-EVOLUTION +colgajo. I-EVOLUTION + I-EVOLUTION +La B-TREATMENT +mano I-TREATMENT +se I-TREATMENT +inmovilizó I-TREATMENT +durante I-TREATMENT +4 I-TREATMENT +semanas I-TREATMENT +y I-TREATMENT +se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +rehabilitación I-TREATMENT +con I-TREATMENT +ejercicios I-TREATMENT +activos I-TREATMENT +protegidos I-TREATMENT +durante I-TREATMENT +8 I-TREATMENT +semanas, I-TREATMENT +obteniendo I-TREATMENT +un I-TREATMENT +resultado I-TREATMENT +funcional I-TREATMENT +satisfactorio I-TREATMENT +y B-EVOLUTION +reincorporación I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +al I-EVOLUTION +trabajo I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de B-PRESENT_ILLNESS +interés, I-PRESENT_ILLNESS +remitido I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +compartimento I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +dolorosa I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor, I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +velocidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento, I-PRESENT_ILLNESS +impotencia I-PRESENT_ILLNESS +funcional I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +parestesias. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pierna I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +15 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +con I-EXPLORATION +distensión I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +compartimentos I-EXPLORATION +posteriores I-EXPLORATION +y I-EXPLORATION +laterales. I-EXPLORATION +Asimismo, I-EXPLORATION +refería I-EXPLORATION +parestesias I-EXPLORATION +discontinuas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +afecta I-EXPLORATION +e I-EXPLORATION +hiperestesia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pulpejo I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +dedo I-EXPLORATION +del I-EXPLORATION +pie I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +peronea. I-EXPLORATION +La I-EXPLORATION +vascularización I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +estaba I-EXPLORATION +indemne, I-EXPLORATION +presentando I-EXPLORATION +pulsos I-EXPLORATION +poplíteos, I-EXPLORATION +tibial I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +pedio I-EXPLORATION +conservados. I-EXPLORATION +No I-EXPLORATION +obstante, I-EXPLORATION +constatamos I-EXPLORATION +una I-EXPLORATION +mayor I-EXPLORATION +frialdad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pie I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +contralateral. I-EXPLORATION + I-EXPLORATION +Realizamos I-EXPLORATION +Trucut I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +con I-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +sarcoma I-EXPLORATION +fusocelular I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado I-EXPLORATION +(sarcoma I-EXPLORATION +sinovial). I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +(RMN) I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pierna I-EXPLORATION +izquierda I-EXPLORATION +que I-EXPLORATION +afectaba I-EXPLORATION +a I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +músculo I-EXPLORATION +sóleo, I-EXPLORATION +marcadamente I-EXPLORATION +heterogénea, I-EXPLORATION +multinodular I-EXPLORATION +y I-EXPLORATION +polilobulada, I-EXPLORATION +de I-EXPLORATION +14x10x7 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +reciente. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +posterior, I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +comprime I-EXPLORATION +y I-EXPLORATION +desplaza I-EXPLORATION +los I-EXPLORATION +vientres I-EXPLORATION +musculares I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +gemelos I-EXPLORATION +interno I-EXPLORATION +y I-EXPLORATION +externo, I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +contacta I-EXPLORATION +sin I-EXPLORATION +planos I-EXPLORATION +grasos, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +anterior I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +poplíteo, I-EXPLORATION +tibial I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +flexor I-EXPLORATION +común I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dedos. I-EXPLORATION +Anterocaudalmente, I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +infiltra I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +flexor I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +dedo. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +estructuras I-EXPLORATION +óseas I-EXPLORATION +observamos I-EXPLORATION +una I-EXPLORATION +estrecha I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +diáfisis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tibia I-EXPLORATION +y, I-EXPLORATION +aunque I-EXPLORATION +se I-EXPLORATION +mantienen I-EXPLORATION +los I-EXPLORATION +planos I-EXPLORATION +grasos, I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +interpuesto I-EXPLORATION +entre I-EXPLORATION +ambas I-EXPLORATION +estructuras I-EXPLORATION +es I-EXPLORATION +inferior I-EXPLORATION +a I-EXPLORATION +1cm. I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +al I-EXPLORATION +peroné, I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +lo I-EXPLORATION +engloba I-EXPLORATION +semicircularmente I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +extensión I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +12 I-EXPLORATION +cm. I-EXPLORATION +A I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +estrecha I-EXPLORATION +relación I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +tibia I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +peroné, I-EXPLORATION +no I-EXPLORATION +observamos I-EXPLORATION +signos I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +ósea. I-EXPLORATION +En I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +estructuras I-EXPLORATION +vasculares, I-EXPLORATION +apreciamos I-EXPLORATION +cómo I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +llega I-EXPLORATION +a I-EXPLORATION +contactar I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +poplítea I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +bifurcación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +tibial I-EXPLORATION +anterior, I-EXPLORATION +pasando I-EXPLORATION +a I-EXPLORATION +englobar I-EXPLORATION +distalmente I-EXPLORATION +al I-EXPLORATION +tronco I-EXPLORATION +tibio-peroneo I-EXPLORATION +con I-EXPLORATION +repermeabilización I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +peroneos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +resumen, I-EXPLORATION +se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +sólea I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +14 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +sarcoma I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +vascular I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +adyacente. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +intervenido I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +y I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +fue I-TREATMENT +realizada I-TREATMENT +por I-TREATMENT +un I-TREATMENT +único I-TREATMENT +equipo I-TREATMENT +quirúrgico I-TREATMENT +que I-TREATMENT +practicó I-TREATMENT +tanto I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +tumoral I-TREATMENT +como I-TREATMENT +la I-TREATMENT +posterior I-TREATMENT +reconstrucción. I-TREATMENT + I-TREATMENT +Comenzamos I-TREATMENT +con I-TREATMENT +el I-TREATMENT +colgajo I-TREATMENT +plantar I-TREATMENT +disecando I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +fileteado I-TREATMENT +B3 I-TREATMENT +de I-TREATMENT +Künstcher I-TREATMENT +(6) I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +con I-TREATMENT +la I-TREATMENT +amputación I-TREATMENT +infracondilea I-TREATMENT +incluyendo I-TREATMENT +la I-TREATMENT +cortical I-TREATMENT +posterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tibia. I-TREATMENT +Realizamos I-TREATMENT +anastomosis I-TREATMENT +términoterminales I-TREATMENT +(T-T) I-TREATMENT +a I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +poplítea I-TREATMENT +y I-TREATMENT +a I-TREATMENT +ambas I-TREATMENT +safenas I-TREATMENT +y I-TREATMENT +neurorrafia I-TREATMENT +entre I-TREATMENT +ciático I-TREATMENT +poplíteo I-TREATMENT +externo I-TREATMENT +y I-TREATMENT +tibial I-TREATMENT +posterior. I-TREATMENT + B-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +alteración I-EVOLUTION +hemodinámica I-EVOLUTION +alguna I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +colgajo I-EVOLUTION +evolucionó I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +favorable I-EVOLUTION +sin I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +revisión I-EVOLUTION +microquirúrgica I-EVOLUTION +del I-EVOLUTION +mismo I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posteriores I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +extirpada I-EXPLORATION +resultó I-EXPLORATION +ser I-EXPLORATION +de I-EXPLORATION +sarcoma I-EXPLORATION +sinovial I-EXPLORATION +bifásico I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +muscular, I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +quirúrgicos I-EXPLORATION +respetados I-EXPLORATION +(tumor I-EXPLORATION +a I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +borde I-EXPLORATION +quirúrgico I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas). I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +infiltración I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +óseo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +siguió I-EVOLUTION +un I-EVOLUTION +postoperatorio I-EVOLUTION +favorable, I-EVOLUTION +siendo I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +domicilio I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +30 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION +Llevamos B-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +un I-TREATMENT +seguimiento I-TREATMENT +semanal I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +hasta I-TREATMENT +obtener I-TREATMENT +una I-TREATMENT +cicatrización I-TREATMENT +óptima I-TREATMENT +para I-TREATMENT +comenzar I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +ortopédico. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +60 I-EVOLUTION +días I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +deambulaba I-EVOLUTION +con I-EVOLUTION +prótesis I-EVOLUTION +transtibial I-EVOLUTION +tipo I-EVOLUTION +PTB I-EVOLUTION +(patellartendon-bearing I-EVOLUTION +prosthesis) I-EVOLUTION +con I-EVOLUTION +sistema I-EVOLUTION +endoesquelético I-EVOLUTION +y I-EVOLUTION +pie I-EVOLUTION +dinámico I-EVOLUTION +con I-EVOLUTION +sensibilidad I-EVOLUTION +completa I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +muñón I-EVOLUTION +de I-EVOLUTION +amputación. I-EVOLUTION +El I-EVOLUTION +seguimiento I-EVOLUTION +total I-EVOLUTION +por I-EVOLUTION +nuestra I-EVOLUTION +parte I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +7 I-EVOLUTION +meses I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION +Dos B-TREATMENT +años I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención, I-TREATMENT +continúa I-TREATMENT +en I-TREATMENT +seguimiento I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +los I-TREATMENT +Servicios I-TREATMENT +de I-TREATMENT +Oncología I-TREATMENT +y I-TREATMENT +Rehabilitación I-TREATMENT +de I-TREATMENT +nuestro I-TREATMENT +hospital, I-TREATMENT +que I-TREATMENT +procederán I-TREATMENT +al I-TREATMENT +recambio I-TREATMENT +protésico I-TREATMENT +según I-TREATMENT +su I-TREATMENT +protocolo I-TREATMENT +cada I-TREATMENT +2 I-TREATMENT +años. I-TREATMENT +Hasta B-EVOLUTION +la I-EVOLUTION +fecha, I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +encontrado I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +recurrencia I-EVOLUTION +local. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que B-PAST_MEDICAL_HISTORY +acude I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infiltración I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +material I-PAST_MEDICAL_HISTORY +desconocido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ambas I-PAST_MEDICAL_HISTORY +mamas I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +200 I-PAST_MEDICAL_HISTORY +cc I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +lado, I-PAST_MEDICAL_HISTORY +presentando B-PRESENT_ILLNESS +dolor, I-PRESENT_ILLNESS +deformidad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cambios I-PRESENT_ILLNESS +tróficos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +afectada. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +pétrea I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +retroareolar I-EXPLORATION +que I-EXPLORATION +involucra I-EXPLORATION +prácticamente I-EXPLORATION +al I-EXPLORATION +80 I-EXPLORATION +% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +mamaria. I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +a I-TREATMENT +base I-TREATMENT +de I-TREATMENT +esteroides, I-TREATMENT +metrotexate I-TREATMENT +y I-TREATMENT +antiinflamatorios I-TREATMENT +no I-TREATMENT +esteroideos I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Reumatología I-TREATMENT +de I-TREATMENT +nuestro I-TREATMENT +hospital I-TREATMENT +y I-TREATMENT +se I-TREATMENT +programa I-TREATMENT +para I-TREATMENT +mastectomía I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +mediante I-TREATMENT +colgajo I-TREATMENT +TRAM I-TREATMENT +pediculado I-TREATMENT +bilateral, I-TREATMENT +procedimiento I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +ni I-TREATMENT +incidentes. I-TREATMENT +Queda I-TREATMENT +pendiente I-TREATMENT +de I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +bilateral I-TREATMENT +del I-TREATMENT +complejo I-TREATMENT +pezón-areola. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia, I-PAST_MEDICAL_HISTORY +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +tumoración I-DERIVED_FROM/TO +premaxilar I-DERIVED_FROM/TO +izquierda, I-DERIVED_FROM/TO +blanda, I-DERIVED_FROM/TO +móvil I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +adherida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +planos I-DERIVED_FROM/TO +profundos I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +exploración, I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +unos I-DERIVED_FROM/TO +4cm. I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +diámetro I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +6 I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución, I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +otra I-DERIVED_FROM/TO +sintomatología I-DERIVED_FROM/TO +asociada, I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +ha I-DERIVED_FROM/TO +presentado I-DERIVED_FROM/TO +crecimiento I-DERIVED_FROM/TO +lento I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +este I-DERIVED_FROM/TO +tiempo. I-DERIVED_FROM/TO +A B-EXPLORATION +simple I-EXPLORATION +vista I-EXPLORATION +impresiona I-EXPLORATION +de I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +o I-EXPLORATION +lipoma, I-EXPLORATION +pero I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +su I-EXPLORATION +localización I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +consistencia I-EXPLORATION +blanda, I-EXPLORATION +elástica I-EXPLORATION +y I-EXPLORATION +móvil I-EXPLORATION +hacen I-EXPLORATION +sospechar I-EXPLORATION +que I-EXPLORATION +pueda I-EXPLORATION +tratarse I-EXPLORATION +de I-EXPLORATION +otro I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +lesión. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +aporta I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +(RMN) I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +otro I-EXPLORATION +centro, I-EXPLORATION +con I-EXPLORATION +informe I-EXPLORATION +de I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +25mm. I-EXPLORATION +en I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +hueso I-EXPLORATION +maxilar I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +inespecífica, I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +fibroso I-EXPLORATION +o I-EXPLORATION +hematoma, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +no I-EXPLORATION +existir I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +traumatismo I-EXPLORATION +facial. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +esta I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +programamos I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +biopsia I-EXPLORATION +en I-EXPLORATION +quirófano, I-EXPLORATION +bajo I-EXPLORATION +anestesia I-EXPLORATION +local, I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +encontramos I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +friabilidad I-EXPLORATION +y I-EXPLORATION +sangrado I-EXPLORATION +en I-EXPLORATION +sábana I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +que I-EXPLORATION +impresiona I-EXPLORATION +de I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +vascular, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +posteriormente I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +que I-EXPLORATION +refiere: I-EXPLORATION +tumoración I-EXPLORATION +mesenquimal I-EXPLORATION +vascular I-EXPLORATION +cuya I-EXPLORATION +morfología I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +inmunohistoquímico I-EXPLORATION +es I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +patrón I-EXPLORATION +observado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemangiopericitoma. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +resultado: I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +CD99 I-EXPLORATION +(difuso), I-EXPLORATION +BCL2, I-EXPLORATION +Betacatenina I-EXPLORATION +(focal I-EXPLORATION +intracitoplasmática) I-EXPLORATION +y I-EXPLORATION +CD34 I-EXPLORATION +(focal I-EXPLORATION +citoplasmática), I-EXPLORATION +y I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +S100, I-EXPLORATION +GLUT-1, I-EXPLORATION +WT1, I-EXPLORATION +AE1, I-EXPLORATION +CD31 I-EXPLORATION +y I-EXPLORATION +Factor I-EXPLORATION +VIII. I-EXPLORATION +El I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +celular I-EXPLORATION +Ki I-EXPLORATION +67 I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +5%. I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +confirmación I-EXPLORATION +diagnóstica I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +haberse I-EXPLORATION +realizado I-EXPLORATION +la I-EXPLORATION +RMN I-EXPLORATION +inicial I-EXPLORATION +en I-EXPLORATION +otro I-EXPLORATION +centro, I-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Radiología I-EXPLORATION +de I-EXPLORATION +nuestro I-EXPLORATION +hospital I-EXPLORATION +nos I-EXPLORATION +recomienda I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +adicional I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +certeza I-EXPLORATION +la I-EXPLORATION +afectación I-EXPLORATION +ósea I-EXPLORATION +de I-EXPLORATION +cara I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cirugía; I-EXPLORATION +este I-EXPLORATION +estudio I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +hipervascular I-EXPLORATION +en I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +premaxilar I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +y I-EXPLORATION +extensión I-EXPLORATION +en I-EXPLORATION +profundidad I-EXPLORATION +hacia I-EXPLORATION +planos I-EXPLORATION +musculares, I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +estructuras I-EXPLORATION +óseas I-EXPLORATION +vecinas.. I-EXPLORATION + I-EXPLORATION +Bajo B-TREATMENT +ese I-TREATMENT +diagnóstico I-TREATMENT +final, I-TREATMENT +intervenimos I-TREATMENT +quirúrgicamente I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +empleando I-TREATMENT +visión I-TREATMENT +de I-TREATMENT +aumento I-TREATMENT +con I-TREATMENT +gafas I-TREATMENT +lupa I-TREATMENT +(x4.3); I-TREATMENT +realizamos I-TREATMENT +extirpación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +en I-TREATMENT +bloque I-TREATMENT +con I-TREATMENT +margen I-TREATMENT +de I-TREATMENT +seguridad I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +2, I-TREATMENT +5cm. I-TREATMENT +e I-TREATMENT +incluyendo I-TREATMENT +la I-TREATMENT +musculatura I-TREATMENT +afectada: I-TREATMENT +porción I-TREATMENT +orbitaria I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +orbicular I-TREATMENT +mayor I-TREATMENT +inferior I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +parcialmente I-TREATMENT +el I-TREATMENT +músculo I-TREATMENT +cigomático I-TREATMENT +menor I-TREATMENT +y I-TREATMENT +el I-TREATMENT +elevador I-TREATMENT +del I-TREATMENT +labio I-TREATMENT +superior, I-TREATMENT +incluidos I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tumor. I-TREATMENT +Identificamos I-TREATMENT +la I-TREATMENT +rama I-TREATMENT +angular I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +facial, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +introduce I-TREATMENT +en I-TREATMENT +el I-TREATMENT +seno I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración, I-TREATMENT +y I-TREATMENT +que I-TREATMENT +ligamos, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +las I-TREATMENT +ramas I-TREATMENT +cigomáticas I-TREATMENT +del I-TREATMENT +nervio I-TREATMENT +facial I-TREATMENT +que I-TREATMENT +quedan I-TREATMENT +en I-TREATMENT +el I-TREATMENT +lecho I-TREATMENT +quirúrgico I-TREATMENT +y I-TREATMENT +que I-TREATMENT +se I-TREATMENT +preservan I-TREATMENT +en I-TREATMENT +su I-TREATMENT +totalidad. I-TREATMENT + I-TREATMENT +Realizamos I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +quirúrgico I-TREATMENT +con I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +avance I-TREATMENT +de I-TREATMENT +mejilla I-TREATMENT +de I-TREATMENT +base I-TREATMENT +ínfero-lateral. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +final I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +hemangiopericitoma I-EXPLORATION +que I-EXPLORATION +respeta I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +quirúrgicos I-EXPLORATION +de I-EXPLORATION +resección, I-EXPLORATION +con I-EXPLORATION +inflamación I-EXPLORATION +gigantocelular I-EXPLORATION +de I-EXPLORATION +cuerpo I-EXPLORATION +extraño I-EXPLORATION +acompañante. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +definitivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +CD34 I-EXPLORATION +difuso, I-EXPLORATION +CD99 I-EXPLORATION +focal, I-EXPLORATION +y I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +S-100, I-EXPLORATION +CD31 I-EXPLORATION +y I-EXPLORATION +factor I-EXPLORATION +VIII, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +celular I-EXPLORATION +Ki-67 I-EXPLORATION +del I-EXPLORATION +5%. I-EXPLORATION + I-EXPLORATION +Presentamos B-TREATMENT +el I-TREATMENT +caso I-TREATMENT +en I-TREATMENT +el I-TREATMENT +Comité I-TREATMENT +de I-TREATMENT +Tumores I-TREATMENT +del I-TREATMENT +hospital, I-TREATMENT +donde I-TREATMENT +en I-TREATMENT +función I-TREATMENT +de I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +postoperatorios, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +que I-TREATMENT +no I-TREATMENT +era I-TREATMENT +necesario I-TREATMENT +realizar I-TREATMENT +ningún I-TREATMENT +tratamiento I-TREATMENT +complementario, I-TREATMENT +solo I-TREATMENT +un I-TREATMENT +seguimiento I-TREATMENT +periódico I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +Tras B-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +postoperatorio, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +buen I-EVOLUTION +resultado I-EVOLUTION +estético I-EVOLUTION +y I-EVOLUTION +funcional, I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +datos I-EVOLUTION +de I-EVOLUTION +recurrencia I-EVOLUTION +ni I-EVOLUTION +clínica I-EVOLUTION +ni I-EVOLUTION +radiológica I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +postoperatorios I-EVOLUTION +realizados I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +fecha. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +traída I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +deformidad I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +2o I-PRESENT_ILLNESS +dedo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +La B-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +sufrió I-PAST_MEDICAL_HISTORY +caída I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +altura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +cm. I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aplastamiento I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cariotipo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +resultado I-PAST_MEDICAL_HISTORY +normal I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +contexto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alteraciones I-PAST_MEDICAL_HISTORY +electroencefalográficas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +plagiocefalia I-PAST_MEDICAL_HISTORY +parietooccipital I-PAST_MEDICAL_HISTORY +resueltas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +Urgencias I-EXPLORATION +observamos I-EXPLORATION +ensanchamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +del I-EXPLORATION +2o I-EXPLORATION +dedo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +interfalángica I-EXPLORATION +proximal, I-EXPLORATION +que I-EXPLORATION +alcanza I-EXPLORATION +los I-EXPLORATION +50 I-EXPLORATION +grados I-EXPLORATION +de I-EXPLORATION +flexión I-EXPLORATION +máxima. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +neurovascular I-EXPLORATION +no I-EXPLORATION +determinó I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION +Efectuamos I-EXPLORATION +también I-EXPLORATION +exploraciones I-EXPLORATION +radiológicas I-EXPLORATION +del I-EXPLORATION +2o I-EXPLORATION +dedo I-EXPLORATION +en I-EXPLORATION +proyecciones I-EXPLORATION +anteroposterior I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +perfil, I-EXPLORATION +que I-EXPLORATION +determinan I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +dicho I-EXPLORATION +dedo I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +volar. I-EXPLORATION + I-EXPLORATION +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +diagnosticada I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +subluxación I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +consultas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Traumatología I-DERIVED_FROM/TO +Infantil I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +control I-DERIVED_FROM/TO +radiográfico. I-DERIVED_FROM/TO +Allí B-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +macroscópico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +del I-EXPLORATION +2o I-EXPLORATION +dedo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +derecha, I-EXPLORATION +y I-EXPLORATION +limitación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +interfalángica I-EXPLORATION +proximal, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +máximo I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +grados. I-EXPLORATION +Acude I-EXPLORATION +con I-EXPLORATION +radiografía I-EXPLORATION +control. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +palmar I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +con I-EXPLORATION +borramiento I-EXPLORATION +del I-EXPLORATION +cartílago I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +a I-EXPLORATION +ese I-EXPLORATION +nivel; I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +proyección I-EXPLORATION +anteroposterior I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +superposición I-EXPLORATION +ósea. I-EXPLORATION +Se I-EXPLORATION +postula I-EXPLORATION +como I-EXPLORATION +posible I-EXPLORATION +diagnóstico I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +fractura I-EXPLORATION +antigua I-EXPLORATION +de I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +con I-EXPLORATION +callo I-EXPLORATION +de I-EXPLORATION +fractura I-EXPLORATION +prominente I-EXPLORATION +y I-EXPLORATION +epifisiodesis. I-EXPLORATION +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +mano I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Plástica I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Reparadora I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +secuela I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +fractura. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +consulta I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Cirugía I-EXPLORATION +Plástica I-EXPLORATION +y I-EXPLORATION +Reparadora I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +cambios I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +descritos I-EXPLORATION +por I-EXPLORATION +Traumatología I-EXPLORATION +Infantil. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +aporta I-EXPLORATION +las I-EXPLORATION +radiografías I-EXPLORATION +que I-EXPLORATION +le I-EXPLORATION +habían I-EXPLORATION +sido I-EXPLORATION +entregadas I-EXPLORATION +en I-EXPLORATION +mano I-EXPLORATION +en I-EXPLORATION +Urgencias I-EXPLORATION +y I-EXPLORATION +Traumatología I-EXPLORATION +Infantil I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +cita I-EXPLORATION +nuevamente I-EXPLORATION +para I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +insiste I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +necesidad I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +aporte I-EXPLORATION +las I-EXPLORATION +radiografías I-EXPLORATION +previas. I-EXPLORATION +Osteocondroma I-EXPLORATION +gigante I-EXPLORATION +de I-EXPLORATION +falange I-EXPLORATION +en I-EXPLORATION +paciente I-EXPLORATION +pediátrico I-EXPLORATION +Cirugía I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +cita I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +siguientes. I-EVOLUTION +Pasado I-EVOLUTION +este I-EVOLUTION +tiempo, I-EVOLUTION +solicita I-EVOLUTION +nuevamente I-EVOLUTION +cita I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +de I-EVOLUTION +Cirugía I-EVOLUTION +Plástica I-EVOLUTION +y I-EVOLUTION +Reparadora I-EVOLUTION +por I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +deformidad I-EVOLUTION +del I-EVOLUTION +dedo. I-EVOLUTION +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +notable I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +del I-EXPLORATION +2o I-EXPLORATION +dedo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +derecha I-EXPLORATION +(macrodactilia). I-EXPLORATION +La I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +es I-EXPLORATION +mayor, I-EXPLORATION +alcanzando I-EXPLORATION +los I-EXPLORATION +20 I-EXPLORATION +grados I-EXPLORATION +de I-EXPLORATION +flexión I-EXPLORATION +máxima. I-EXPLORATION +Solicitamos I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +control. I-EXPLORATION + I-EXPLORATION +Observamos I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +radiografías, I-EXPLORATION +en I-EXPLORATION +proyección I-EXPLORATION +de I-EXPLORATION +perfil, I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +lobulado, I-EXPLORATION +con I-EXPLORATION +distintas I-EXPLORATION +densidades, I-EXPLORATION +que I-EXPLORATION +parece I-EXPLORATION +provenir I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +del I-EXPLORATION +2o I-EXPLORATION +dedo. I-EXPLORATION +La I-EXPLORATION +masa I-EXPLORATION +alcanza I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +proximal. I-EXPLORATION +Asimismo I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +muesca I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +porción I-EXPLORATION +superior. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +proyección I-EXPLORATION +anteroposterior I-EXPLORATION +apreciamos I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +sobrepasa I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +de I-EXPLORATION +anchura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +segunda I-EXPLORATION +falange. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +osteocondroma/encondroma I-EXPLORATION +solicitamos I-EXPLORATION +RM I-EXPLORATION +que I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +exóstosis I-EXPLORATION +lobulada I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +espesor, I-EXPLORATION +con I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +20x20 I-EXPLORATION +mm, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +proximalmente I-EXPLORATION +afectando I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +placa I-EXPLORATION +volar I-EXPLORATION +de I-EXPLORATION +inserción I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +flexor I-EXPLORATION +superficial, I-EXPLORATION +con I-EXPLORATION +desplazamiento I-EXPLORATION +del I-EXPLORATION +tendón I-EXPLORATION +flexor I-EXPLORATION +profundo I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +de I-EXPLORATION +anclaje I-EXPLORATION +de I-EXPLORATION +poleas, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +osteocondroma. I-EXPLORATION + I-EXPLORATION +Estadiamos I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +empleando I-EXPLORATION +la I-EXPLORATION +clasificación I-EXPLORATION +de I-EXPLORATION +Enneking I-EXPLORATION +y I-EXPLORATION +determinamos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +estadio I-EXPLORATION +III, I-EXPLORATION +lesión I-EXPLORATION +benigna I-EXPLORATION +agresiva: I-EXPLORATION +lesión I-EXPLORATION +benigna I-EXPLORATION +de I-EXPLORATION +baja I-EXPLORATION +agresividad I-EXPLORATION +(G0), I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inserción I-EXPLORATION +perióstica I-EXPLORATION +del I-EXPLORATION +extensor I-EXPLORATION +superficial I-EXPLORATION +(extracompartimental) I-EXPLORATION +(T2) I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +metástasis I-EXPLORATION +(M0). I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +alteración I-TREATMENT +funcional I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +el I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +tumoral, I-TREATMENT +decidimos I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +efectuamos I-TREATMENT +acceso I-TREATMENT +a I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +mediante I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +Brunner I-TREATMENT +en I-TREATMENT +zig-zag I-TREATMENT +evitando I-TREATMENT +así I-TREATMENT +la I-TREATMENT +sección I-TREATMENT +transversal I-TREATMENT +de I-TREATMENT +los I-TREATMENT +pliegues I-TREATMENT +palmares I-TREATMENT +que I-TREATMENT +pudiera I-TREATMENT +generar I-TREATMENT +futuras I-TREATMENT +retracciones. I-TREATMENT +Localizamos I-TREATMENT +el I-TREATMENT +tendón I-TREATMENT +flexor I-TREATMENT +superficial I-TREATMENT +y I-TREATMENT +colocamos I-TREATMENT +la I-TREATMENT +articulación I-TREATMENT +metacarpofalángica I-TREATMENT +del I-TREATMENT +2o I-TREATMENT +dedo, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +la I-TREATMENT +muñeca, I-TREATMENT +en I-TREATMENT +flexión I-TREATMENT +máxima I-TREATMENT +para I-TREATMENT +alcanzar I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +más I-TREATMENT +proximal I-TREATMENT +del I-TREATMENT +tendón I-TREATMENT +flexor I-TREATMENT +superficial. I-TREATMENT +Lo I-TREATMENT +seccionamos, I-TREATMENT +elegiendo I-TREATMENT +realizar I-TREATMENT +dicha I-TREATMENT +sección I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +proximal I-TREATMENT +para I-TREATMENT +prevenir I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +del I-TREATMENT +fenómeno I-TREATMENT +conocido I-TREATMENT +como I-TREATMENT +Cuádriga I-TREATMENT +de I-TREATMENT +Verdán, I-TREATMENT +entendido I-TREATMENT +como I-TREATMENT +alteración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +flexión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +articulación I-TREATMENT +metacarpofalángica I-TREATMENT +por I-TREATMENT +adhesión I-TREATMENT +en I-TREATMENT +una I-TREATMENT +articulación I-TREATMENT +del I-TREATMENT +cabo I-TREATMENT +proximal I-TREATMENT +de I-TREATMENT +un I-TREATMENT +tendón I-TREATMENT +tras I-TREATMENT +su I-TREATMENT +sección. I-TREATMENT +Mediante I-TREATMENT +escoplo, I-TREATMENT +escindimos I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +que I-TREATMENT +sobresalía I-TREATMENT +de I-TREATMENT +la I-TREATMENT +falange I-TREATMENT +sana I-TREATMENT +y I-TREATMENT +una I-TREATMENT +porción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cortical I-TREATMENT +adyacente. I-TREATMENT +Seguidamente I-TREATMENT +practicamos I-TREATMENT +curetaje I-TREATMENT +mediante I-TREATMENT +cucharilla I-TREATMENT +de I-TREATMENT +la I-TREATMENT +médula I-TREATMENT +y I-TREATMENT +del I-TREATMENT +tejido I-TREATMENT +óseo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +superficie I-TREATMENT +dorsal. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +la I-TREATMENT +reconstrucción: I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +generada I-TREATMENT +empleamos I-TREATMENT +material I-TREATMENT +osteoconductor I-TREATMENT +(Actifuse I-TREATMENT +Abx I-TREATMENT +Silicated I-TREATMENT +Calcium I-TREATMENT +Phosphate®, I-TREATMENT +BioSurgery, I-TREATMENT +EE. I-TREATMENT +UU). I-TREATMENT +Efectuamos I-TREATMENT +inmovilización I-TREATMENT +mediante I-TREATMENT +férula I-TREATMENT +dorsal I-TREATMENT +de I-TREATMENT +yeso I-TREATMENT +desde I-TREATMENT +tercio I-TREATMENT +proximal I-TREATMENT +del I-TREATMENT +antebrazo I-TREATMENT +hasta I-TREATMENT +final I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dedos, I-TREATMENT +con I-TREATMENT +muñeca I-TREATMENT +en I-TREATMENT +40o I-TREATMENT +de I-TREATMENT +flexión I-TREATMENT +palmar, I-TREATMENT +articulaciones I-TREATMENT +metacarpofalángicas I-TREATMENT +en I-TREATMENT +90o I-TREATMENT +y I-TREATMENT +articulaciones I-TREATMENT +interfalángicas I-TREATMENT +en I-TREATMENT +extensión. I-TREATMENT +Mantuvimos B-EVOLUTION +la I-EVOLUTION +inmovilización I-EVOLUTION +durante I-EVOLUTION +3 I-EVOLUTION +semanas, I-EVOLUTION +tras I-EVOLUTION +las I-EVOLUTION +cuales I-EVOLUTION +no I-EVOLUTION +fue I-EVOLUTION +necesaria I-EVOLUTION +la I-EVOLUTION +rehabilitación I-EVOLUTION +dada I-EVOLUTION +la I-EVOLUTION +edad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +movilidad I-EVOLUTION +postoperatoria I-EVOLUTION +que I-EVOLUTION +presentaba. I-EVOLUTION + I-EVOLUTION +Practicamos I-EVOLUTION +radiografía I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +anual I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +movilidad I-EVOLUTION +completa I-EVOLUTION +tras I-EVOLUTION +3 I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +bronquial. I-PAST_MEDICAL_HISTORY +En B-TREATMENT +revisión I-TREATMENT +ginecológica I-TREATMENT +periódica I-TREATMENT +se I-TREATMENT +le I-TREATMENT +diagnostica I-TREATMENT +carcinoma I-TREATMENT +ductal I-TREATMENT +infiltrante I-TREATMENT +de I-TREATMENT +mama I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +es I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +mastectomía I-TREATMENT +radical I-TREATMENT +modificada I-TREATMENT +con I-TREATMENT +vaciamiento I-TREATMENT +axilar I-TREATMENT +por I-TREATMENT +el I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Cirugía I-TREATMENT +General, I-TREATMENT +recibiendo I-TREATMENT +tratamiento I-TREATMENT +adyuvante I-TREATMENT +con I-TREATMENT +radioterapia I-TREATMENT +y I-TREATMENT +quimioterapia. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +resultó I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +adenopatías I-EXPLORATION +locorregionales I-EXPLORATION +y I-EXPLORATION +metástasis I-EXPLORATION +a I-EXPLORATION +distancia I-EXPLORATION +(pT3pN0M0). I-EXPLORATION +Al B-DERIVED_FROM/TO +finalizar I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +solicita I-DERIVED_FROM/TO +reconstrucción I-DERIVED_FROM/TO +mamaria, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Plástica. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-TREATMENT +los I-TREATMENT +4 I-TREATMENT +años I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mastectomía I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +mamaria I-TREATMENT +con I-TREATMENT +diversos I-TREATMENT +procedimientos I-TREATMENT +que I-TREATMENT +describimos I-TREATMENT +a I-TREATMENT +continuación. I-TREATMENT +En I-TREATMENT +primer I-TREATMENT +lugar I-TREATMENT +reconstrucción I-TREATMENT +de I-TREATMENT +mama I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +miocutáneo I-TREATMENT +de I-TREATMENT +recto I-TREATMENT +abdominal I-TREATMENT +transverso I-TREATMENT +(TRAM), I-TREATMENT +sufriendo I-TREATMENT +pérdida I-TREATMENT +parcial I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +resolvió I-TREATMENT +con I-TREATMENT +desbridamiento I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +directo. I-TREATMENT +Dos I-TREATMENT +años I-TREATMENT +después I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +prótesis I-TREATMENT +expansora I-TREATMENT +de I-TREATMENT +Becker I-TREATMENT +subTRAM I-TREATMENT +y I-TREATMENT +finalmente, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +recambio I-TREATMENT +del I-TREATMENT +expansor I-TREATMENT +por I-TREATMENT +prótesis I-TREATMENT +mamaria I-TREATMENT +definitiva I-TREATMENT +y I-TREATMENT +mastopexia I-TREATMENT +simetrizadora I-TREATMENT +de I-TREATMENT +mama I-TREATMENT +contralateral, I-TREATMENT +quedando I-TREATMENT +pendiente I-TREATMENT +de I-TREATMENT +completar I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +del I-TREATMENT +complejo I-TREATMENT +areola I-TREATMENT +pezón I-TREATMENT +(CAP). I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +última I-EVOLUTION +intervención I-EVOLUTION +comienza I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +periareolar I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +derecha I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +centro I-EVOLUTION +del I-EVOLUTION +colgajo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +izquierda I-EVOLUTION +de I-EVOLUTION +pequeñas I-EVOLUTION +lesiones I-EVOLUTION +pustulosas I-EVOLUTION +con I-EVOLUTION +posterior I-EVOLUTION +desarrollo I-EVOLUTION +de I-EVOLUTION +úlceras I-EVOLUTION +dolorosas I-EVOLUTION +de I-EVOLUTION +borde I-EVOLUTION +violáceo I-EVOLUTION +y I-EVOLUTION +fondo I-EVOLUTION +con I-EVOLUTION +tejido I-EVOLUTION +de I-EVOLUTION +granulación,. I-EVOLUTION + I-EVOLUTION +Con B-EXPLORATION +el I-EXPLORATION +presunto I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +dehiscencia I-EXPLORATION +de I-EXPLORATION +herida I-EXPLORATION +quirúrgica I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +biopsia I-EXPLORATION +que I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +granulación, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +curas I-TREATMENT +con I-TREATMENT +desbridamiento I-TREATMENT +durante I-TREATMENT +más I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +meses. I-TREATMENT +Dada B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +mala I-DERIVED_FROM/TO +evolución, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +interconsulta I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Dermatología, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +ante I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +inicial I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +pioderma I-DERIVED_FROM/TO +gangrenoso, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realiza I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +exhaustivo I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +descartar I-DERIVED_FROM/TO +otros I-DERIVED_FROM/TO +procesos. I-DERIVED_FROM/TO +Se B-EXPLORATION +solicitaron I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +pruebas: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Analítica, I-EXPLORATION +incluyendo I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +autoinmunidad I-EXPLORATION +(ANAs I-EXPLORATION +y I-EXPLORATION +ENAs) I-EXPLORATION +y I-EXPLORATION +proteinograma: I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +patológicas. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Serología I-EXPLORATION +luética, I-EXPLORATION +virus I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +VIH: I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Mantoux: I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +engrosamiento I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +bronquiales; I-EXPLORATION +cambios I-EXPLORATION +quirúrgicos I-EXPLORATION +en I-EXPLORATION +mama I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +grapas I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +axilar. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Biopsia I-EXPLORATION +con I-EXPLORATION +técnicas I-EXPLORATION +de I-EXPLORATION +PAS, I-EXPLORATION +Grocott I-EXPLORATION +y I-EXPLORATION +Ziehl- I-EXPLORATION +Neelsen: I-EXPLORATION +ulceración I-EXPLORATION +epidérmica I-EXPLORATION +focal I-EXPLORATION +con I-EXPLORATION +abscesificación I-EXPLORATION +dérmica I-EXPLORATION +y I-EXPLORATION +folicular, I-EXPLORATION +inflamación I-EXPLORATION +crónica I-EXPLORATION +linfohistiocitaria I-EXPLORATION +y I-EXPLORATION +plasmocitaria I-EXPLORATION +adyacente I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +perivascular I-EXPLORATION +en I-EXPLORATION +dermis I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +profunda. I-EXPLORATION +Hallazgos I-EXPLORATION +histopatológicos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +pioderma I-EXPLORATION +gangrenoso I-EXPLORATION +clásico I-EXPLORATION +o I-EXPLORATION +ulcerado. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Cultivo I-EXPLORATION +biopsia I-EXPLORATION +(aerobio, I-EXPLORATION +anaerobio, I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +micobacterias): I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +exclusión I-TREATMENT +de I-TREATMENT +pioderma I-TREATMENT +gangrenoso I-TREATMENT +clásico, I-TREATMENT +iniciamos I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +oral I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +60 I-TREATMENT +mg/día I-TREATMENT +asociando I-TREATMENT +propionato I-TREATMENT +de I-TREATMENT +clobetasol I-TREATMENT +0, I-TREATMENT +05% I-TREATMENT +tópico I-TREATMENT +durante I-TREATMENT +3 I-TREATMENT +meses. I-TREATMENT +Al I-TREATMENT +reducir I-TREATMENT +la I-TREATMENT +pauta I-TREATMENT +esteroidea I-TREATMENT +a I-TREATMENT +30 I-TREATMENT +mg/día I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +comenzó I-TREATMENT +con I-TREATMENT +un I-TREATMENT +rebrote I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +decidimos I-TREATMENT +asociar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ciclosporina I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +mg/Kg I-TREATMENT +de I-TREATMENT +peso, I-TREATMENT +sustituir I-TREATMENT +los I-TREATMENT +corticoides I-TREATMENT +tópicos I-TREATMENT +por I-TREATMENT +tacrolimus I-TREATMENT +0, I-TREATMENT +1% I-TREATMENT +tópico I-TREATMENT +y I-TREATMENT +reducir I-TREATMENT +también I-TREATMENT +paulatinamente I-TREATMENT +la I-TREATMENT +prednisona I-TREATMENT +hasta I-TREATMENT +su I-TREATMENT +suspensión I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +periodo I-TREATMENT +de I-TREATMENT +mes I-TREATMENT +y I-TREATMENT +medio. I-TREATMENT + I-TREATMENT +Inicialmente, B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +experimenta I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable I-EVOLUTION +salvo I-EVOLUTION +hipertensión I-EVOLUTION +controlada I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +diurético I-EVOLUTION +tiazídico I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +consigue I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +reepitelización I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones; I-EVOLUTION +pero I-EVOLUTION +tras I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +ciclosporina I-EVOLUTION +comienza I-EVOLUTION +con I-EVOLUTION +efectos I-EVOLUTION +secundarios I-EVOLUTION +muy I-EVOLUTION +molestos: I-EVOLUTION +hiperplasia I-EVOLUTION +gingival, I-EVOLUTION +hipertricosis, I-EVOLUTION +hirsutismo I-EVOLUTION +y I-EVOLUTION +disestesias I-EVOLUTION +que I-EVOLUTION +nos I-EVOLUTION +obligan I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +reducción I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +tratamiento, I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +tiene I-EVOLUTION +como I-EVOLUTION +consecuencia I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +rebrote I-EVOLUTION +de I-EVOLUTION +pequeñas I-EVOLUTION +lesiones I-EVOLUTION +pustulosas I-EVOLUTION +que B-TREATMENT +infiltramos I-TREATMENT +con I-TREATMENT +triamcinolona I-TREATMENT +a I-TREATMENT +la I-TREATMENT +vez I-TREATMENT +que I-TREATMENT +retiramos I-TREATMENT +el I-TREATMENT +tacrolimus I-TREATMENT +tópico. I-TREATMENT +La I-TREATMENT +intolerancia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +a I-TREATMENT +los I-TREATMENT +efectos I-TREATMENT +secundarios I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ciclosporina, I-TREATMENT +nos I-TREATMENT +obligó I-TREATMENT +a I-TREATMENT +su I-TREATMENT +suspensión I-TREATMENT +completa I-TREATMENT +tras I-TREATMENT +4 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT + I-TREATMENT +Finalmente, I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +nuevas I-TREATMENT +lesiones I-TREATMENT +y I-TREATMENT +la I-TREATMENT +mala I-TREATMENT +tolerancia I-TREATMENT +a I-TREATMENT +los I-TREATMENT +tratamientos I-TREATMENT +previos, I-TREATMENT +optamos I-TREATMENT +por I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +infliximab I-TREATMENT +(agente I-TREATMENT +anti-TNF), I-TREATMENT +comenzando I-TREATMENT +con I-TREATMENT +una I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +inducción I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mg/kg I-TREATMENT +a I-TREATMENT +las I-TREATMENT +0, I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +semanas I-TREATMENT +similar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +empleada I-TREATMENT +en I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +inflamatoria I-TREATMENT +intestinal I-TREATMENT +o I-TREATMENT +en I-TREATMENT +la I-TREATMENT +psoriasis, I-TREATMENT +continuando I-TREATMENT +con I-TREATMENT +infusiones I-TREATMENT +de I-TREATMENT +mantenimiento I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +semanas. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +satisfactoria I-EVOLUTION +con I-EVOLUTION +reepitelización I-EVOLUTION +completa I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +nuevo I-EVOLUTION +tratamiento, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +decidimos I-TREATMENT +mantener I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +similar I-TREATMENT +al I-TREATMENT +de I-TREATMENT +otras I-TREATMENT +dermatosis I-TREATMENT +inflamatorias I-TREATMENT +hasta I-TREATMENT +objetivar I-TREATMENT +estabilización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad, I-TREATMENT +tras I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +nos I-TREATMENT +plantearemos I-TREATMENT +reducir, I-TREATMENT +con I-TREATMENT +espaciamiento I-TREATMENT +progresivo I-TREATMENT +de I-TREATMENT +las I-TREATMENT +dosis. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +neonato I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +sufre I-PRESENT_ILLNESS +cefalohematoma I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +parto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fórceps. I-PRESENT_ILLNESS +La B-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Neonatología I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +hospitalario I-DERIVED_FROM/TO +solicita I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Plástica. I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +observamos I-EXPLORATION +tejido I-EXPLORATION +necrótico I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +3x4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +occipital. I-EXPLORATION + I-EXPLORATION +Procedimos B-TREATMENT +a I-TREATMENT +desbridamientos I-TREATMENT +seriados I-TREATMENT +que I-TREATMENT +se I-TREATMENT +llevaron I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +a I-TREATMENT +los I-TREATMENT +8 I-TREATMENT +y I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT +En I-TREATMENT +esa I-TREATMENT +segunda I-TREATMENT +intervención, I-TREATMENT +optamos I-TREATMENT +por I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +sistema I-TREATMENT +de I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +vacío I-TREATMENT +(Renasys®, I-TREATMENT +Smith&Nephew®, I-TREATMENT +Londres, I-TREATMENT +Reino I-TREATMENT +Unido) I-TREATMENT +de I-TREATMENT +modo I-TREATMENT +continuo, I-TREATMENT +a I-TREATMENT +120 I-TREATMENT +mmHg I-TREATMENT +durante I-TREATMENT +20 I-TREATMENT +días, I-TREATMENT +con I-TREATMENT +cambios I-TREATMENT +de I-TREATMENT +apósitos I-TREATMENT +cada I-TREATMENT +72 I-TREATMENT +horas. I-TREATMENT +Con I-TREATMENT +este I-TREATMENT +tratamiento I-TREATMENT +observamos I-TREATMENT +contracción I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +original, I-TREATMENT +procediendo I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +colgajos I-TREATMENT +rotacionales I-TREATMENT +para I-TREATMENT +el I-TREATMENT +cierre I-TREATMENT +definitivo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +4o I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +postoperatorio, I-EVOLUTION +sin I-EVOLUTION +mayores I-EVOLUTION +incidencias. I-EVOLUTION +La I-EVOLUTION +última I-EVOLUTION +valoración I-EVOLUTION +fue I-EVOLUTION +realizada I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +postoperatorio, I-EVOLUTION +observando I-EVOLUTION +solo I-EVOLUTION +una I-EVOLUTION +pequeña I-EVOLUTION +zona I-EVOLUTION +de I-EVOLUTION +alopecia I-EVOLUTION +cicatricial I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +una I-EVOLUTION +brida I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +nuca, I-EVOLUTION +susceptibles I-EVOLUTION +de I-EVOLUTION +nuevas I-EVOLUTION +intervenciones I-EVOLUTION +quirúrgicas I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +futuro I-EVOLUTION +si I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +o I-EVOLUTION +la I-EVOLUTION +familia I-EVOLUTION +lo I-EVOLUTION +requieren. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +recién I-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gestación, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +Pediatría I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +malformación I-DERIVED_FROM/TO +linfática I-DERIVED_FROM/TO +microquística I-DERIVED_FROM/TO +cérvicoescápulo- I-DERIVED_FROM/TO +humeral. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-TREATMENT +los I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +punción I-TREATMENT +y I-TREATMENT +evacuación I-TREATMENT +del I-TREATMENT +linfangioma I-TREATMENT +con I-TREATMENT +posterior I-TREATMENT +instilación I-TREATMENT +de I-TREATMENT +polidocanol I-TREATMENT +y I-TREATMENT +etanol. I-TREATMENT +Se I-TREATMENT +repitió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +5 I-TREATMENT +días I-TREATMENT +después. I-TREATMENT +De I-TREATMENT +los I-TREATMENT +7 I-TREATMENT +drenajes I-TREATMENT +colocados, I-TREATMENT +1 I-TREATMENT +de I-TREATMENT +localización I-TREATMENT +axilar I-TREATMENT +fue I-TREATMENT +retirado I-TREATMENT +a I-TREATMENT +los I-TREATMENT +3 I-TREATMENT +días I-TREATMENT +por I-TREATMENT +aparente I-TREATMENT +sufrimiento I-TREATMENT +cutáneo. I-TREATMENT + I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +infiltración I-EVOLUTION +observamos I-EVOLUTION +herida I-EVOLUTION +superficial I-EVOLUTION +de I-EVOLUTION +3x10 I-EVOLUTION +cm I-EVOLUTION +de I-EVOLUTION +diámetro, I-EVOLUTION +que I-EVOLUTION +afecta I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +humeral I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +superficie I-EVOLUTION +anterior I-EVOLUTION +del I-EVOLUTION +tórax, I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +extravasación I-EVOLUTION +por I-EVOLUTION +punta I-EVOLUTION +del I-EVOLUTION +catéter I-EVOLUTION +de I-EVOLUTION +instilación I-EVOLUTION +de I-EVOLUTION +polidocanol. I-EVOLUTION +La B-TREATMENT +lesión I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +curas I-TREATMENT +con I-TREATMENT +apósitos I-TREATMENT +de I-TREATMENT +hidrocoloide. I-TREATMENT +Una I-TREATMENT +semana I-TREATMENT +después, I-TREATMENT +procedimos I-TREATMENT +a I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +sistema I-TREATMENT +de I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +vacío I-TREATMENT +(Renasys®, I-TREATMENT +Smith&Nephew®, I-TREATMENT +Londres, I-TREATMENT +Reino I-TREATMENT +Unido) I-TREATMENT +a I-TREATMENT +100 I-TREATMENT +mmHg, I-TREATMENT +en I-TREATMENT +modo I-TREATMENT +continuo, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +finalidad I-TREATMENT +de I-TREATMENT +acelerar I-TREATMENT +el I-TREATMENT +cierre I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +y I-TREATMENT +controlar I-TREATMENT +la I-TREATMENT +linforrea. I-TREATMENT +Los I-TREATMENT +cambios I-TREATMENT +de I-TREATMENT +apósitos I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +cada I-TREATMENT +72 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +vacío I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +durante I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +hospitalizado I-EVOLUTION +hasta I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con B-TREATMENT +curas I-TREATMENT +domiciliarias I-TREATMENT +con I-TREATMENT +Aquacel® I-TREATMENT +Ag I-TREATMENT +(ConvaTec®, I-TREATMENT +Reino I-TREATMENT +Unido), I-TREATMENT +hasta I-TREATMENT +lograr I-TREATMENT +el I-TREATMENT +cierre I-TREATMENT +total I-TREATMENT +y I-TREATMENT +estable I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +ambulatoria. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +11 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +masa I-EVOLUTION +persistente, I-EVOLUTION +fundamentalmente I-EVOLUTION +a I-EVOLUTION +expensas I-EVOLUTION +de I-EVOLUTION +hipertrofia I-EVOLUTION +del I-EVOLUTION +tejido I-EVOLUTION +celular I-EVOLUTION +subcutáneo, I-EVOLUTION +con I-EVOLUTION +lesiones I-EVOLUTION +quísticas I-EVOLUTION +residuales I-EVOLUTION +de I-EVOLUTION +predominio I-EVOLUTION +microquístico I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +superficie I-EVOLUTION +medial I-EVOLUTION +del I-EVOLUTION +brazo I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +pared I-EVOLUTION +torácica. I-EVOLUTION +Dado B-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +está I-TREATMENT +asintomático, I-TREATMENT +tras I-TREATMENT +consultar I-TREATMENT +con I-TREATMENT +la I-TREATMENT +familia I-TREATMENT +decidimos I-TREATMENT +mantener I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +conservador I-TREATMENT +y I-TREATMENT +valorar I-TREATMENT +su I-TREATMENT +evolución I-TREATMENT +con I-TREATMENT +la I-TREATMENT +edad. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +resección I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +paredes I-PRESENT_ILLNESS +laterales I-PRESENT_ILLNESS +nasales I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +basocelular I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +focos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +nasal. I-PRESENT_ILLNESS +Reconstrucción B-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +frontal I-TREATMENT +paramediano I-TREATMENT +con I-TREATMENT +base I-TREATMENT +estrecha I-TREATMENT +después I-TREATMENT +de I-TREATMENT +conocer I-TREATMENT +los I-TREATMENT +límites I-TREATMENT +quirúrgicos I-TREATMENT +negativos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +biopsia I-TREATMENT +por I-TREATMENT +congelación. I-TREATMENT +Autonomización B-EVOLUTION +del I-EVOLUTION +colgajo I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +3 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Dermatología I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +carcinoma I-DERIVED_FROM/TO +basocelular I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +columela I-DERIVED_FROM/TO +nasal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +años I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución. I-DERIVED_FROM/TO +Tras B-TREATMENT +resección I-TREATMENT +tumoral I-TREATMENT +con I-TREATMENT +límites I-TREATMENT +negativos I-TREATMENT +en I-TREATMENT +la I-TREATMENT +biopsia I-TREATMENT +por I-TREATMENT +congelación, I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +reconstrucción I-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +frontal I-TREATMENT +paramediano I-TREATMENT +izquierdo I-TREATMENT +de I-TREATMENT +base I-TREATMENT +estrecha I-TREATMENT +prolongado I-TREATMENT +hacia I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +lado. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +colgajo I-EVOLUTION +quedó I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +ligera I-EVOLUTION +tensión, I-EVOLUTION +pero I-EVOLUTION +esto I-EVOLUTION +no I-EVOLUTION +produjo I-EVOLUTION +ningún I-EVOLUTION +sufrimiento I-EVOLUTION +ni I-EVOLUTION +necrosis I-EVOLUTION +del I-EVOLUTION +mismo. I-EVOLUTION +Se I-EVOLUTION +autonomizó I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +3 I-EVOLUTION +semanas I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +quedar I-EVOLUTION +un I-EVOLUTION +poco I-EVOLUTION +redundante, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +mostró I-EVOLUTION +satisfecha I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +quiso I-EVOLUTION +otro I-EVOLUTION +procedimiento. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que B-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +elefantiasis I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +extremidad I-PAST_MEDICAL_HISTORY +inferior I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +linfedema I-PAST_MEDICAL_HISTORY +congénito I-PAST_MEDICAL_HISTORY +primario I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +agenesia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vasos I-PAST_MEDICAL_HISTORY +linfáticos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +hemicuerpo I-PAST_MEDICAL_HISTORY +izquierdo. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +diagnostica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +primera I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +raíz I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +observación I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +perímetro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +extremidad I-PAST_MEDICAL_HISTORY +respecto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +contralateral, I-PAST_MEDICAL_HISTORY +iniciándose I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +medidas I-PAST_MEDICAL_HISTORY +físicas I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +local I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +patología. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ya I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +pubertad, I-PAST_MEDICAL_HISTORY +evoluciona I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +elefantiasis I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +importante I-PAST_MEDICAL_HISTORY +limitación I-PAST_MEDICAL_HISTORY +funcional I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +imposibilita I-PAST_MEDICAL_HISTORY +deambular, I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +preciso I-PAST_MEDICAL_HISTORY +iniciar I-PAST_MEDICAL_HISTORY +tandas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antibioticoterapia I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +menos I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +vez I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cuadros I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +linfangitis. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +periodo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +llega I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sufrir I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +perímetro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pierna I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +102 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +llegando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +180 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +constata I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +frecuencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +linfangitis I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +mínimo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +mensual, I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +finalmente I-PRESENT_ILLNESS +obliga I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +replantear I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +evaluación I-EXPLORATION +radiológica I-EXPLORATION +mediante I-EXPLORATION +linfografía I-EXPLORATION +demuestra I-EXPLORATION +ausencia I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +drenaje I-EXPLORATION +linfático I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +drenaje I-EXPLORATION +linfático I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +superior I-EXPLORATION +izquierda. I-EXPLORATION +La I-EXPLORATION +tomografia I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +muestra I-EXPLORATION +hipertrofia I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +subcutáneo. I-EXPLORATION + I-EXPLORATION +Una B-TREATMENT +vez I-TREATMENT +constatado I-TREATMENT +el I-TREATMENT +avanzado I-TREATMENT +estado I-TREATMENT +clínico I-TREATMENT +y I-TREATMENT +radiológico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +patología I-TREATMENT +y I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +respuesta I-TREATMENT +clínica I-TREATMENT +a I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +conservadoras, I-TREATMENT +se I-TREATMENT +propone I-TREATMENT +practicar I-TREATMENT +cirugía I-TREATMENT +escisional I-TREATMENT +según I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +Charles. I-TREATMENT + I-TREATMENT +En I-TREATMENT +un I-TREATMENT +primer I-TREATMENT +tiempo I-TREATMENT +quirúrgico I-TREATMENT +realizamos I-TREATMENT +una I-TREATMENT +escisión I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +piel I-TREATMENT +y I-TREATMENT +tejido I-TREATMENT +celular I-TREATMENT +subcutáneo I-TREATMENT +en I-TREATMENT +todo I-TREATMENT +su I-TREATMENT +espesor, I-TREATMENT +respetando I-TREATMENT +la I-TREATMENT +fascia I-TREATMENT +muscular, I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +tobillo I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +raíz I-TREATMENT +del I-TREATMENT +muslo I-TREATMENT +y I-TREATMENT +cobertura I-TREATMENT +mediante I-TREATMENT +autoinjertos I-TREATMENT +de I-TREATMENT +espesor I-TREATMENT +parcial I-TREATMENT +mallados I-TREATMENT +1: I-TREATMENT +1.5 I-TREATMENT +aprovechando I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +muslo I-TREATMENT +izquierdo. I-TREATMENT +Tras I-TREATMENT +20 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +ingreso I-TREATMENT +hospitalario I-TREATMENT +y I-TREATMENT +curas, I-TREATMENT +realizamos I-TREATMENT +una I-TREATMENT +segunda I-TREATMENT +intervención I-TREATMENT +para I-TREATMENT +cubrir I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +cruentas I-TREATMENT +dispersas I-TREATMENT +residuales I-TREATMENT +en I-TREATMENT +el I-TREATMENT +3% I-TREATMENT +de I-TREATMENT +superficie I-TREATMENT +corporal I-TREATMENT +total. I-TREATMENT +Obtuvimos I-TREATMENT +los I-TREATMENT +injertos I-TREATMENT +del I-TREATMENT +muslo I-TREATMENT +derecho, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +aplicaron I-TREATMENT +mallados I-TREATMENT +1: I-TREATMENT +1.5. I-TREATMENT +En B-EVOLUTION +una I-EVOLUTION +semana, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +31 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +ingreso, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +los I-EVOLUTION +injertos I-EVOLUTION +prendidos I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +mayoría, I-EVOLUTION +quedando I-EVOLUTION +aun I-EVOLUTION +así I-EVOLUTION +zonas I-EVOLUTION +residuales I-EVOLUTION +dispersas I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +superficie I-EVOLUTION +inferior I-EVOLUTION +al I-EVOLUTION +0.5%. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +área I-EVOLUTION +tratada I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +fue I-EVOLUTION +muy I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +zonas I-EVOLUTION +cruentas I-EVOLUTION +residuales I-EVOLUTION +en I-EVOLUTION +3 I-EVOLUTION +semanas. I-EVOLUTION +Iniciamos B-TREATMENT +presoterapia I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +en I-TREATMENT +todo I-TREATMENT +momento I-TREATMENT +la I-TREATMENT +fisioterapia. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +observamos I-EVOLUTION +un I-EVOLUTION +aumento I-EVOLUTION +progresivo I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +dorso I-EVOLUTION +del I-EVOLUTION +pie I-EVOLUTION +izquierdo, I-EVOLUTION +además I-EVOLUTION +de I-EVOLUTION +pequeñas I-EVOLUTION +erosiones I-EVOLUTION +cutáneas I-EVOLUTION +debidas I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +fricción I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +prendas I-EVOLUTION +de I-EVOLUTION +presoterapia, I-EVOLUTION +que I-EVOLUTION +evolucionaron I-EVOLUTION +favorablemente I-EVOLUTION +con B-TREATMENT +curas I-TREATMENT +tópicas. I-TREATMENT + I-TREATMENT +A I-TREATMENT +los I-TREATMENT +7 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +cirugía I-TREATMENT +procedimos I-TREATMENT +a I-TREATMENT +intervenir I-TREATMENT +quirúrgicamente I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +para I-TREATMENT +tratar I-TREATMENT +el I-TREATMENT +linfedema I-TREATMENT +residual I-TREATMENT +del I-TREATMENT +dorso I-TREATMENT +del I-TREATMENT +pie. I-TREATMENT +De I-TREATMENT +igual I-TREATMENT +modo, I-TREATMENT +llevaremos I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +según I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +Charles I-TREATMENT +escisión I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +piel I-TREATMENT +y I-TREATMENT +tejido I-TREATMENT +subcutáneo I-TREATMENT +del I-TREATMENT +dorso I-TREATMENT +del I-TREATMENT +pie I-TREATMENT +izquierdo, I-TREATMENT +preservando I-TREATMENT +la I-TREATMENT +fascia I-TREATMENT +profunda, I-TREATMENT +y I-TREATMENT +cobertura I-TREATMENT +del I-TREATMENT +área I-TREATMENT +cruenta I-TREATMENT +mediante I-TREATMENT +autoinjertos I-TREATMENT +de I-TREATMENT +espesor I-TREATMENT +parcial I-TREATMENT +mallados I-TREATMENT +1: I-TREATMENT +1.5 I-TREATMENT +obtenidos I-TREATMENT +del I-TREATMENT +muslo I-TREATMENT +derecho. I-TREATMENT +En B-EVOLUTION +6 I-EVOLUTION +días I-EVOLUTION +los I-EVOLUTION +injertos I-EVOLUTION +estaban I-EVOLUTION +prendidos I-EVOLUTION +y I-EVOLUTION +estables I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +recibió I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +hospitalaria. I-EVOLUTION + I-EVOLUTION +Pasados I-EVOLUTION +3 I-EVOLUTION +años I-EVOLUTION +con I-EVOLUTION +controles I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +ambulatoria I-EVOLUTION +en I-EVOLUTION +intervalos I-EVOLUTION +de I-EVOLUTION +aproximadamente I-EVOLUTION +2 I-EVOLUTION +meses, I-EVOLUTION +persiste I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +errática I-EVOLUTION +de I-EVOLUTION +áreas I-EVOLUTION +cruentas I-EVOLUTION +irritativas I-EVOLUTION +con I-EVOLUTION +exudado I-EVOLUTION +no I-EVOLUTION +purulento I-EVOLUTION +que B-TREATMENT +se I-TREATMENT +van I-TREATMENT +controlando I-TREATMENT +con I-TREATMENT +curas I-TREATMENT +tópicas I-TREATMENT +en I-TREATMENT +las I-TREATMENT +que I-TREATMENT +se I-TREATMENT +alterna I-TREATMENT +sulfadiazina I-TREATMENT +argéntica, I-TREATMENT +nitrofurazona I-TREATMENT +y I-TREATMENT +solución I-TREATMENT +yodada. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +extremidad I-EVOLUTION +funcional I-EVOLUTION +con I-EVOLUTION +dimensiones I-EVOLUTION +muy I-EVOLUTION +cercanas I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +contralateral I-EVOLUTION +sana I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +linfangitis I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +fecha. I-EVOLUTION +Sigue B-TREATMENT +realizando I-TREATMENT +presoterapia, I-TREATMENT +rehabilitación I-TREATMENT +y I-TREATMENT +medidas I-TREATMENT +higiénicas. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +aspecto I-EVOLUTION +es I-EVOLUTION +muy I-EVOLUTION +bueno, I-EVOLUTION +la I-EVOLUTION +pierna I-EVOLUTION +afectada I-EVOLUTION +mantiene I-EVOLUTION +un I-EVOLUTION +diámetro I-EVOLUTION +igual I-EVOLUTION +o I-EVOLUTION +incluso I-EVOLUTION +menor I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +sana; I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +calidad I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +injertos I-EVOLUTION +aceptable, I-EVOLUTION +con I-EVOLUTION +tejido I-EVOLUTION +fibrótico I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +pierna, I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +linforrea I-EVOLUTION +ocasional I-EVOLUTION +que I-EVOLUTION +causa I-EVOLUTION +procesos I-EVOLUTION +de I-EVOLUTION +irritación I-EVOLUTION +cutánea I-EVOLUTION +que I-EVOLUTION +generan I-EVOLUTION +un I-EVOLUTION +proceso I-EVOLUTION +crónico I-EVOLUTION +de I-EVOLUTION +fibrosis. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +muslo I-EVOLUTION +no I-EVOLUTION +aparece I-EVOLUTION +linforrea, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +injertada I-EVOLUTION +del I-EVOLUTION +mismo I-EVOLUTION +presenta I-EVOLUTION +mejor I-EVOLUTION +aspecto I-EVOLUTION +que I-EVOLUTION +los I-EVOLUTION +injertos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +pierna. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +personales I-FAMILY_HISTORY +de I-FAMILY_HISTORY +linfocitosis I-FAMILY_HISTORY +diagnosticada I-FAMILY_HISTORY +hace I-FAMILY_HISTORY +10 I-FAMILY_HISTORY +años, I-FAMILY_HISTORY +no I-FAMILY_HISTORY +habiendo I-FAMILY_HISTORY +precisado I-FAMILY_HISTORY +ningún I-FAMILY_HISTORY +tratamiento; I-FAMILY_HISTORY +hipertensión B-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +medicamentoso. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tres B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +denotó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +axilar I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +progresivamente I-PRESENT_ILLNESS +aumentando I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Se B-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +extirpación I-TREATMENT +quirúrgica. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +apreció I-TREATMENT +una I-TREATMENT +masa I-TREATMENT +tumoral I-TREATMENT +de I-TREATMENT +10x10x5 I-TREATMENT +centímetros, I-TREATMENT +que I-TREATMENT +afectaba I-TREATMENT +a I-TREATMENT +la I-TREATMENT +axila, I-TREATMENT +pectorales I-TREATMENT +e I-TREATMENT +infiltraba I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +axilar, I-TREATMENT +el I-TREATMENT +plexo I-TREATMENT +nervioso I-TREATMENT +y I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +costal I-TREATMENT +por I-TREATMENT +debajo I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +dorsal I-TREATMENT +ancho. I-TREATMENT +Se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +infiltración I-EXPLORATION +difusa I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +escaso I-EXPLORATION +citoplasma, I-EXPLORATION +abundantes I-EXPLORATION +mitosis I-EXPLORATION +e I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +apoptosis. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +eran I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +cromogranina, I-EXPLORATION +NSE, I-EXPLORATION +sinaptofisina I-EXPLORATION +y I-EXPLORATION +mostraban I-EXPLORATION +positividad I-EXPLORATION +débil I-EXPLORATION +para I-EXPLORATION +AE1 I-EXPLORATION +y I-EXPLORATION +AE3, I-EXPLORATION +siendo I-EXPLORATION +negativas I-EXPLORATION +para I-EXPLORATION +CD I-EXPLORATION +45, I-EXPLORATION +Actina I-EXPLORATION +ML, I-EXPLORATION +Actina I-EXPLORATION +Me, I-EXPLORATION +S100, I-EXPLORATION +Vimentina, I-EXPLORATION +EMA, I-EXPLORATION +CEA, I-EXPLORATION +CD I-EXPLORATION +57, I-EXPLORATION +CD I-EXPLORATION +34, I-EXPLORATION +CD I-EXPLORATION +38, I-EXPLORATION +CD I-EXPLORATION +15, I-EXPLORATION +proteína I-EXPLORATION +básica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mielina, I-EXPLORATION +tiroglobulina, I-EXPLORATION +CK I-EXPLORATION +7, I-EXPLORATION +CK I-EXPLORATION +20, I-EXPLORATION +HMB I-EXPLORATION +45 I-EXPLORATION +y I-EXPLORATION +GCD I-EXPLORATION +FP I-EXPLORATION +15. I-EXPLORATION +Fue I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +carcinoma I-EXPLORATION +neuroendocrino I-EXPLORATION +primario I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +(carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Merkel). I-EXPLORATION +Se I-EXPLORATION +recomendó I-EXPLORATION +descartar I-EXPLORATION +afectación I-EXPLORATION +primaria I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +gastrointestinal I-EXPLORATION +y I-EXPLORATION +pulmón. I-EXPLORATION + I-EXPLORATION +Otros I-EXPLORATION +estudios I-EXPLORATION +realizados: I-EXPLORATION +hemograma, I-EXPLORATION +perfil I-EXPLORATION +bioquímico, I-EXPLORATION +normales I-EXPLORATION +excepto I-EXPLORATION +LDH I-EXPLORATION +de I-EXPLORATION +1088 I-EXPLORATION +U/l, I-EXPLORATION +CEA I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +65 I-EXPLORATION +U/l, I-EXPLORATION +Ca I-EXPLORATION +125 I-EXPLORATION +y I-EXPLORATION +Ca I-EXPLORATION +15.3, I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +gastroscopia I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +divertículos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +sigma I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +pólipo I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +2 I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +a I-EXPLORATION +30 I-EXPLORATION +centímetros I-EXPLORATION +del I-EXPLORATION +ano, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +biopsiado, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +histología I-EXPLORATION +de I-EXPLORATION +fragmento I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +velloso I-EXPLORATION +con I-EXPLORATION +foco I-EXPLORATION +de I-EXPLORATION +displasia I-EXPLORATION +severa. I-EXPLORATION +Se I-EXPLORATION +envió I-EXPLORATION +posteriormente I-EXPLORATION +a I-EXPLORATION +realizar I-EXPLORATION +polipectomía. I-EXPLORATION + I-EXPLORATION +TAC I-EXPLORATION +toraco-abdominal: I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Posteriormente B-TREATMENT +se I-TREATMENT +completó I-TREATMENT +el I-TREATMENT +tratamiento, I-TREATMENT +efectuándose I-TREATMENT +radioterapia I-TREATMENT +loco-regional. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +junio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1995 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +constata I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +distendido, I-EXPLORATION +con I-EXPLORATION +semiología I-EXPLORATION +de I-EXPLORATION +ascitis, I-EXPLORATION +no I-EXPLORATION +a I-EXPLORATION +tensión. I-EXPLORATION +No I-EXPLORATION +hay I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +ni I-EXPLORATION +insuficiencia I-EXPLORATION +cardíaca. I-EXPLORATION +Las I-EXPLORATION +exploraciones I-EXPLORATION +complementarias I-EXPLORATION +muestran I-EXPLORATION +una I-EXPLORATION +bioquímica I-EXPLORATION +básica I-EXPLORATION +y I-EXPLORATION +hemograma I-EXPLORATION +sin I-EXPLORATION +alteraciones, I-EXPLORATION +unos I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +Ca I-EXPLORATION +125: I-EXPLORATION +35 I-EXPLORATION +Ul/ml, I-EXPLORATION +Ca I-EXPLORATION +19.9: I-EXPLORATION +37 I-EXPLORATION +Ul/ml I-EXPLORATION +y I-EXPLORATION +CEA: I-EXPLORATION +8 I-EXPLORATION +Ul/ml. I-EXPLORATION +Se I-EXPLORATION +intenta I-EXPLORATION +realizar I-EXPLORATION +paracentesis I-EXPLORATION +diagnóstica, I-EXPLORATION +pero I-EXPLORATION +es I-EXPLORATION +infructuosa I-EXPLORATION +en I-EXPLORATION +varios I-EXPLORATION +intentos. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +hablan I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +abdomino-pélvica I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +ascitis, I-EXPLORATION +con I-EXPLORATION +adenopatías I-EXPLORATION +y I-EXPLORATION +varios I-EXPLORATION +nódulos I-EXPLORATION +peritoneales; I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +ginecológica I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Finalmente I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +somete I-EXPLORATION +a I-EXPLORATION +laparotomía I-EXPLORATION +exploradora I-EXPLORATION +encontrándose I-EXPLORATION +una I-EXPLORATION +cantidad I-EXPLORATION +moderada I-EXPLORATION +de I-EXPLORATION +ascitis I-EXPLORATION +con I-EXPLORATION +abundante I-EXPLORATION +moco, I-EXPLORATION +múltiples I-EXPLORATION +adherencias I-EXPLORATION +a I-EXPLORATION +intestino I-EXPLORATION +y I-EXPLORATION +anejos I-EXPLORATION +ginecológicos, I-EXPLORATION +numerosos I-EXPLORATION +implantes I-EXPLORATION +en I-EXPLORATION +omento, I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +peritoneo I-EXPLORATION +y, I-EXPLORATION +un I-EXPLORATION +apéndice I-EXPLORATION +abierto I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +mucoso. I-EXPLORATION +Se B-TREATMENT +practica I-TREATMENT +un I-TREATMENT +histerectomía I-TREATMENT +con I-TREATMENT +doble I-TREATMENT +anexectomía, I-TREATMENT +linfadenectomía I-TREATMENT +pélvica, I-TREATMENT +apendicectomía I-TREATMENT +y I-TREATMENT +hemicolectomía I-TREATMENT +derecha. I-TREATMENT +La I-TREATMENT +cirugía I-TREATMENT +no I-TREATMENT +es I-TREATMENT +radical, I-TREATMENT +permaneciendo I-TREATMENT +enfermedad I-TREATMENT +residual I-TREATMENT +superior I-TREATMENT +a I-TREATMENT +2 I-TREATMENT +cms. I-TREATMENT +El B-EXPLORATION +análisis I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +piezas I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +carcinomatosis I-EXPLORATION +peritoneal I-EXPLORATION +por I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +apéndice; I-EXPLORATION +colon I-EXPLORATION +y I-EXPLORATION +ovario I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +postcirugía I-EXPLORATION +muestra I-EXPLORATION +nódulos I-EXPLORATION +tumorales I-EXPLORATION +en I-EXPLORATION +epiplón I-EXPLORATION +y I-EXPLORATION +peritoneo. I-EXPLORATION +Los I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +habían I-EXPLORATION +descendido I-EXPLORATION +a I-EXPLORATION +niveles I-EXPLORATION +normales I-EXPLORATION +(CEA: I-EXPLORATION +1, I-EXPLORATION +7 I-EXPLORATION +Ul/ml; I-EXPLORATION +Ca I-EXPLORATION +19.9: I-EXPLORATION +27 I-EXPLORATION +Ul/ I-EXPLORATION +ml). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +administrar I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Clínica I-TREATMENT +Mayo I-TREATMENT +(5FU-FA). I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +recibe I-TREATMENT +tratamiento I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +año I-TREATMENT +con I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +ciclos, I-TREATMENT +desapareciendo I-TREATMENT +las I-TREATMENT +imágenes I-TREATMENT +de I-TREATMENT +TAC I-TREATMENT +y I-TREATMENT +con I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +marcadores. I-TREATMENT +Desde I-TREATMENT +febrero I-TREATMENT +de I-TREATMENT +1997 I-TREATMENT +permanece I-TREATMENT +en I-TREATMENT +control I-TREATMENT +por I-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +oncología I-TREATMENT +médica. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +seguimiento, I-EVOLUTION +se I-EVOLUTION +aprecian I-EVOLUTION +nódulos I-EVOLUTION +peritoneales I-EVOLUTION +de I-EVOLUTION +lento I-EVOLUTION +crecimiento, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +ascenso I-EVOLUTION +progresivo I-EVOLUTION +de I-EVOLUTION +marcadores I-EVOLUTION +tumorales. I-EVOLUTION +Se B-TREATMENT +opta I-TREATMENT +por I-TREATMENT +la I-TREATMENT +abstención I-TREATMENT +terapéutica, I-TREATMENT +dado I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +permanece I-TREATMENT +asintomática. I-TREATMENT +Cuando B-EXPLORATION +el I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +nódulos I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +manifiesto, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +punción I-EXPLORATION +biopsia, I-EXPLORATION +en I-EXPLORATION +junio I-EXPLORATION +de I-EXPLORATION +2001, I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +recaída I-EXPLORATION +peritoneal I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +apendicular. I-EXPLORATION +En B-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +retratar I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +Clínica I-TREATMENT +Mayo I-TREATMENT +hasta I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +ciclos, I-TREATMENT +alcanzando I-TREATMENT +criterios I-TREATMENT +de I-TREATMENT +enfermedad I-TREATMENT +estable. I-TREATMENT +Se I-TREATMENT +decide I-TREATMENT +continuar I-TREATMENT +con I-TREATMENT +quimioterapia I-TREATMENT +de I-TREATMENT +tercera I-TREATMENT +línea I-TREATMENT +con I-TREATMENT +Tomudex-Oxaliplatino I-TREATMENT +(6 I-TREATMENT +ciclos). I-TREATMENT +La B-EVOLUTION +respuesta, I-EVOLUTION +en I-EVOLUTION +agosto I-EVOLUTION +de I-EVOLUTION +2002, I-EVOLUTION +fue I-EVOLUTION +nuevamente I-EVOLUTION +de I-EVOLUTION +estabilización. I-EVOLUTION +Desde I-EVOLUTION +entonces I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +oligoasintomática I-EVOLUTION +con I-EVOLUTION +vida I-EVOLUTION +activa, I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +múltiples I-EVOLUTION +nódulos I-EVOLUTION +peritoneales I-EVOLUTION +que I-EVOLUTION +forman I-EVOLUTION +una I-EVOLUTION +coraza I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +pared I-EVOLUTION +abdominal. I-EVOLUTION +En I-EVOLUTION +diciembre I-EVOLUTION +de I-EVOLUTION +2003, I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +progresa I-EVOLUTION +produciéndose I-EVOLUTION +compresión I-EVOLUTION +de I-EVOLUTION +cola I-EVOLUTION +de I-EVOLUTION +caballo I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +masa I-EVOLUTION +presacra. I-EVOLUTION +Recibe B-TREATMENT +radioterapia I-TREATMENT +paliativa, I-TREATMENT +aliviándose I-TREATMENT +el I-TREATMENT +dolor I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +producirse I-TREATMENT +déficit I-TREATMENT +neurológico. I-TREATMENT +La B-EVOLUTION +situación I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +a I-EVOLUTION +octubre I-EVOLUTION +de I-EVOLUTION +2004, I-EVOLUTION +es I-EVOLUTION +la I-EVOLUTION +de I-EVOLUTION +lento I-EVOLUTION +deterioro I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +por I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +enfermedad, I-EVOLUTION +con I-EVOLUTION +anemia I-EVOLUTION +y I-EVOLUTION +desnutrición I-EVOLUTION +por I-EVOLUTION +dificultad I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +ingesta I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +cuadros I-EVOLUTION +suboclusivos. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años/paquete, I-PAST_MEDICAL_HISTORY +consumidor I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cocaína I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +drogas I-PAST_MEDICAL_HISTORY +sintéticas I-PAST_MEDICAL_HISTORY +(anfetaminas, I-PAST_MEDICAL_HISTORY +speed, I-PAST_MEDICAL_HISTORY +...) I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +enolismo I-PAST_MEDICAL_HISTORY +< I-PAST_MEDICAL_HISTORY +80 I-PAST_MEDICAL_HISTORY +gr. I-PAST_MEDICAL_HISTORY +etanol/día. I-PAST_MEDICAL_HISTORY +Homosexual I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +SIDA I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Noviembre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2001 I-PAST_MEDICAL_HISTORY +(estadio I-PAST_MEDICAL_HISTORY +C3), I-PAST_MEDICAL_HISTORY +según I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +criterios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +CDC I-PAST_MEDICAL_HISTORY +(neumonía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +P. I-PAST_MEDICAL_HISTORY +carinni I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +recuento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +linfocitos I-PAST_MEDICAL_HISTORY +<200 I-PAST_MEDICAL_HISTORY +CD4/µL). I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +subpoblaciones I-PAST_MEDICAL_HISTORY +linfoides I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +sangre I-PAST_MEDICAL_HISTORY +periférica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +aquella I-PAST_MEDICAL_HISTORY +fecha I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +siguientes I-PAST_MEDICAL_HISTORY +resultados I-PAST_MEDICAL_HISTORY +CD4: I-PAST_MEDICAL_HISTORY +4, I-PAST_MEDICAL_HISTORY +5% I-PAST_MEDICAL_HISTORY +(81), I-PAST_MEDICAL_HISTORY +CD8: I-PAST_MEDICAL_HISTORY +71, I-PAST_MEDICAL_HISTORY +7% I-PAST_MEDICAL_HISTORY +(1290) I-PAST_MEDICAL_HISTORY +CD4/CD8: I-PAST_MEDICAL_HISTORY +0, I-PAST_MEDICAL_HISTORY +06 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +carga I-PAST_MEDICAL_HISTORY +viral I-PAST_MEDICAL_HISTORY +HIV: I-PAST_MEDICAL_HISTORY +19.200 I-PAST_MEDICAL_HISTORY +copias I-PAST_MEDICAL_HISTORY +RNA/ml. I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +estos I-PAST_MEDICAL_HISTORY +datos I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +Tratamiento I-PAST_MEDICAL_HISTORY +Antiretroviral I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Alta I-PAST_MEDICAL_HISTORY +Eficacia I-PAST_MEDICAL_HISTORY +(HAART), I-PAST_MEDICAL_HISTORY +utilizando I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +inhibidores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +transcriptasa I-PAST_MEDICAL_HISTORY +inversa, I-PAST_MEDICAL_HISTORY +zidovudina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +lamivudina, I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +inhibidor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +proteasa, I-PAST_MEDICAL_HISTORY +abacavir, I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +ido I-PAST_MEDICAL_HISTORY +cambiando I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +combinando I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +fármacos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +misma I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +(efavirenz, I-PAST_MEDICAL_HISTORY +estavudina, I-PAST_MEDICAL_HISTORY +ritonavir). I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +Diciembre I-PRESENT_ILLNESS +2001 I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +disfonía I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +a B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +ORL I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +rinitis I-EXPLORATION +seca-costrosa I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +bilateral I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +rinitis I-EXPLORATION +por I-EXPLORATION +inhalación I-EXPLORATION +de I-EXPLORATION +cocaína, I-EXPLORATION +candidiasis I-EXPLORATION +oral I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +laringoscopia I-EXPLORATION +indirecta, I-EXPLORATION +lesión I-EXPLORATION +violácea I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +banda I-EXPLORATION +ventricular I-EXPLORATION +y I-EXPLORATION +repliegue I-EXPLORATION +aritenoepiglótico I-EXPLORATION +izdo., I-EXPLORATION +movilidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cuerda I-EXPLORATION +vocal I-EXPLORATION +y I-EXPLORATION +aritenoides I-EXPLORATION +izdo. I-EXPLORATION +disminuida. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +sarcoma I-EXPLORATION +de I-EXPLORATION +Kaposi, I-EXPLORATION +y I-EXPLORATION +dada I-EXPLORATION +las I-EXPLORATION +posibles I-EXPLORATION +complicaciones I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión, I-EXPLORATION +no I-EXPLORATION +obstante, I-EXPLORATION +se I-EXPLORATION +practicaron I-EXPLORATION +broncoscopia I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +laríngeo I-EXPLORATION +de I-EXPLORATION +placas I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +rojo I-EXPLORATION +intenso I-EXPLORATION +que I-EXPLORATION +también I-EXPLORATION +estaban I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +más I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +traquea I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +igualmente I-EXPLORATION +eran I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +sarcoma I-EXPLORATION +de I-EXPLORATION +Kaposi I-EXPLORATION +a I-EXPLORATION +dicho I-EXPLORATION +nivel; I-EXPLORATION +gastroscopia I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +no I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +colonoscopia I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +hemorroides I-EXPLORATION +grado I-EXPLORATION +II/IV I-EXPLORATION +con I-EXPLORATION +discreta I-EXPLORATION +estenosis I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +anal. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +clínico I-TREATMENT +de I-TREATMENT +sarcoma I-TREATMENT +de I-TREATMENT +Kaposi I-TREATMENT +laringeo I-TREATMENT +el I-TREATMENT +paciente, I-TREATMENT +y I-TREATMENT +ante I-TREATMENT +el I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +obstrucción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +aérea, I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +radiaciones I-TREATMENT +ionizantes I-TREATMENT +sobre I-TREATMENT +PTV-región I-TREATMENT +laringea, I-TREATMENT +mediante I-TREATMENT +dos I-TREATMENT +campos I-TREATMENT +laterales I-TREATMENT +y I-TREATMENT +opuestos, I-TREATMENT +utilizando I-TREATMENT +mascara I-TREATMENT +termolábil I-TREATMENT +de I-TREATMENT +inmovilización I-TREATMENT +y I-TREATMENT +planificación I-TREATMENT +mediante I-TREATMENT +TAC I-TREATMENT +se I-TREATMENT +alcanzó I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +15 I-TREATMENT +Gy I-TREATMENT +a I-TREATMENT +la I-TREATMENT +isodosis I-TREATMENT +del I-TREATMENT +95% I-TREATMENT +a I-TREATMENT +un I-TREATMENT +fraccionamiento I-TREATMENT +de I-TREATMENT +150 I-TREATMENT +cGy I-TREATMENT +/día I-TREATMENT +en I-TREATMENT +10 I-TREATMENT +fracciones I-TREATMENT +y I-TREATMENT +en I-TREATMENT +2 I-TREATMENT +semanas. I-TREATMENT +Una I-TREATMENT +semana I-TREATMENT +previa I-TREATMENT +al I-TREATMENT +inicio I-TREATMENT +del I-TREATMENT +tratamiento, I-TREATMENT +durante I-TREATMENT +y I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +después I-TREATMENT +de I-TREATMENT +haber I-TREATMENT +finalizado I-TREATMENT +la I-TREATMENT +radioterapia I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +medicado I-TREATMENT +con I-TREATMENT +fluconazol I-TREATMENT +50 I-TREATMENT +mg. I-TREATMENT +V.O./24h. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +finalizado I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +había I-EVOLUTION +recuperado I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +disfonía I-EVOLUTION +sin I-EVOLUTION +haber I-EVOLUTION +presentado I-EVOLUTION +toxicidad I-EVOLUTION +mucosa I-EVOLUTION +aguda I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +36 I-EVOLUTION +meses, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +haya I-EVOLUTION +en I-EVOLUTION +remisión I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +sarcoma I-EVOLUTION +de I-EVOLUTION +Kaposi I-EVOLUTION +laringeo, I-EVOLUTION +con I-EVOLUTION +controles I-EVOLUTION +periódicos. I-EVOLUTION +No I-EVOLUTION +obstante, I-EVOLUTION +en I-EVOLUTION +Febrero I-EVOLUTION +de I-EVOLUTION +2002 I-EVOLUTION +fue I-EVOLUTION +diagnosticado I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +Giardiasis I-EVOLUTION +intestinal, I-EVOLUTION +que B-TREATMENT +se I-TREATMENT +resolvió I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +y I-TREATMENT +de I-TREATMENT +un I-TREATMENT +Ameboma I-TREATMENT +rectal I-TREATMENT +que I-TREATMENT +requirió I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +que B-EVOLUTION +ha I-EVOLUTION +dejado I-EVOLUTION +como I-EVOLUTION +secuelas I-EVOLUTION +una I-EVOLUTION +incontinencia I-EVOLUTION +anorrectal I-EVOLUTION +grado I-EVOLUTION +IV I-EVOLUTION +de I-EVOLUTION +caracter I-EVOLUTION +irreversible. I-EVOLUTION +También I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +diagnosticado I-EVOLUTION +en I-EVOLUTION +Abril I-EVOLUTION +2002 I-EVOLUTION +de I-EVOLUTION +Condilomas I-EVOLUTION +acuminados I-EVOLUTION +perianales, I-EVOLUTION +habiendo B-TREATMENT +sido I-TREATMENT +intervenido I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +ocasiones, I-TREATMENT +en I-TREATMENT +Junio I-TREATMENT +2002 I-TREATMENT +y I-TREATMENT +Abril I-TREATMENT +2004. I-TREATMENT +Así B-EVOLUTION +mismo I-EVOLUTION +en I-EVOLUTION +Enero I-EVOLUTION +2003 I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +diagnosticado I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +Hepatopatía I-EVOLUTION +crónica I-EVOLUTION +por I-EVOLUTION +virus I-EVOLUTION +C I-EVOLUTION +(informe I-EVOLUTION +AP: I-EVOLUTION +hepatitis I-EVOLUTION +crónica I-EVOLUTION +C I-EVOLUTION +de I-EVOLUTION +actividad I-EVOLUTION +leve, I-EVOLUTION +estadio I-EVOLUTION +1 I-EVOLUTION +(fibrosis I-EVOLUTION +portal); I-EVOLUTION +siderosis I-EVOLUTION +focal I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +células I-EVOLUTION +de I-EVOLUTION +Kupffer); I-EVOLUTION +carga I-EVOLUTION +viral I-EVOLUTION +VHC I-EVOLUTION +(virus I-EVOLUTION +hepatitis I-EVOLUTION +C) I-EVOLUTION +2.443.750 I-EVOLUTION +UI/ml I-EVOLUTION +genotipo I-EVOLUTION +1, I-EVOLUTION +subtipo I-EVOLUTION +B. I-EVOLUTION +El B-EXPLORATION +último I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +subpoblaciones I-EXPLORATION +linfoides I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +periférica I-EXPLORATION +en I-EXPLORATION +Enero I-EXPLORATION +2005 I-EXPLORATION +muestra I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +resultados I-EXPLORATION +CD4: I-EXPLORATION +10, I-EXPLORATION +3% I-EXPLORATION +(504,7), I-EXPLORATION +CD8: I-EXPLORATION +60, I-EXPLORATION +7% I-EXPLORATION +(2.974,3), I-EXPLORATION +CD3: I-EXPLORATION +76, I-EXPLORATION +3, I-EXPLORATION +CD4/CD8: I-EXPLORATION +0, I-EXPLORATION +17 I-EXPLORATION +y I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +HIV: I-EXPLORATION +304 I-EXPLORATION +copias I-EXPLORATION +RNA/ml. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +no I-EXPLORATION +revela I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +analítico I-EXPLORATION +(hematológico I-EXPLORATION +y I-EXPLORATION +bioquímico) I-EXPLORATION +no I-EXPLORATION +presenta I-EXPLORATION +alteraciones. I-EXPLORATION +La I-EXPLORATION +radiología I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +revela I-EXPLORATION +pequeñas I-EXPLORATION +imágenes I-EXPLORATION +radiopacas I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +cálcica I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +hepática, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +corresponden I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +con I-EXPLORATION +varias I-EXPLORATION +lesiones I-EXPLORATION +hipoecoicas I-EXPLORATION +e I-EXPLORATION +hipodensas I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +hepáticos, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tamaño I-EXPLORATION +comprendido I-EXPLORATION +entre I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +y I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +interpretadas I-EXPLORATION +como I-EXPLORATION +metástasis. I-EXPLORATION +Las I-EXPLORATION +exploraciones I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +primario I-EXPLORATION +mamario I-EXPLORATION +y I-EXPLORATION +gastrointestinal I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +somete I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +laparotomia I-EXPLORATION +exploradora I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +visualizan I-EXPLORATION +varias I-EXPLORATION +lesiones I-EXPLORATION +blanquecinas I-EXPLORATION +que I-EXPLORATION +protuyen I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +hepáticos, I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +lisa, I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +toman I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico. I-EXPLORATION + I-EXPLORATION +Estudio I-EXPLORATION +anatomopatológico I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +muestras I-EXPLORATION +corresponden I-EXPLORATION +a I-EXPLORATION +dos I-EXPLORATION +fragmentos I-EXPLORATION +cuneiformes I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +y I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +dimensiones I-EXPLORATION +máximas, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +blanquecino I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +central I-EXPLORATION +y I-EXPLORATION +marrón I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +periferia. I-EXPLORATION +Al I-EXPLORATION +corte I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +dos I-EXPLORATION +lesiones I-EXPLORATION +blanquecinas, I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +definidos I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +rodeadas I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +marrón. I-EXPLORATION +Las I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +seleccionadas I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +fueron I-EXPLORATION +fijadas I-EXPLORATION +en I-EXPLORATION +formol I-EXPLORATION +acuoso I-EXPLORATION +al I-EXPLORATION +10% I-EXPLORATION +durante I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +e I-EXPLORATION +incluidas I-EXPLORATION +en I-EXPLORATION +parafina. I-EXPLORATION +Se I-EXPLORATION +obtuvieron I-EXPLORATION +cortes I-EXPLORATION +histológicos I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +micras I-EXPLORATION +de I-EXPLORATION +espesor I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +tiñeron I-EXPLORATION +con I-EXPLORATION +hematoxilina-eosina. I-EXPLORATION +Otros I-EXPLORATION +cortes I-EXPLORATION +se I-EXPLORATION +montaron I-EXPLORATION +sobre I-EXPLORATION +portas I-EXPLORATION +cargados I-EXPLORATION +eléctricamente I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +destinaron I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +automatizada I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +aparato I-EXPLORATION +tipo I-EXPLORATION +ventana. I-EXPLORATION + I-EXPLORATION +Microscópicamente I-EXPLORATION +se I-EXPLORATION +advierte I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +neoplásica I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +sólido I-EXPLORATION +y I-EXPLORATION +márgenes I-EXPLORATION +infiltrativos I-EXPLORATION +que I-EXPLORATION +ocupa I-EXPLORATION +parcial I-EXPLORATION +o I-EXPLORATION +totalmente I-EXPLORATION +las I-EXPLORATION +luces I-EXPLORATION +venulares I-EXPLORATION +y I-EXPLORATION +sinusoidales, I-EXPLORATION +respetando I-EXPLORATION +los I-EXPLORATION +espacios I-EXPLORATION +porta I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +cierta I-EXPLORATION +medida I-EXPLORATION +las I-EXPLORATION +trabéculas I-EXPLORATION +hepáticas I-EXPLORATION +y I-EXPLORATION +conductillos I-EXPLORATION +biliares. I-EXPLORATION +Alternan I-EXPLORATION +áreas I-EXPLORATION +celulares I-EXPLORATION +con I-EXPLORATION +otras I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +fibroso. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +neoplásicas I-EXPLORATION +dominantes I-EXPLORATION +exhiben I-EXPLORATION +citoplasmas I-EXPLORATION +amplios I-EXPLORATION +y I-EXPLORATION +densos, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +definidos, I-EXPLORATION +a I-EXPLORATION +veces I-EXPLORATION +con I-EXPLORATION +vacuolas I-EXPLORATION +únicas I-EXPLORATION +o I-EXPLORATION +múltiples, I-EXPLORATION +ocasionalmente I-EXPLORATION +ocupadas I-EXPLORATION +por I-EXPLORATION +hematíes I-EXPLORATION +y I-EXPLORATION +núcleos I-EXPLORATION +vesiculares I-EXPLORATION +con I-EXPLORATION +nucleolos I-EXPLORATION +evidentes I-EXPLORATION +y I-EXPLORATION +aisladas I-EXPLORATION +mitosis. I-EXPLORATION +La I-EXPLORATION +mayoría I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +expresan I-EXPLORATION +inmunopositividad I-EXPLORATION +fuerte I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +marcadores I-EXPLORATION +vasculares I-EXPLORATION +FVIII, I-EXPLORATION +CD I-EXPLORATION +31 I-EXPLORATION +y I-EXPLORATION +CD I-EXPLORATION +34 I-EXPLORATION +y I-EXPLORATION +ocasionalmente I-EXPLORATION +frente I-EXPLORATION +al I-EXPLORATION +anticuerpo I-EXPLORATION +citoqueratina. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +ha I-TREATMENT +recibido I-TREATMENT +tratamiento I-TREATMENT +y B-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +han I-EVOLUTION +permanecido I-EVOLUTION +estables I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +actual, I-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +diagnóstico. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +transcurso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +exploración I-PRESENT_ILLNESS +ginecológica I-PRESENT_ILLNESS +rutinaria I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +descubre I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ecografía I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro I-PRESENT_ILLNESS +máximo I-PRESENT_ILLNESS +sonodensa, I-PRESENT_ILLNESS +homogénea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +definida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +contornos I-PRESENT_ILLNESS +posteriores I-PRESENT_ILLNESS +ya I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +existe I-PRESENT_ILLNESS +interfase I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tejido I-PRESENT_ILLNESS +graso I-PRESENT_ILLNESS +circundante, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +localización I-PRESENT_ILLNESS +presacra, I-PRESENT_ILLNESS +detrás I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +imagen I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +recto-sigma. I-PRESENT_ILLNESS +Dicha B-EXPLORATION +masa I-EXPLORATION +fue I-EXPLORATION +confirmada I-EXPLORATION +por I-EXPLORATION +TAC I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +redondeada, I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +coeficientes I-EXPLORATION +de I-EXPLORATION +absorción I-EXPLORATION +predominantemente I-EXPLORATION +grasos I-EXPLORATION +con I-EXPLORATION +discreta I-EXPLORATION +heterogeneidad, I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +posible I-EXPLORATION +tumor I-EXPLORATION +dermoide I-EXPLORATION +presacro. I-EXPLORATION +Dicha I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +unas I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +38% I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +hematológicas I-EXPLORATION +acompañantes. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +visceromegalias. I-EXPLORATION + I-EXPLORATION +Macroscópicamente I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +irregular I-EXPLORATION +bien I-EXPLORATION +delimitada I-EXPLORATION +de I-EXPLORATION +7x5x3 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +estar I-EXPLORATION +constituida I-EXPLORATION +fundamentalmente I-EXPLORATION +por I-EXPLORATION +tejido I-EXPLORATION +adiposo, I-EXPLORATION +observándose I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +central I-EXPLORATION +hemorrágica I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +periferia, I-EXPLORATION +una I-EXPLORATION +serie I-EXPLORATION +de I-EXPLORATION +áreas I-EXPLORATION +blanquecinas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +fibroso I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +otras I-EXPLORATION +edematosas. I-EXPLORATION + I-EXPLORATION +Histológicamente I-EXPLORATION +la I-EXPLORATION +neoplasia I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +relativamente I-EXPLORATION +bien I-EXPLORATION +circunscrita I-EXPLORATION +y I-EXPLORATION +estaba I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +maduro, I-EXPLORATION +tejido I-EXPLORATION +conectivo I-EXPLORATION +laxo I-EXPLORATION +y I-EXPLORATION +celularidad I-EXPLORATION +hematopoyética I-EXPLORATION +mixta. I-EXPLORATION +Este I-EXPLORATION +último I-EXPLORATION +componente I-EXPLORATION +predominaba I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +áreas I-EXPLORATION +centrales I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +hallaba I-EXPLORATION +representado I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +tres I-EXPLORATION +series I-EXPLORATION +hematopoyéticas I-EXPLORATION +(megacariocítica, I-EXPLORATION +serie I-EXPLORATION +roja I-EXPLORATION +y I-EXPLORATION +serie I-EXPLORATION +blanca), I-EXPLORATION +con I-EXPLORATION +diferentes I-EXPLORATION +proporciones I-EXPLORATION +según I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +estudiada I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +eritromieloide I-EXPLORATION +que I-EXPLORATION +oscilaba I-EXPLORATION +entre I-EXPLORATION +1: I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +2: I-EXPLORATION +1. I-EXPLORATION +Los I-EXPLORATION +megacariocíticos I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +con I-EXPLORATION +facilidad I-EXPLORATION +y I-EXPLORATION +aunque I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +ocasionales I-EXPLORATION +formas I-EXPLORATION +inmaduras I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +mismos, I-EXPLORATION +no I-EXPLORATION +presentaban I-EXPLORATION +rasgos I-EXPLORATION +displásicos. I-EXPLORATION +El I-EXPLORATION +estroma I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +áreas I-EXPLORATION +hematopoyéticas I-EXPLORATION +era I-EXPLORATION +casi I-EXPLORATION +exclusivamente I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +adiposo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +más I-EXPLORATION +periférica I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +predominaba I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +maduro I-EXPLORATION +con I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +y I-EXPLORATION +abundantes I-EXPLORATION +hemosiderinófagos. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +lipoblastos I-EXPLORATION +ni I-EXPLORATION +células I-EXPLORATION +mesenquimales I-EXPLORATION +bizarras I-EXPLORATION +y I-EXPLORATION +existía I-EXPLORATION +cierto I-EXPLORATION +componente I-EXPLORATION +inflamatorio I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +linfocitario, I-EXPLORATION +ocasionalmente I-EXPLORATION +dispuesto I-EXPLORATION +en I-EXPLORATION +agregados I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +aleatoria I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +zonas I-EXPLORATION +hematopoyéticas I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +adiposas. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +en B-PAST_MEDICAL_HISTORY +1997, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +tumoración I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +mama I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +adenopatía I-PAST_MEDICAL_HISTORY +palpable. I-PAST_MEDICAL_HISTORY +Estudio I-PAST_MEDICAL_HISTORY +radiológico I-PAST_MEDICAL_HISTORY +compatible I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +carcinoma. I-PAST_MEDICAL_HISTORY +Es I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +mastectomía I-PAST_MEDICAL_HISTORY +radical I-PAST_MEDICAL_HISTORY +modificada I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +Madden I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +intraoperatoria I-PAST_MEDICAL_HISTORY +positiva I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +carcinoma. I-PAST_MEDICAL_HISTORY +Informe I-PAST_MEDICAL_HISTORY +anatomopatológico: I-PAST_MEDICAL_HISTORY +Carcinoma I-PAST_MEDICAL_HISTORY +ductal I-PAST_MEDICAL_HISTORY +infiltrante I-PAST_MEDICAL_HISTORY +mucinoso I-PAST_MEDICAL_HISTORY +(coloide) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3.2 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +eje I-PAST_MEDICAL_HISTORY +máximo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +adenopatía I-PAST_MEDICAL_HISTORY +positiva I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +22 I-PAST_MEDICAL_HISTORY +ganglios I-PAST_MEDICAL_HISTORY +axilares I-PAST_MEDICAL_HISTORY +aislados. I-PAST_MEDICAL_HISTORY +Recibe I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +complementario I-PAST_MEDICAL_HISTORY +tamoxifeno I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +diarios. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +realizan I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rastreo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tumor I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +resultan I-PAST_MEDICAL_HISTORY +negativos. I-PAST_MEDICAL_HISTORY +Así I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizan I-PAST_MEDICAL_HISTORY +ecografías I-PAST_MEDICAL_HISTORY +ginecológicas I-PAST_MEDICAL_HISTORY +anuales I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +son I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +Mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2001 I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +metrorragia I-PRESENT_ILLNESS +postmenopáusica. I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +vaginal I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +ser I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +"pólipo I-EXPLORATION +endometrial" I-EXPLORATION +de I-EXPLORATION +19*16 I-EXPLORATION +mm. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +Histeroscopia I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +excrecente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +vagina I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +biopsiada I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +intrauterino I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +polipoidea I-EXPLORATION +con I-EXPLORATION +vasos I-EXPLORATION +anómalos, I-EXPLORATION +altamente I-EXPLORATION +sospechosa I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +igualmente I-EXPLORATION +biopsiada. I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +en I-EXPLORATION +vagina I-EXPLORATION +se I-EXPLORATION +informa I-EXPLORATION +como I-EXPLORATION +carcinoma I-EXPLORATION +pobremente I-EXPLORATION +diferenciado I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +formación I-EXPLORATION +polipoidea I-EXPLORATION +como I-EXPLORATION +atipia I-EXPLORATION +celular I-EXPLORATION +no I-EXPLORATION +filiada. I-EXPLORATION + B-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +histerectomía I-TREATMENT +total I-TREATMENT +con I-TREATMENT +doble I-TREATMENT +anexectomía, I-TREATMENT +manguito I-TREATMENT +vaginal I-TREATMENT +y I-TREATMENT +linfadenectomía. I-TREATMENT +Informe B-EXPLORATION +anatomopatológico: I-EXPLORATION +Lavado I-EXPLORATION +peritoneal I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +células I-EXPLORATION +malignas. I-EXPLORATION +Tumor I-EXPLORATION +intracavitario I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +Tumor I-EXPLORATION +Mülleriano I-EXPLORATION +Mixto I-EXPLORATION +Maligno I-EXPLORATION +Heterólogo I-EXPLORATION +con I-EXPLORATION +extensa I-EXPLORATION +permeación I-EXPLORATION +vascular I-EXPLORATION +linfática. I-EXPLORATION +Metástasis I-EXPLORATION +múltiples I-EXPLORATION +en I-EXPLORATION +miometrio, I-EXPLORATION +trompa I-EXPLORATION +y I-EXPLORATION +ovarios I-EXPLORATION +y I-EXPLORATION +metástasis I-EXPLORATION +ganglionares. I-EXPLORATION +La I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +vagina I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +pobremente I-EXPLORATION +diferenciado I-EXPLORATION +probablemente I-EXPLORATION +metástasis I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +Mülleriano I-EXPLORATION +mixto I-EXPLORATION +descrito I-EXPLORATION +(Estadio I-EXPLORATION +III). I-EXPLORATION +Realiza B-TREATMENT +tratamiento I-TREATMENT +complementario I-TREATMENT +con I-TREATMENT +Taxol, I-TREATMENT +que I-TREATMENT +tolera I-TREATMENT +mal, I-TREATMENT +y I-TREATMENT +radioterapia, I-TREATMENT +falleciendo I-TREATMENT +al I-TREATMENT +año I-TREATMENT +de I-TREATMENT +este I-TREATMENT +proceso. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-FAMILY_HISTORY +historia I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés, I-FAMILY_HISTORY +y B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +intervención I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estrabismo I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ex-fumadora I-PAST_MEDICAL_HISTORY +(10 I-PAST_MEDICAL_HISTORY +cigarrillos/día). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Inicia B-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +otorrinolaringólogo I-PRESENT_ILLNESS +(ORL) I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +nasal I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +gusto, I-PRESENT_ILLNESS +anosmia, I-PRESENT_ILLNESS +epístaxis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +epífora I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +ocasional, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +intensa I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +iniciar I-PRESENT_ILLNESS +estudio. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +ORL I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +que I-EXPLORATION +ocupa I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +derecha I-EXPLORATION +e I-EXPLORATION +impide I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio I-EXPLORATION +con I-EXPLORATION +desplazamiento I-EXPLORATION +septal I-EXPLORATION +a I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +biopsia I-EXPLORATION +sospechosa I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +indiferenciado. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectan I-EXPLORATION +adenopatías I-EXPLORATION +palpables. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +analítica I-EXPLORATION +y I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitan I-EXPLORATION +Tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +(TAC) I-EXPLORATION +y I-EXPLORATION +Resonancia I-EXPLORATION +nuclear I-EXPLORATION +magnética I-EXPLORATION +(RNM) I-EXPLORATION +craneofacial I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +desplaza I-EXPLORATION +el I-EXPLORATION +septum I-EXPLORATION +y I-EXPLORATION +afecta I-EXPLORATION +celdillas I-EXPLORATION +etmoidales I-EXPLORATION +y I-EXPLORATION +coanas I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +lado. I-EXPLORATION + I-EXPLORATION +Es B-TREATMENT +intervenida I-TREATMENT +quirúrgicamente I-TREATMENT +mediante I-TREATMENT +resección I-TREATMENT +craneofacial I-TREATMENT +de I-TREATMENT +etmoides I-TREATMENT +y I-TREATMENT +translocación I-TREATMENT +facial I-TREATMENT +medial, I-TREATMENT +que I-TREATMENT +permite I-TREATMENT +apreciar I-TREATMENT +que I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +ocupaba I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +seno I-TREATMENT +maxilar I-TREATMENT +derecho I-TREATMENT +y I-TREATMENT +celdas I-TREATMENT +etmoidales, I-TREATMENT +a I-TREATMENT +las I-TREATMENT +cuales I-TREATMENT +desplaza I-TREATMENT +por I-TREATMENT +compresión, I-TREATMENT +con I-TREATMENT +disrupción I-TREATMENT +de I-TREATMENT +partes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +ósea I-TREATMENT +posterior I-TREATMENT +y I-TREATMENT +medial I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +maxilar. I-TREATMENT +El I-TREATMENT +tumor I-TREATMENT +rellenaba I-TREATMENT +submucosamente I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +fosa I-TREATMENT +nasal I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +esfenoidal. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +Anatomo-patológico I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +Neuroestesioblastoma, I-EXPLORATION +estadio I-EXPLORATION +B I-EXPLORATION +de I-EXPLORATION +Kádish. I-EXPLORATION +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +sufrió I-EVOLUTION +una I-EVOLUTION +meningitis I-EVOLUTION +bacteriana I-EVOLUTION +con I-EVOLUTION +evolución I-EVOLUTION +satisfactoria. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +RNM I-EXPLORATION +posquirúrgica I-EXPLORATION +solo I-EXPLORATION +se I-EXPLORATION +visualizan I-EXPLORATION +cambios I-EXPLORATION +postcirugía. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +valoración I-TREATMENT +en I-TREATMENT +Subcomité I-TREATMENT +de I-TREATMENT +tumores I-TREATMENT +de I-TREATMENT +cabeza I-TREATMENT +y I-TREATMENT +cuello I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +Radioterapia I-TREATMENT +postoperatoria, I-TREATMENT +recibiendo I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +sobre I-TREATMENT +lecho I-TREATMENT +tumoral I-TREATMENT +de I-TREATMENT +60 I-TREATMENT +Gy I-TREATMENT +con I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +simulación I-TREATMENT +virtual I-TREATMENT +y I-TREATMENT +planificación I-TREATMENT +tridimensional I-TREATMENT +(3D) I-TREATMENT +sobre I-TREATMENT +tomografía I-TREATMENT +computarizada I-TREATMENT +(TC) I-TREATMENT +helicoidal I-TREATMENT +individualizada I-TREATMENT +(cortes I-TREATMENT +cada I-TREATMENT +5 I-TREATMENT +mm), I-TREATMENT +con I-TREATMENT +protección I-TREATMENT +plomada I-TREATMENT +personalizada I-TREATMENT +de I-TREATMENT +órganos I-TREATMENT +sanos, I-TREATMENT +fraccionamiento I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +Gy/fracción, I-TREATMENT +5 I-TREATMENT +fracciones I-TREATMENT +semana I-TREATMENT +mediante I-TREATMENT +fotones I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +Megavoltios I-TREATMENT +(MV) I-TREATMENT +procedentes I-TREATMENT +de I-TREATMENT +Acelerador I-TREATMENT +Lineal. I-TREATMENT +Se I-TREATMENT +emplea I-TREATMENT +sistema I-TREATMENT +de I-TREATMENT +homogeneización I-TREATMENT +de I-TREATMENT +dosis I-TREATMENT +con I-TREATMENT +cuñas I-TREATMENT +de I-TREATMENT +compensación I-TREATMENT +tisular, I-TREATMENT +e I-TREATMENT +inmovilización I-TREATMENT +con I-TREATMENT +máscara I-TREATMENT +termoplástica I-TREATMENT +facial I-TREATMENT +para I-TREATMENT +una I-TREATMENT +adecuada I-TREATMENT +reproductibilidad I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +largo I-TREATMENT +del I-TREATMENT +tratamiento. I-TREATMENT +La B-EVOLUTION +tolerancia I-EVOLUTION +es I-EVOLUTION +buena, I-EVOLUTION +con I-EVOLUTION +toxicidad I-EVOLUTION +aguda I-EVOLUTION +dérmica I-EVOLUTION +grado I-EVOLUTION +1 I-EVOLUTION +(G1), I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +mucosa I-EVOLUTION +grado I-EVOLUTION +2 I-EVOLUTION +(G2). I-EVOLUTION +A B-TREATMENT +las I-TREATMENT +4 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +finalizada I-TREATMENT +la I-TREATMENT +irradiación I-TREATMENT +es I-TREATMENT +reintervenida I-TREATMENT +por I-TREATMENT +fístula I-TREATMENT +oroantral I-TREATMENT +en I-TREATMENT +el I-TREATMENT +surco I-TREATMENT +gingival I-TREATMENT +derecho I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +primer I-TREATMENT +molar. I-TREATMENT +Siete I-TREATMENT +meses I-TREATMENT +después, I-TREATMENT +es I-TREATMENT +reintervenida I-TREATMENT +con I-TREATMENT +abordaje I-TREATMENT +craneofacial I-TREATMENT +por I-TREATMENT +granuloma I-TREATMENT +a I-TREATMENT +cuerpo I-TREATMENT +extraño I-TREATMENT +en I-TREATMENT +cavidad I-TREATMENT +frontal I-TREATMENT +izquierda I-TREATMENT +sin I-TREATMENT +datos I-TREATMENT +histológicos I-TREATMENT +de I-TREATMENT +recidiva. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +tras I-EVOLUTION +26 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +intervención, I-EVOLUTION +no I-EVOLUTION +existe I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +local, I-EVOLUTION +hallándose I-EVOLUTION +en I-EVOLUTION +remisión I-EVOLUTION +completa, I-EVOLUTION +realizando I-EVOLUTION +vida I-EVOLUTION +normal I-EVOLUTION +activa. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +homosexual I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antecedentes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tuberculosis I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +estreptomicina, I-PAST_MEDICAL_HISTORY +esfinterotomía I-PAST_MEDICAL_HISTORY +lateral I-PAST_MEDICAL_HISTORY +interna I-PAST_MEDICAL_HISTORY +reciente I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +fisura I-PAST_MEDICAL_HISTORY +anal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +centinela, I-PAST_MEDICAL_HISTORY +serología I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +positiva I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +enero I-PAST_MEDICAL_HISTORY +2003, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +C3 I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +neumonía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Pneumocystis I-PAST_MEDICAL_HISTORY +carinii. I-PAST_MEDICAL_HISTORY +Último I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +CD I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +2.220.000 I-PAST_MEDICAL_HISTORY +copias I-PAST_MEDICAL_HISTORY +virales. I-PAST_MEDICAL_HISTORY +Inicia B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +lamivudina-zidovudina-ritonavir-lopinavir. I-TREATMENT +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +postpandrial I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +pirosis. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +lesiones I-EXPLORATION +sobreelevadas I-EXPLORATION +rojovioláceas I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +laterocervical I-EXPLORATION +izquierda I-EXPLORATION +e I-EXPLORATION +inguinal I-EXPLORATION +derecha, I-EXPLORATION +la I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +endoscopia I-EXPLORATION +oral, I-EXPLORATION +apreciándose I-EXPLORATION +lesiones I-EXPLORATION +eritematosas I-EXPLORATION +en I-EXPLORATION +estómago I-EXPLORATION +y I-EXPLORATION +primeras I-EXPLORATION +porciones I-EXPLORATION +duodenales, I-EXPLORATION +alguna I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +ulceradas I-EXPLORATION +con I-EXPLORATION +biopsia I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +sarcoma I-EXPLORATION +de I-EXPLORATION +Kaposi. I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +negativo, I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +toracabdominal I-EXPLORATION +normal. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +sarcoma I-TREATMENT +de I-TREATMENT +kaposi I-TREATMENT +con I-TREATMENT +afectación I-TREATMENT +visceral I-TREATMENT +y I-TREATMENT +cutánea I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +adriamicina I-TREATMENT +liposomal I-TREATMENT +20 I-TREATMENT +mg/m2 I-TREATMENT +cada I-TREATMENT +3 I-TREATMENT +semanas. I-TREATMENT +Desde B-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +de I-EVOLUTION +ciclo I-EVOLUTION +de I-EVOLUTION +tratamiento, I-EVOLUTION +se I-EVOLUTION +produce I-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +afectación I-EVOLUTION +cutánea I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +queda I-EVOLUTION +asintomático, I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +ciclo I-EVOLUTION +se I-EVOLUTION +repite I-EVOLUTION +endoscopia I-EVOLUTION +oral, I-EVOLUTION +mostrando I-EVOLUTION +una I-EVOLUTION +resolución I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesiones. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés I-FAMILY_HISTORY +oncológico I-FAMILY_HISTORY +y B-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +túnel I-PAST_MEDICAL_HISTORY +carpiano I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mano I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +nódulos I-PAST_MEDICAL_HISTORY +mamarios I-PAST_MEDICAL_HISTORY +benignos. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +diagnostico I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +suplementos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +calcitonina I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +osteoporosis. I-PAST_MEDICAL_HISTORY +Desde B-PRESENT_ILLNESS +noviembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1999 I-PRESENT_ILLNESS +notaba I-PRESENT_ILLNESS +perdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +visión I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +ocular I-PRESENT_ILLNESS +ocasional I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +conjuntivitis I-PRESENT_ILLNESS +bilateral. I-PRESENT_ILLNESS +Vista B-EXPLORATION +por I-EXPLORATION +oftalmología I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +"edema I-EXPLORATION +de I-EXPLORATION +papila" I-EXPLORATION +unilateral I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +izquierdo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +movimientos I-EXPLORATION +oculares I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +órbitas. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +exploraciones I-EXPLORATION +complementarias. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +órbita: I-EXPLORATION +en I-EXPLORATION +vértice I-EXPLORATION +de I-EXPLORATION +órbita I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +íntimo I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +nervio I-EXPLORATION +óptico, I-EXPLORATION +se I-EXPLORATION +visualiza I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +intraconal I-EXPLORATION +que I-EXPLORATION +captaba I-EXPLORATION +contraste I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +intensa I-EXPLORATION +y I-EXPLORATION +homogénea, I-EXPLORATION +observándose I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vaina I-EXPLORATION +del I-EXPLORATION +nervio I-EXPLORATION +óptico I-EXPLORATION +formando I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +en I-EXPLORATION +"railes I-EXPLORATION +de I-EXPLORATION +tranvía". I-EXPLORATION +No I-EXPLORATION +había I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +agrandamiento I-EXPLORATION +del I-EXPLORATION +agujero I-EXPLORATION +óptico I-EXPLORATION +ni I-EXPLORATION +invasión I-EXPLORATION +intracraneal; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +erosiones I-EXPLORATION +óseas. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +RMN I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +órbita: I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +isointensa I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +cerebral I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +secuencias I-EXPLORATION +que I-EXPLORATION +ocupa I-EXPLORATION +el I-EXPLORATION +agujero I-EXPLORATION +óptico I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +captación I-EXPLORATION +intensa I-EXPLORATION +y I-EXPLORATION +homogénea I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +englobaba I-EXPLORATION +el I-EXPLORATION +nervio I-EXPLORATION +óptico I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +discretamente I-EXPLORATION +comprimido. I-EXPLORATION +El I-EXPLORATION +tamaño I-EXPLORATION +aproximado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +2x1x1 I-EXPLORATION +cm. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +radiológicos I-EXPLORATION +sugerían I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +meningioma I-EXPLORATION +aunque I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +podían I-EXPLORATION +descartar I-EXPLORATION +otras I-EXPLORATION +posibilidades I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vaina I-EXPLORATION +nerviosa. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Estudio I-EXPLORATION +oftalmológico: I-EXPLORATION +mostró I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +una I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +visión I-EXPLORATION +a I-EXPLORATION +1/10 I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +campimétrico I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +déficit I-EXPLORATION +en I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +conservando I-EXPLORATION +parcialmente I-EXPLORATION +la I-EXPLORATION +visión I-EXPLORATION +en I-EXPLORATION +cuadrante I-EXPLORATION +superior I-EXPLORATION +interno. I-EXPLORATION + I-EXPLORATION +Valorado B-TREATMENT +por I-TREATMENT +el I-TREATMENT +Comité I-TREATMENT +de I-TREATMENT +Radiocirugía I-TREATMENT +(RC) I-TREATMENT +se I-TREATMENT +aceptó I-TREATMENT +el I-TREATMENT +caso I-TREATMENT +para I-TREATMENT +RTEF, I-TREATMENT +siendo I-TREATMENT +irradiado I-TREATMENT +con I-TREATMENT +un I-TREATMENT +Acelerador I-TREATMENT +Lineal I-TREATMENT +con I-TREATMENT +fotones I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +Mv, I-TREATMENT +con I-TREATMENT +colimadores I-TREATMENT +cónicos I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +y I-TREATMENT +25 I-TREATMENT +mm, I-TREATMENT +con I-TREATMENT +2 I-TREATMENT +isocentros, I-TREATMENT +administrándose I-TREATMENT +8 I-TREATMENT +arcos I-TREATMENT +esterotáxicos I-TREATMENT +y I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +de I-TREATMENT +52, I-TREATMENT +2 I-TREATMENT +Gy I-TREATMENT +en I-TREATMENT +fracciones I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +8 I-TREATMENT +Gy, I-TREATMENT +hasta I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +29 I-TREATMENT +fracciones. I-TREATMENT +Se I-TREATMENT +eligió I-TREATMENT +como I-TREATMENT +referencia I-TREATMENT +la I-TREATMENT +Isodosis I-TREATMENT +de I-TREATMENT +Cubrimiento I-TREATMENT +del I-TREATMENT +80%. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +respondió I-EVOLUTION +clínicamente I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +dolorosa I-EVOLUTION +orbitaria I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +exoftalmos I-EVOLUTION +ya I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +control I-EVOLUTION +semestral. I-EVOLUTION +Las I-EVOLUTION +exploraciones I-EVOLUTION +con I-EVOLUTION +RMN I-EVOLUTION +confirmaron I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +control I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +significativa I-EVOLUTION +del I-EVOLUTION +tamaño I-EVOLUTION +tumoral, I-EVOLUTION +quedando I-EVOLUTION +zonas I-EVOLUTION +de I-EVOLUTION +captación I-EVOLUTION +alrededor I-EVOLUTION +del I-EVOLUTION +agujero I-EVOLUTION +óptico, I-EVOLUTION +sugestivas I-EVOLUTION +de I-EVOLUTION +restos I-EVOLUTION +tumorales I-EVOLUTION +de I-EVOLUTION +meningioma I-EVOLUTION +que I-EVOLUTION +han I-EVOLUTION +permanecido I-EVOLUTION +estables I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +posteriores. I-EVOLUTION +Los I-EVOLUTION +estudios I-EVOLUTION +oftalmológicos I-EVOLUTION +demostraron I-EVOLUTION +mejora I-EVOLUTION +de I-EVOLUTION +cierto I-EVOLUTION +grado I-EVOLUTION +de I-EVOLUTION +visión, I-EVOLUTION +situación I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +paso I-EVOLUTION +del I-EVOLUTION +tiempo. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +etiquetada I-EVOLUTION +en I-EVOLUTION +remisión I-EVOLUTION +clínica I-EVOLUTION +parcial/completa. I-EVOLUTION +No I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +toxicidad I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +vía I-EVOLUTION +óptica I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +actual. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos, I-PRESENT_ILLNESS +escasa I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +máximos I-PRESENT_ILLNESS +esfuerzos I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +hizo I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +moderados I-PRESENT_ILLNESS +esfuerzos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +exfumador I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +(1.5 I-PAST_MEDICAL_HISTORY +paq/día), I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +ocular, I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fémur I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tibia I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +13 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +complicada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +osteomielitis, I-PAST_MEDICAL_HISTORY +herniorrafia I-PAST_MEDICAL_HISTORY +umbilical I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +apendicitis. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Exploración B-EXPLORATION +física: I-EXPLORATION +no I-EXPLORATION +fiebre, I-EXPLORATION +no I-EXPLORATION +dolor I-EXPLORATION +torácico, I-EXPLORATION +eupneico I-EXPLORATION +en I-EXPLORATION +reposo, I-EXPLORATION +no I-EXPLORATION +síndrome I-EXPLORATION +constitucional, I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ventilación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemitórax I-EXPLORATION +izquierdo. I-EXPLORATION +Peso=73, I-EXPLORATION +4 I-EXPLORATION +Kg, I-EXPLORATION +altura=1, I-EXPLORATION +69 I-EXPLORATION +m. I-EXPLORATION + I-EXPLORATION +Analítica: I-EXPLORATION +leucocitosis I-EXPLORATION +leve I-EXPLORATION +(11.3x10^9/l) I-EXPLORATION +y I-EXPLORATION +ligera I-EXPLORATION +neutrofilia I-EXPLORATION +(74.7%), I-EXPLORATION +bioquímica I-EXPLORATION +y I-EXPLORATION +coagulación: I-EXPLORATION +normales. I-EXPLORATION +Gasometría I-EXPLORATION +arterial: I-EXPLORATION +pH=7.41, I-EXPLORATION +pO2=74.0 I-EXPLORATION +mmHg, I-EXPLORATION +pCO2=36.3 I-EXPLORATION +mmHg. I-EXPLORATION +Rx-TC: I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +regulares I-EXPLORATION +de I-EXPLORATION +10.8 I-EXPLORATION +x I-EXPLORATION +8.4 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mediastino I-EXPLORATION +anterior I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +extensión I-EXPLORATION +al I-EXPLORATION +hilio I-EXPLORATION +ipsilateral I-EXPLORATION +comprimiéndolo, I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +izquierdo I-EXPLORATION +moderado. I-EXPLORATION +Fibrobroncoscopia: I-EXPLORATION +no I-EXPLORATION +tumoración I-EXPLORATION +endobronquial, I-EXPLORATION +hiperemia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +difusa. I-EXPLORATION +Pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +respiratoria: I-EXPLORATION +FEV1=2010 I-EXPLORATION +l. I-EXPLORATION +(59%), I-EXPLORATION +FVC=2290 I-EXPLORATION +l. I-EXPLORATION +(54.8%), I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +Tiffenau=87.8%. I-EXPLORATION +PAAF: I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +con I-EXPLORATION +discreto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +atipia I-EXPLORATION +y I-EXPLORATION +abundantes I-EXPLORATION +linfocitos, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +histiocitos, I-EXPLORATION +células I-EXPLORATION +gigantes I-EXPLORATION +multinucleadas I-EXPLORATION +y I-EXPLORATION +eosinófilos, I-EXPLORATION +algunas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +(citología I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +timoma). I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +fue I-EXPLORATION +sometido I-EXPLORATION +a I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +toracoscopia: I-EXPLORATION +nódulos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pleura I-EXPLORATION +parietal I-EXPLORATION +y I-EXPLORATION +diafragmática, I-EXPLORATION +nódulos I-EXPLORATION +pulmonares I-EXPLORATION +en I-EXPLORATION +LII I-EXPLORATION +(informe I-EXPLORATION +de I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +intraoperatoria I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +linfoide I-EXPLORATION +y I-EXPLORATION +material I-EXPLORATION +fibrohemorrágico), I-EXPLORATION +evacuación I-EXPLORATION +de I-EXPLORATION +2000 I-EXPLORATION +ml I-EXPLORATION +de I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +y I-EXPLORATION +observación I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +tumoral I-EXPLORATION +en I-EXPLORATION +mediastino I-EXPLORATION +anterior. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +anatomopatológicos I-EXPLORATION +definitivos I-EXPLORATION +fueron: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Citología I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +pleural: I-EXPLORATION +hiperplasia I-EXPLORATION +mesotelial I-EXPLORATION +reactiva I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Biopsia I-EXPLORATION +de I-EXPLORATION +pleura I-EXPLORATION +parietal I-EXPLORATION +y I-EXPLORATION +diafragmática: I-EXPLORATION +tejido I-EXPLORATION +fibroso I-EXPLORATION +hialinizado, I-EXPLORATION +tejido I-EXPLORATION +fibroso I-EXPLORATION +y I-EXPLORATION +muscular I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +mediastínica: I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +citoqueratina I-EXPLORATION +y I-EXPLORATION +CAM I-EXPLORATION +5.2, I-EXPLORATION +células I-EXPLORATION +linfoides I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +CD-3 I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +timoma I-EXPLORATION +cortical. I-EXPLORATION + I-EXPLORATION +Por B-TREATMENT +tratarse I-TREATMENT +de I-TREATMENT +un I-TREATMENT +timoma I-TREATMENT +invasor I-TREATMENT +(estadío-III I-TREATMENT +de I-TREATMENT +Massaoka), I-TREATMENT +se I-TREATMENT +planeó I-TREATMENT +una I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Qt I-TREATMENT +neoadyuvante, I-TREATMENT +cirugía I-TREATMENT +y I-TREATMENT +posterior I-TREATMENT +radioterapia. I-TREATMENT + I-TREATMENT +La I-TREATMENT +Qt I-TREATMENT +consistió I-TREATMENT +en: I-TREATMENT +adriamicina I-TREATMENT +50 I-TREATMENT +mg/m I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +CDDP I-TREATMENT +100 I-TREATMENT +mg/m2 I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +ciclos I-TREATMENT +con I-TREATMENT +intervalo I-TREATMENT +de I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +segundo I-TREATMENT +y I-TREATMENT +tercer I-TREATMENT +ciclos I-TREATMENT +se I-TREATMENT +disminuyó I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +CDDP I-TREATMENT +a I-TREATMENT +75 I-TREATMENT +mg/m2 I-TREATMENT +por I-TREATMENT +vómitos I-TREATMENT +y I-TREATMENT +somnolencia. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +Qt I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +una I-EVOLUTION +reducción I-EVOLUTION +del I-EVOLUTION +tamaño I-EVOLUTION +aproximadamente I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +25% I-EVOLUTION +a I-EVOLUTION +expensas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +porción I-EVOLUTION +periférica I-EVOLUTION +manteniendo I-EVOLUTION +la I-EVOLUTION +prolongación I-EVOLUTION +hacia I-EVOLUTION +el I-EVOLUTION +hilio I-EVOLUTION +pulmonar: I-EVOLUTION +7.9 I-EVOLUTION +x I-EVOLUTION +6.3 I-EVOLUTION +cm I-EVOLUTION +infiltrando I-EVOLUTION +la I-EVOLUTION +pleura I-EVOLUTION +mediastínica I-EVOLUTION +y I-EVOLUTION +contactando I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +arteria I-EVOLUTION +pulmonar I-EVOLUTION +izquierda. I-EVOLUTION + I-EVOLUTION +En B-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +en I-TREATMENT +bloque I-TREATMENT +del I-TREATMENT +timoma I-TREATMENT +junto I-TREATMENT +a I-TREATMENT +una I-TREATMENT +neumonectomía I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +linfadenectomía I-TREATMENT +mediastínica I-TREATMENT +englobando I-TREATMENT +los I-TREATMENT +ganglios I-TREATMENT +de I-TREATMENT +las I-TREATMENT +áreas I-TREATMENT +5, I-TREATMENT +6, I-TREATMENT +7, I-TREATMENT +8 I-TREATMENT +y I-TREATMENT +9. I-TREATMENT +Los I-TREATMENT +nervios I-TREATMENT +frénico I-TREATMENT +y I-TREATMENT +vago I-TREATMENT +izquierdos I-TREATMENT +fueron I-TREATMENT +seccionados I-TREATMENT +por I-TREATMENT +invasión I-TREATMENT +tumoral. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +anemia I-EVOLUTION +bien I-EVOLUTION +tolerada I-EVOLUTION +sin I-EVOLUTION +precisar I-EVOLUTION +transfusión I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION +Los B-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +fueron: I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +adenopatías I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +tumor, I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +previo I-EXPLORATION +de I-EXPLORATION +timoma I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +tumoral I-EXPLORATION +del I-EXPLORATION +20%. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +paquetes/año, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buen I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +farmacológico, I-PAST_MEDICAL_HISTORY +miopía I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +catarata I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +destacables. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +oftalmología I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital, I-PRESENT_ILLNESS +consistió I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +escotoma I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +central I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +respiratorios, I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +constitucional. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmoscópica I-EXPLORATION +se I-EXPLORATION +identificaba I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +más I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +papila, I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +despigmentación, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +pigmentadas I-EXPLORATION +anaranjadas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +centro, I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +4-5 I-EXPLORATION +diámetros I-EXPLORATION +papilares I-EXPLORATION +y I-EXPLORATION +levantamiento I-EXPLORATION +exudativo I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +bordes. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +angiografía I-EXPLORATION +fluoresceínica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +reconoce I-EXPLORATION +de I-EXPLORATION +nuevo I-EXPLORATION +esta I-EXPLORATION +misma I-EXPLORATION +lesión I-EXPLORATION +descrita I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +retinografía, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +o I-EXPLORATION +hemangioma. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +orbitaria I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +3 I-EXPLORATION +milímetros I-EXPLORATION +(mm) I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +mm. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +mínimo I-EXPLORATION +engrosamiento I-EXPLORATION +focal I-EXPLORATION +retiniano I-EXPLORATION +inmediatamente I-EXPLORATION +adyacente I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +papila, I-EXPLORATION +sin I-EXPLORATION +hiperseñal I-EXPLORATION +ni I-EXPLORATION +realce I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION +Un I-EXPLORATION +mes I-EXPLORATION +después I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +retinografía I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +orbitaria, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +claro I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +retiniana, I-EXPLORATION +llegando I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +dimensión I-EXPLORATION +de I-EXPLORATION +9, I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +3, I-EXPLORATION +9 I-EXPLORATION +mm. I-EXPLORATION +La I-EXPLORATION +aproximación I-EXPLORATION +diagnóstica I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +retiniano, I-EXPLORATION +posiblemente I-EXPLORATION +metastásico. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +general I-EXPLORATION +de I-EXPLORATION +búsqueda I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +primario, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +toracoabdominopélvica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +2 I-EXPLORATION +cm, I-EXPLORATION +que I-EXPLORATION +engloba I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +del I-EXPLORATION +bronquio I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +superior, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +adenopatías I-EXPLORATION +mediastínicas I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +superior I-EXPLORATION +a I-EXPLORATION +2 I-EXPLORATION +centímetros I-EXPLORATION +(cm) I-EXPLORATION +prevasculares, I-EXPLORATION +pretraqueales I-EXPLORATION +derechas, I-EXPLORATION +ventana I-EXPLORATION +aortopulmonar I-EXPLORATION +y I-EXPLORATION +subcarinales. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +abdominal I-EXPLORATION +destacan I-EXPLORATION +nódulos I-EXPLORATION +suprarrenales I-EXPLORATION +bilaterales I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +derecho. I-EXPLORATION +La I-EXPLORATION +Tomografía I-EXPLORATION +por I-EXPLORATION +emisión I-EXPLORATION +de I-EXPLORATION +positrones I-EXPLORATION +(PET) I-EXPLORATION +mostraba I-EXPLORATION +múltiples I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +elevada I-EXPLORATION +actividad I-EXPLORATION +metabólica I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +paratraqueal I-EXPLORATION +derecho, I-EXPLORATION +mediastínico I-EXPLORATION +y I-EXPLORATION +región I-EXPLORATION +hiliar I-EXPLORATION +y I-EXPLORATION +parahiliar I-EXPLORATION +izquierdo, I-EXPLORATION +región I-EXPLORATION +suprarrenal I-EXPLORATION +derecha, I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +tumoral I-EXPLORATION +maligna. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +mediastinoscopia I-EXPLORATION +para I-EXPLORATION +toma I-EXPLORATION +de I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +paratraqueal I-EXPLORATION +derecha, I-EXPLORATION +cuyo I-EXPLORATION +resultado I-EXPLORATION +fue I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +adenocarcinoma. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +metástasis I-TREATMENT +retiniana I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +suprarrenal I-TREATMENT +de I-TREATMENT +adenocarcinoma I-TREATMENT +de I-TREATMENT +pulmón, I-TREATMENT +comienza I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +docetaxel I-TREATMENT +y I-TREATMENT +cisplatino, I-TREATMENT +mostrando I-TREATMENT +tras I-TREATMENT +dos I-TREATMENT +ciclos I-TREATMENT +una I-TREATMENT +respuesta I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +medible I-TREATMENT +y I-TREATMENT +una I-TREATMENT +aparente I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +formación I-TREATMENT +retiniana, I-TREATMENT +aunque I-TREATMENT +posteriormente, I-TREATMENT +se I-TREATMENT +complicó I-TREATMENT +con I-TREATMENT +un I-TREATMENT +desprendimiento I-TREATMENT +de I-TREATMENT +retina I-TREATMENT +leve I-TREATMENT +y I-TREATMENT +tuvo I-TREATMENT +que I-TREATMENT +ser I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +radioterapia. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +visto I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +vez I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestras I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +marzo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2003. I-PRESENT_ILLNESS +Fue B-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Nefrología I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +diagnosticarse I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tumor I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +músculo I-DERIVED_FROM/TO +liso I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +potencial I-DERIVED_FROM/TO +maligno I-DERIVED_FROM/TO +incierto. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +cólico I-PAST_MEDICAL_HISTORY +nefrítico I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +estudiado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dicho I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +haberse I-PAST_MEDICAL_HISTORY +detectado I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +se I-EXPLORATION +describió I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +abdominal I-EXPLORATION +polilobulada I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +realzaba I-EXPLORATION +en I-EXPLORATION +parte I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +y I-EXPLORATION +presentaba I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +espacio I-EXPLORATION +subfrénico I-EXPLORATION +hasta I-EXPLORATION +hilio I-EXPLORATION +esplénico I-EXPLORATION +y I-EXPLORATION +cola I-EXPLORATION +pancreática. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +13-2-03 I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecoendoscopia: I-EXPLORATION +gran I-EXPLORATION +tumoración I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +probable I-EXPLORATION +localización I-EXPLORATION +en I-EXPLORATION +retroperitoneo, I-EXPLORATION +independiente I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cola I-EXPLORATION +del I-EXPLORATION +páncreas I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +bazo I-EXPLORATION +del I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +podía I-EXPLORATION +independizar. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +adenopatías. I-EXPLORATION +Se B-TREATMENT +intervino I-TREATMENT +el I-TREATMENT +6-3-03 I-TREATMENT +encontrándose I-TREATMENT +tumoración I-TREATMENT +multilobulada I-TREATMENT +entre I-TREATMENT +fornix I-TREATMENT +e I-TREATMENT +hilio I-TREATMENT +esplénico, I-TREATMENT +realizándose I-TREATMENT +extirpación I-TREATMENT +total I-TREATMENT +junto I-TREATMENT +a I-TREATMENT +bazo I-TREATMENT +y I-TREATMENT +pared I-TREATMENT +gástrica I-TREATMENT +a I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +adhiere. I-TREATMENT + I-TREATMENT +Anatomía B-EXPLORATION +Patológica I-EXPLORATION +: I-EXPLORATION +Macroscópicamente I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +hilio I-EXPLORATION +esplénico I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +multinodular I-EXPLORATION +de I-EXPLORATION +11x9x6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +firme I-EXPLORATION +y I-EXPLORATION +coloración I-EXPLORATION +pardusca I-EXPLORATION +que I-EXPLORATION +al I-EXPLORATION +corte I-EXPLORATION +presenta I-EXPLORATION +frecuentes I-EXPLORATION +áreas I-EXPLORATION +hemorrágicas. I-EXPLORATION +Microscópicamente, I-EXPLORATION +el I-EXPLORATION +bazo I-EXPLORATION +no I-EXPLORATION +muestra I-EXPLORATION +infiltración I-EXPLORATION +tumoral. I-EXPLORATION +Fragmento I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +gástrica I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +El I-EXPLORATION +tumor I-EXPLORATION +descrito I-EXPLORATION +previamente I-EXPLORATION +está I-EXPLORATION +bien I-EXPLORATION +delimitado I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +delgada I-EXPLORATION +cápsula I-EXPLORATION +fibrosa I-EXPLORATION +y I-EXPLORATION +está I-EXPLORATION +constituido I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +fusiformes I-EXPLORATION +isomorfas, I-EXPLORATION +sin I-EXPLORATION +atipia I-EXPLORATION +ni I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +necrosis, I-EXPLORATION +presentado I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +mitótico I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +mitosis I-EXPLORATION +por I-EXPLORATION +10 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +aumento. I-EXPLORATION +La I-EXPLORATION +inmunohistoquímica I-EXPLORATION +(IMH) I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +actina I-EXPLORATION +de I-EXPLORATION +músculo I-EXPLORATION +liso I-EXPLORATION +y I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +desmina, I-EXPLORATION +S-100, I-EXPLORATION +CD I-EXPLORATION +57, I-EXPLORATION +EMA, I-EXPLORATION +CD68 I-EXPLORATION +y I-EXPLORATION +neurofilamentos. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +fue I-EXPLORATION +"Tumor I-EXPLORATION +de I-EXPLORATION +musculo I-EXPLORATION +liso I-EXPLORATION +de I-EXPLORATION +potencial I-EXPLORATION +maligno I-EXPLORATION +incierto" I-EXPLORATION +(11 I-EXPLORATION +cm). I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +negativo, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +revisión I-EXPLORATION +del I-EXPLORATION +caso I-EXPLORATION +para I-EXPLORATION +catalogación I-EXPLORATION +definitiva I-EXPLORATION +mediante I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +IMH I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +esta I-EXPLORATION +ocasión I-EXPLORATION +incluyera I-EXPLORATION +CD I-EXPLORATION +117; I-EXPLORATION +ésta I-EXPLORATION +fue I-EXPLORATION +intensamente I-EXPLORATION +positiva. I-EXPLORATION + I-EXPLORATION +Resultados: I-EXPLORATION +Actina I-EXPLORATION +de I-EXPLORATION +músculo I-EXPLORATION +liso I-EXPLORATION +y I-EXPLORATION +Actina I-EXPLORATION +muscular I-EXPLORATION +específica: I-EXPLORATION +inmunotinción I-EXPLORATION +débil I-EXPLORATION +y I-EXPLORATION +focal; I-EXPLORATION +CD34 I-EXPLORATION +y I-EXPLORATION +c-kit I-EXPLORATION +(CD I-EXPLORATION +117): I-EXPLORATION +inmunotinción I-EXPLORATION +intensa I-EXPLORATION +con I-EXPLORATION +control I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +CD I-EXPLORATION +117; I-EXPLORATION +S-100 I-EXPLORATION +y I-EXPLORATION +desmina: I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +inmunotinción; I-EXPLORATION +Ki67: I-EXPLORATION +10%. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +tumor I-EXPLORATION +estromal I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +en I-EXPLORATION +retroperitoneo I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +entre B-PAST_MEDICAL_HISTORY +cuyos I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +I, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +únicamente I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +medidas I-PAST_MEDICAL_HISTORY +dietéticas, I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +beta-talasemia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +dermatitis I-PAST_MEDICAL_HISTORY +atópica. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hábito I-PAST_MEDICAL_HISTORY +tabáquico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +paquetes/año I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +estudiada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cirugía I-PRESENT_ILLNESS +vascular I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2003 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +raiz I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +úlceras I-PRESENT_ILLNESS +profundas, I-PRESENT_ILLNESS +dolorosas, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ellas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pierna I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +mejoría I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +tratamientos I-PRESENT_ILLNESS +administrados I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +llegándose I-PRESENT_ILLNESS +finalmente I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pioderma I-PRESENT_ILLNESS +gangrenoso I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +realización I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +biopsia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lesión. I-PRESENT_ILLNESS +Ante B-DERIVED_FROM/TO +dicho I-DERIVED_FROM/TO +hallazgo, I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +medicina I-DERIVED_FROM/TO +interna I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +mayo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2004 I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +sometida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +diversas I-DERIVED_FROM/TO +pruebas I-DERIVED_FROM/TO +diagnósticas, I-DERIVED_FROM/TO +destacando I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +normalidad I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +pruebas I-DERIVED_FROM/TO +realizadas, I-DERIVED_FROM/TO +tanto I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +pruebas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +imagen, I-DERIVED_FROM/TO +como I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +inmunológico. I-DERIVED_FROM/TO +Así I-DERIVED_FROM/TO +mismo I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +negaba I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +digestiva I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cualquier I-DERIVED_FROM/TO +índole. I-DERIVED_FROM/TO +Se B-TREATMENT +instaura I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +corticoides I-TREATMENT +y I-TREATMENT +ciclosporina I-TREATMENT +A I-TREATMENT +con I-TREATMENT +muy I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínica I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +sigue I-TREATMENT +este I-TREATMENT +tratamiento I-TREATMENT +hasta I-TREATMENT +noviembre I-TREATMENT +de I-TREATMENT +2004 I-TREATMENT +así I-TREATMENT +como I-TREATMENT +curas I-TREATMENT +locales I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +ulcerosas, I-TREATMENT +aunque I-TREATMENT +con I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +dichas I-TREATMENT +lesiones. I-TREATMENT + B-EVOLUTION +En I-EVOLUTION +noviembre I-EVOLUTION +de I-EVOLUTION +2004 I-EVOLUTION +comienza I-EVOLUTION +con I-EVOLUTION +clínica I-EVOLUTION +digestiva I-EVOLUTION +inespecífica I-EVOLUTION +consistente I-EVOLUTION +en I-EVOLUTION +molestias I-EVOLUTION +abdominales I-EVOLUTION +difusas I-EVOLUTION +y I-EVOLUTION +alteración I-EVOLUTION +del I-EVOLUTION +ritmo I-EVOLUTION +intestinal, I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +clínica I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +anemia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +(en I-EXPLORATION +principio I-EXPLORATION +atribuida I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +beta-talasemia) I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +y I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +baja, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +en I-EXPLORATION +recto I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +inmediatamente I-EXPLORATION +al I-EXPLORATION +pasar I-EXPLORATION +el I-EXPLORATION +esfinter, I-EXPLORATION +de I-EXPLORATION +tacto I-EXPLORATION +dura, I-EXPLORATION +mamelonada I-EXPLORATION +y I-EXPLORATION +muy I-EXPLORATION +friable, I-EXPLORATION +región I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +toman I-EXPLORATION +biopsias. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +mucosecretor I-EXPLORATION +tipo I-EXPLORATION +coloide. I-EXPLORATION +Ante B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +referido I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +realizándose I-TREATMENT +una I-TREATMENT +amputación I-TREATMENT +abdomino-perineal I-TREATMENT +y I-TREATMENT +una I-TREATMENT +colostom��a I-TREATMENT +terminal I-TREATMENT +izquierda I-TREATMENT +a I-TREATMENT +fecha I-TREATMENT +de I-TREATMENT +enero I-TREATMENT +de I-TREATMENT +2005. I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +mucosecretor I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado I-EXPLORATION +con I-EXPLORATION +extensas I-EXPLORATION +necrosis I-EXPLORATION +que I-EXPLORATION +infiltraba I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared. I-EXPLORATION +Afectación I-EXPLORATION +por I-EXPLORATION +adenocarcinoma I-EXPLORATION +en I-EXPLORATION +cinco I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +nueve I-EXPLORATION +ganglios I-EXPLORATION +aislados. I-EXPLORATION +Márgenes I-EXPLORATION +libres. I-EXPLORATION + I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +realizada I-EXPLORATION +la I-EXPLORATION +cirugía, I-EXPLORATION +se I-EXPLORATION +somete I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión, I-EXPLORATION +que I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +pulmonares I-EXPLORATION +múltiples, I-EXPLORATION +y I-EXPLORATION +afectación I-EXPLORATION +adenopática I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +mesentérico, I-EXPLORATION +retroperitoneal, I-EXPLORATION +y I-EXPLORATION +pélvico. I-EXPLORATION +Con B-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +adenocarcinoma I-TREATMENT +de I-TREATMENT +recto I-TREATMENT +estadio-IV I-TREATMENT +decidimos I-TREATMENT +iniciar I-TREATMENT +quimioterapia I-TREATMENT +paliativa I-TREATMENT +en I-TREATMENT +régimen I-TREATMENT +FOLFOX-6, I-TREATMENT +tratamiento I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +a I-TREATMENT +finales I-TREATMENT +de I-TREATMENT +febrero I-TREATMENT +de I-TREATMENT +2005. I-TREATMENT +La B-EVOLUTION +respuesta I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +quimioterápico I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +respuesta I-EVOLUTION +parcial I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +metástasis I-EVOLUTION +pulmonares I-EVOLUTION +y I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +afectación I-EVOLUTION +adenopática, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +marcadores I-EVOLUTION +tumorales. I-EVOLUTION +En I-EVOLUTION +cuanto I-EVOLUTION +al I-EVOLUTION +pioderma I-EVOLUTION +gangrenoso I-EVOLUTION +y I-EVOLUTION +ya I-EVOLUTION +sin I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +que I-EVOLUTION +seguía I-EVOLUTION +previamente I-EVOLUTION +para I-EVOLUTION +éste, I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +completa I-EVOLUTION +en I-EVOLUTION +ambas I-EVOLUTION +piernas, I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +ningún I-EVOLUTION +tipo I-EVOLUTION +de I-EVOLUTION +sintomatología I-EVOLUTION +añadida. I-EVOLUTION + I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +curso I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +(finalizado I-EVOLUTION +el I-EVOLUTION +4º I-EVOLUTION +ciclo) I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +acude I-EVOLUTION +al I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencias I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +febril I-EVOLUTION +de I-EVOLUTION +39º, I-EVOLUTION +náuseas, I-EVOLUTION +vómitos I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +derecho, I-EVOLUTION +destacando I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +pruebas I-EVOLUTION +complementarias I-EVOLUTION +una I-EVOLUTION +neutropenia I-EVOLUTION +grado I-EVOLUTION +IV, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +un I-EVOLUTION +patrón I-EVOLUTION +de I-EVOLUTION +citólisis I-EVOLUTION +hepática, I-EVOLUTION +colestasis I-EVOLUTION +e I-EVOLUTION +insuficiencia I-EVOLUTION +renal. I-EVOLUTION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +shock I-TREATMENT +séptico I-TREATMENT +secundario I-TREATMENT +a I-TREATMENT +una I-TREATMENT +colangitis, I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +en I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Cuidados I-TREATMENT +Intensivos, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +instauraron I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +antibióticas I-TREATMENT +necesarias, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +drogas I-TREATMENT +vasoactivas, I-TREATMENT +sin B-EVOLUTION +conseguir I-EVOLUTION +la I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +proceso I-EVOLUTION +y I-EVOLUTION +produciéndose I-EVOLUTION +el I-EVOLUTION +éxitus I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que B-PAST_MEDICAL_HISTORY +trabaja I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +auxiliar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermería I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +38 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +encontramos: I-PAST_MEDICAL_HISTORY +alérgica I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +Paracetamol, I-PAST_MEDICAL_HISTORY +hipotiroidismo, I-PAST_MEDICAL_HISTORY +microapneas. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +quirúrgicos I-PAST_MEDICAL_HISTORY +CIN3 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +varices I-PAST_MEDICAL_HISTORY +MMII. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +cardiovascular I-PAST_MEDICAL_HISTORY +destacan: I-PAST_MEDICAL_HISTORY +Hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento, I-PAST_MEDICAL_HISTORY +dislipemia, I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +paroxística I-PAST_MEDICAL_HISTORY +revertida I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2012. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Existe I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conflicto I-PAST_MEDICAL_HISTORY +laboral I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +compañera, I-PAST_MEDICAL_HISTORY +conocido I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +valorado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Prevención I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2005. I-PAST_MEDICAL_HISTORY +Entonces I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +recomendó I-PAST_MEDICAL_HISTORY +separar I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +partes I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +conflicto I-PAST_MEDICAL_HISTORY +si I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +podían I-PAST_MEDICAL_HISTORY +garantizar I-PAST_MEDICAL_HISTORY +unas I-PAST_MEDICAL_HISTORY +condiciones I-PAST_MEDICAL_HISTORY +óptimas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trabajo. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +ofertó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cambio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +puesto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trabajo, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +rechazado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +trabajadora. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Prevención I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Riesgos I-PAST_MEDICAL_HISTORY +Laborales I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +ofreció I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +comenzar I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +trabajar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +técnicas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +afrontamiento I-PAST_MEDICAL_HISTORY +asertivo I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +manejo I-PAST_MEDICAL_HISTORY +adaptativo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +situación. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +julio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2012, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +produce I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +nueva I-PAST_MEDICAL_HISTORY +situación I-PAST_MEDICAL_HISTORY +estresante I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +compañera I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +mantenía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +conflicto. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +precordial, I-PRESENT_ILLNESS +llanto I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +produce I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +relatar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +compañeras, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +situación I-PRESENT_ILLNESS +vital I-PRESENT_ILLNESS +estresante I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acababa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ocurrirle, I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +conflicto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +compañera. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Exploración B-EXPLORATION +física I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +urgencia: I-EXPLORATION +TA: I-EXPLORATION +160/110 I-EXPLORATION +mmHg. I-EXPLORATION +Disneica. I-EXPLORATION +Crepitantes I-EXPLORATION +bibasales, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +gasometría, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +insuficiencia I-EXPLORATION +respiratoria I-EXPLORATION +aguda, I-EXPLORATION +con I-EXPLORATION +saturación I-EXPLORATION +del I-EXPLORATION +82%, I-EXPLORATION +PO2 I-EXPLORATION +de I-EXPLORATION +40 I-EXPLORATION +e I-EXPLORATION +hiperlactacidemia I-EXPLORATION +de I-EXPLORATION +3. I-EXPLORATION +Se B-TREATMENT +administran I-TREATMENT +dos I-TREATMENT +ampollas I-TREATMENT +de I-TREATMENT +Furosemida I-TREATMENT +intravenosa, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +nitroglicerina I-TREATMENT +intravenosa I-TREATMENT +y I-TREATMENT +ventilación I-TREATMENT +con I-TREATMENT +mascarilla I-TREATMENT +reservorio, I-TREATMENT +con B-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +y I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +cifras I-EVOLUTION +tensionales. I-EVOLUTION + I-EVOLUTION +ECG B-EXPLORATION +realizado I-EXPLORATION +al I-EXPLORATION +ingreso: I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +a I-EXPLORATION +92 I-EXPLORATION +lpm, I-EXPLORATION +eje I-EXPLORATION +desviado I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +izquierda, I-EXPLORATION +PR I-EXPLORATION +200 I-EXPLORATION +mseg, I-EXPLORATION +HBAI; I-EXPLORATION +pobre I-EXPLORATION +progresión I-EXPLORATION +de I-EXPLORATION +derivaciones I-EXPLORATION +en I-EXPLORATION +V1-V3 I-EXPLORATION +y I-EXPLORATION +dudosa I-EXPLORATION +supradesnivelación I-EXPLORATION +de I-EXPLORATION +ST I-EXPLORATION +en I-EXPLORATION +V1-V2, I-EXPLORATION +T I-EXPLORATION +picuda I-EXPLORATION +en I-EXPLORATION +V3-V6 I-EXPLORATION +y I-EXPLORATION +negativa I-EXPLORATION +en I-EXPLORATION +I I-EXPLORATION +y I-EXPLORATION +AVL I-EXPLORATION +(ECG, I-EXPLORATION +figuras I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +2, I-EXPLORATION +una I-EXPLORATION +vez I-EXPLORATION +desaparece I-EXPLORATION +el I-EXPLORATION +dolor). I-EXPLORATION + I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +insuficiencia I-EXPLORATION +cardíaca. I-EXPLORATION + I-EXPLORATION +Ecocardiografía I-EXPLORATION +transtorácica: I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +esférico I-EXPLORATION +con I-EXPLORATION +acinesia I-EXPLORATION +septal, I-EXPLORATION +hipocinesia I-EXPLORATION +de I-EXPLORATION +segmento I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +cara I-EXPLORATION +inferior I-EXPLORATION +y I-EXPLORATION +FEVI I-EXPLORATION +estimada I-EXPLORATION +en I-EXPLORATION +torno I-EXPLORATION +al I-EXPLORATION +20-25% I-EXPLORATION +e I-EXPLORATION +IM I-EXPLORATION +leve. I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +Sd. I-TREATMENT +De I-TREATMENT +takotsubo, I-TREATMENT +discinesia I-TREATMENT +apical I-TREATMENT +transitoria I-TREATMENT +sin I-TREATMENT +aumento I-TREATMENT +del I-TREATMENT +valor I-TREATMENT +enzimático, I-TREATMENT +se I-TREATMENT +administran I-TREATMENT +300 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +AAS I-TREATMENT +y I-TREATMENT +600 I-TREATMENT +de I-TREATMENT +clopidogrel I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +traslada I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +sala I-EXPLORATION +de I-EXPLORATION +hemodinámica I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +coronariografía. I-EXPLORATION +Esta I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +vía I-EXPLORATION +femoral I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +evidencian I-EXPLORATION +lesiones I-EXPLORATION +angiográficamente I-EXPLORATION +significativas, I-EXPLORATION +aunque I-EXPLORATION +la I-EXPLORATION +DA I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +flujo I-EXPLORATION +TIMI I-EXPLORATION +I. I-EXPLORATION +La I-EXPLORATION +ventriculografía I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +VI I-EXPLORATION +ovoide I-EXPLORATION +con I-EXPLORATION +FEVI I-EXPLORATION +del I-EXPLORATION +25% I-EXPLORATION +y I-EXPLORATION +acinesia I-EXPLORATION +en I-EXPLORATION +banda I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +medial, I-EXPLORATION +hipocinesia I-EXPLORATION +leve I-EXPLORATION +de I-EXPLORATION +segmento I-EXPLORATION +basal I-EXPLORATION +y I-EXPLORATION +ápex. I-EXPLORATION + I-EXPLORATION +Permanece B-EVOLUTION +durante I-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +ingresada, I-EVOLUTION +en I-EVOLUTION +UCOR I-EVOLUTION +(Unidad I-EVOLUTION +Coronaria), I-EVOLUTION +hemodinámicamente I-EVOLUTION +estable I-EVOLUTION +y I-EVOLUTION +asintomática. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +último I-EXPLORATION +ecocardiograma I-EXPLORATION +realizado I-EXPLORATION +durante I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +obtiene I-EXPLORATION +un I-EXPLORATION +FEVI I-EXPLORATION +75%, I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +realizadas I-EXPLORATION +son I-EXPLORATION +normales, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +procede I-EXPLORATION +al I-EXPLORATION +alta I-EXPLORATION +hospitalaria. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Prevención I-EVOLUTION +confirma I-EVOLUTION +los I-EVOLUTION +desencadenantes I-EVOLUTION +emocionales I-EVOLUTION +de I-EVOLUTION +origen I-EVOLUTION +laboral I-EVOLUTION +y I-EVOLUTION +descarta I-EVOLUTION +otros I-EVOLUTION +factores I-EVOLUTION +extralaborales. I-EVOLUTION +Valorada I-EVOLUTION +la I-EVOLUTION +determinación I-EVOLUTION +de I-EVOLUTION +contingencia I-EVOLUTION +del I-EVOLUTION +proceso I-EVOLUTION +este I-EVOLUTION +se I-EVOLUTION +reconocería I-EVOLUTION +finalmente I-EVOLUTION +como I-EVOLUTION +accidente I-EVOLUTION +de I-EVOLUTION +trabajo. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +desplazado B-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Haití I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +octubre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2013 I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +motivos I-PAST_MEDICAL_HISTORY +laborales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +baja I-PAST_MEDICAL_HISTORY +laboral I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +contingencia I-PAST_MEDICAL_HISTORY +común I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +febrero I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2014 I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dengue I-PAST_MEDICAL_HISTORY +confirmada, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +recuperación I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +reincorporación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +puesto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trabajo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mayo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2014, I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +sufrir I-PAST_MEDICAL_HISTORY +abundantes I-PAST_MEDICAL_HISTORY +picaduras I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mosquito, I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +brusca I-PAST_MEDICAL_HISTORY +fiebre I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +odinofagia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +rash I-PAST_MEDICAL_HISTORY +cutáneo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +poliartralgias. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +descartó I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +dengue. I-PAST_MEDICAL_HISTORY +Regresó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +España, I-PRESENT_ILLNESS +causó I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +laboral I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +contingencia I-PRESENT_ILLNESS +común I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +estudiado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Enfermedades I-PRESENT_ILLNESS +Tropicales I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Clínic I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Barcelona. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +hiperemia I-EXPLORATION +orofaringea I-EXPLORATION +y I-EXPLORATION +rash I-EXPLORATION +cutáneo I-EXPLORATION +que I-EXPLORATION +evolucionaron I-EXPLORATION +favorablemente I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +fiebre; I-EXPLORATION +persistiendo I-EXPLORATION +las I-EXPLORATION +poliartralgias I-EXPLORATION +acompañadas I-EXPLORATION +de I-EXPLORATION +astenia I-EXPLORATION +intensa. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +destacar I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +exploraciones I-EXPLORATION +complementarias I-EXPLORATION +practicadas I-EXPLORATION +leve I-EXPLORATION +leucopenia, I-EXPLORATION +serología I-EXPLORATION +Chikungunya I-EXPLORATION +IgM I-EXPLORATION +e I-EXPLORATION +IgG I-EXPLORATION +y I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +ARN I-EXPLORATION +viral I-EXPLORATION +por I-EXPLORATION +RT-PCR I-EXPLORATION +positivas. I-EXPLORATION +PCR I-EXPLORATION +dengue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +de I-EXPLORATION +Fiebre I-EXPLORATION +por I-EXPLORATION +virus I-EXPLORATION +Chikungunya I-EXPLORATION +no I-EXPLORATION +complicada I-EXPLORATION +adquirida I-EXPLORATION +en I-EXPLORATION +Haití I-EXPLORATION +y I-EXPLORATION +artralgias I-EXPLORATION +reactivas I-EXPLORATION +al I-EXPLORATION +proceso I-EXPLORATION +infeccioso, I-EXPLORATION +al I-EXPLORATION +cumplir I-EXPLORATION +criterios I-EXPLORATION +epidemiológicos, I-EXPLORATION +clínicos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +laboratorio. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +siguió I-EVOLUTION +control I-EVOLUTION +médico I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +Público I-EVOLUTION +de I-EVOLUTION +Salud I-EVOLUTION +y I-EVOLUTION +desde I-EVOLUTION +julio I-EVOLUTION +de I-EVOLUTION +2014 I-EVOLUTION +con I-EVOLUTION +Mutua I-EVOLUTION +FREMAP, I-EVOLUTION +al I-EVOLUTION +tener I-EVOLUTION +la I-EVOLUTION +empresa I-EVOLUTION +concertada I-EVOLUTION +la I-EVOLUTION +cobertura I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +contingencia I-EVOLUTION +común I-EVOLUTION +con I-EVOLUTION +esta I-EVOLUTION +entidad10. I-EVOLUTION +El I-EVOLUTION +16 I-EVOLUTION +de I-EVOLUTION +octubre I-EVOLUTION +aportó I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +Servicios I-EVOLUTION +Médicos I-EVOLUTION +de I-EVOLUTION +FREMAP I-EVOLUTION +una I-EVOLUTION +solicitud I-EVOLUTION +de I-EVOLUTION +determinación I-EVOLUTION +de I-EVOLUTION +contingencia I-EVOLUTION +indicando I-EVOLUTION +le I-EVOLUTION +fuera I-EVOLUTION +reconocida I-EVOLUTION +dicha I-EVOLUTION +baja I-EVOLUTION +como I-EVOLUTION +laboral. I-EVOLUTION +Tras I-EVOLUTION +la I-EVOLUTION +valoración I-EVOLUTION +global I-EVOLUTION +del I-EVOLUTION +proceso I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +epidemiológico, I-EVOLUTION +médico I-EVOLUTION +y I-EVOLUTION +laboral I-EVOLUTION +se I-EVOLUTION +aceptó I-EVOLUTION +el I-EVOLUTION +cambio I-EVOLUTION +de I-EVOLUTION +contingencia I-EVOLUTION +a I-EVOLUTION +Accidente I-EVOLUTION +de I-EVOLUTION +Trabajo. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +fue I-EVOLUTION +lenta I-EVOLUTION +y I-EVOLUTION +fluctuante, I-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +astenia I-EVOLUTION +y I-EVOLUTION +poliartralgias I-EVOLUTION +limitantes, I-EVOLUTION +de I-EVOLUTION +predominio I-EVOLUTION +en I-EVOLUTION +carpo I-EVOLUTION +y I-EVOLUTION +manos. I-EVOLUTION +Descartada B-TREATMENT +artritis I-TREATMENT +siguió I-TREATMENT +tratamiento I-TREATMENT +sintomático. I-TREATMENT +En B-EVOLUTION +marzo I-EVOLUTION +de I-EVOLUTION +2015 I-EVOLUTION +manifestó I-EVOLUTION +una I-EVOLUTION +franca I-EVOLUTION +mejoría I-EVOLUTION +coincidiendo I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +cambio I-EVOLUTION +estacional. I-EVOLUTION +Se B-EXPLORATION +solicitó I-EXPLORATION +control I-EXPLORATION +analítico I-EXPLORATION +con I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +bioquímica I-EXPLORATION +incluyendo I-EXPLORATION +VSG, I-EXPLORATION +PCR I-EXPLORATION +e I-EXPLORATION +interleucina I-EXPLORATION +6, I-EXPLORATION +sin I-EXPLORATION +mostrar I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +14 I-EVOLUTION +de I-EVOLUTION +abril I-EVOLUTION +de I-EVOLUTION +2015 I-EVOLUTION +se I-EVOLUTION +extendió I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +laboral I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +julio I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +control I-EVOLUTION +ratificando I-EVOLUTION +la I-EVOLUTION +recuperación I-EVOLUTION +clínica. I-EVOLUTION +Hasta I-EVOLUTION +la I-EVOLUTION +fecha I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +solicitado I-EVOLUTION +nueva I-EVOLUTION +visita. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +residente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Chimbarongo, I-PAST_MEDICAL_HISTORY +VI I-PAST_MEDICAL_HISTORY +Región. I-PAST_MEDICAL_HISTORY +Tenía I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +padecer I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +epilepsia, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fenobarbital. I-PAST_MEDICAL_HISTORY +Ingresó B-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +UCI I-EXPLORATION +del I-EXPLORATION +Hospital I-EXPLORATION +Barros I-EXPLORATION +Luco I-EXPLORATION +Trudeau I-EXPLORATION +(HBLT) I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION +cuarto I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +historia I-EXPLORATION +de I-EXPLORATION +tos, I-EXPLORATION +expectoración I-EXPLORATION +hemoptoica, I-EXPLORATION +apremio I-EXPLORATION +respiratorio I-EXPLORATION +y I-EXPLORATION +epistaxis I-EXPLORATION +anterior. I-EXPLORATION +La I-EXPLORATION +anamnesis I-EXPLORATION +describía I-EXPLORATION +los I-EXPLORATION +primeros I-EXPLORATION +días I-EXPLORATION +un I-EXPLORATION +cuadro I-EXPLORATION +caracterizado I-EXPLORATION +por I-EXPLORATION +fiebre, I-EXPLORATION +compromiso I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +mialgia, I-EXPLORATION +cefalea, I-EXPLORATION +vómitos I-EXPLORATION +y I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +conciencia. I-EXPLORATION +Al I-EXPLORATION +segundo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +se I-EXPLORATION +había I-EXPLORATION +agregado I-EXPLORATION +ictericia I-EXPLORATION +intensa, I-EXPLORATION +coluria I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +abdominal. I-EXPLORATION +Consultó B-DERIVED_FROM/TO +inicialmente I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Emergencia I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Chimbarongo, I-DERIVED_FROM/TO +siendo I-DERIVED_FROM/TO +referido I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hepatitis I-DERIVED_FROM/TO +aguda I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +San I-DERIVED_FROM/TO +Fernando, I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +estado I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hipotensión I-DERIVED_FROM/TO +arterial, I-DERIVED_FROM/TO +taquicárdico, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +epistaxis I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +abdominal I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +hipocondrio I-DERIVED_FROM/TO +derecho; I-DERIVED_FROM/TO +allí B-TREATMENT +fue I-TREATMENT +asistido I-TREATMENT +con I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +al I-TREATMENT +9‰ I-TREATMENT +y I-TREATMENT +dopamina I-TREATMENT +y B-DERIVED_FROM/TO +finalmente I-DERIVED_FROM/TO +enviado I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +HBLT I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +ingresó I-DERIVED_FROM/TO +vigil, I-DERIVED_FROM/TO +orientado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +tiempo I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +espacio, I-DERIVED_FROM/TO +cooperando. I-DERIVED_FROM/TO +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaban I-EXPLORATION +intensa I-EXPLORATION +ictericia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +escleras, I-EXPLORATION +taquicardia, I-EXPLORATION +taquipnea, I-EXPLORATION +normotensión I-EXPLORATION +y I-EXPLORATION +fiebre I-EXPLORATION +(38° I-EXPLORATION +C I-EXPLORATION +axilar), I-EXPLORATION +murmullo I-EXPLORATION +pulmonar I-EXPLORATION +disminuido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemicampo I-EXPLORATION +inferior I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +presente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +derecho. I-EXPLORATION +Aproximadamente B-TREATMENT +50 I-TREATMENT +minutos I-TREATMENT +más I-TREATMENT +tarde I-TREATMENT +se I-TREATMENT +describió I-TREATMENT +en I-TREATMENT +estado I-TREATMENT +de I-TREATMENT +shock I-TREATMENT +séptico, I-TREATMENT +debiendo I-TREATMENT +ser I-TREATMENT +intubado, I-TREATMENT +maniobra I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +eliminó I-TREATMENT +sangre I-TREATMENT +rutilante I-TREATMENT +por I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +aérea, I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +trasladado I-TREATMENT +a I-TREATMENT +UCI. I-TREATMENT +De I-TREATMENT +allí I-TREATMENT +en I-TREATMENT +adelante I-TREATMENT +evolucionó I-TREATMENT +con I-TREATMENT +escasa I-TREATMENT +respiración I-TREATMENT +espontánea I-TREATMENT +debió I-TREATMENT +ser I-TREATMENT +asistido I-TREATMENT +manualmente, I-TREATMENT +presentaba I-TREATMENT +sangramiento I-TREATMENT +por I-TREATMENT +el I-TREATMENT +tubo I-TREATMENT +orotraqueal, I-TREATMENT +ictericia I-TREATMENT +e I-TREATMENT +isocoria I-TREATMENT +reactiva. I-TREATMENT +Se I-TREATMENT +conectó I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +por I-TREATMENT +una I-TREATMENT +desaturación I-TREATMENT +de I-TREATMENT +65%, I-TREATMENT +mientras I-TREATMENT +estaba I-TREATMENT +taquicárdico I-TREATMENT +pero I-TREATMENT +con I-TREATMENT +normotensión. I-TREATMENT +Fue I-TREATMENT +ingresado I-TREATMENT +con I-TREATMENT +los I-TREATMENT +diagnósticos I-TREATMENT +de: I-TREATMENT +shock I-TREATMENT +séptico, I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +distrés I-TREATMENT +respiratorio I-TREATMENT +del I-TREATMENT +adulto I-TREATMENT +y I-TREATMENT +la I-TREATMENT +hipótesis I-TREATMENT +de I-TREATMENT +una I-TREATMENT +leptospirosis. I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +PA I-EVOLUTION +0/0 I-EVOLUTION +mm/Hg I-EVOLUTION +y I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +hora I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +ingresado I-EVOLUTION +en I-EVOLUTION +UCI, I-EVOLUTION +pese I-EVOLUTION +a I-EVOLUTION +maniobras I-EVOLUTION +de I-EVOLUTION +reanimación I-EVOLUTION +avanzada. I-EVOLUTION + I-EVOLUTION +Anatomía B-EXPLORATION +patológica I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +morfológicos I-EXPLORATION +están I-EXPLORATION +relacionados I-EXPLORATION +con I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +microcirculación, I-EXPLORATION +caracterizadas I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +panvasculitis I-EXPLORATION +venulocapilar I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +órganos I-EXPLORATION +y I-EXPLORATION +sistemas9. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +pulmón I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +macroscópicamente I-EXPLORATION +extensas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +parenquimatosa I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +microscopia I-EXPLORATION +necrosis I-EXPLORATION +alveolar. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +hepático I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +extensas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +hepatocelular I-EXPLORATION +e I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +linfoplasmocitario I-EXPLORATION +portal. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +miocardio I-EXPLORATION +exhibía I-EXPLORATION +degeneración I-EXPLORATION +miofibrilar I-EXPLORATION +focal I-EXPLORATION +y I-EXPLORATION +extenso I-EXPLORATION +infiltrado I-EXPLORATION +linfoplasmocitario I-EXPLORATION +intersticial. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +parénquima I-EXPLORATION +renal I-EXPLORATION +presentaba I-EXPLORATION +congestión I-EXPLORATION +vascular, I-EXPLORATION +vasculitis I-EXPLORATION +linfoplasmocitaria I-EXPLORATION +y I-EXPLORATION +extensa I-EXPLORATION +necrosis I-EXPLORATION +tubular I-EXPLORATION +aguda. I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +coloración I-EXPLORATION +argéntica I-EXPLORATION +de I-EXPLORATION +Warthin-Starry I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +formaciones I-EXPLORATION +espirilares I-EXPLORATION +adosadas I-EXPLORATION +al I-EXPLORATION +epitelio I-EXPLORATION +tubular I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +coma, I-EXPLORATION +características I-EXPLORATION +de I-EXPLORATION +leptospira. I-EXPLORATION +Por I-EXPLORATION +métodos I-EXPLORATION +morfométricos I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +una I-EXPLORATION +longitud I-EXPLORATION +promedio I-EXPLORATION +de I-EXPLORATION +13 I-EXPLORATION +mµ. I-EXPLORATION + I-EXPLORATION +Diagnósticos I-EXPLORATION +anátomo-patológicos: I-EXPLORATION + I-EXPLORATION +· I-EXPLORATION +Enfermedad I-EXPLORATION +de I-EXPLORATION +Weil I-EXPLORATION +(leptospirosis) I-EXPLORATION +con: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Hemorragia I-EXPLORATION +pulmonar I-EXPLORATION +parenquimatosa- I-EXPLORATION +alveolitis I-EXPLORATION +necrosante. I-EXPLORATION +- I-EXPLORATION +Panvasculitis I-EXPLORATION +vénulo-capilar. I-EXPLORATION +- I-EXPLORATION +Necrosis I-EXPLORATION +tubular I-EXPLORATION +aguda-nefritis I-EXPLORATION +intersticial I-EXPLORATION +linfo-plasmocitaria. I-EXPLORATION +- I-EXPLORATION +Hepatitis I-EXPLORATION +aguda. I-EXPLORATION +- I-EXPLORATION +Miocarditis I-EXPLORATION +y I-EXPLORATION +pericarditis I-EXPLORATION +linfo-plasmocitaria. I-EXPLORATION +- I-EXPLORATION +Meningitis I-EXPLORATION +linfo-plasmocitaria. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +en B-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +prednisona I-PAST_MEDICAL_HISTORY +12, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +metotrexato I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +semanales I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hidroxicloroquina I-PAST_MEDICAL_HISTORY +200 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lupus I-PAST_MEDICAL_HISTORY +eritematoso I-PAST_MEDICAL_HISTORY +sistémico I-PAST_MEDICAL_HISTORY +(LES) I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +manifestado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +poliartritis, I-PAST_MEDICAL_HISTORY +leucopenia, I-PAST_MEDICAL_HISTORY +linfopenia, I-PAST_MEDICAL_HISTORY +VHS I-PAST_MEDICAL_HISTORY +elevada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +serología I-PAST_MEDICAL_HISTORY +compatible I-PAST_MEDICAL_HISTORY +(anti-DNA I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ANA I-PAST_MEDICAL_HISTORY +positivos, I-PAST_MEDICAL_HISTORY +C3 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +C4 I-PAST_MEDICAL_HISTORY +bajos). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Con B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +insidioso, I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +escasamente I-PRESENT_ILLNESS +productiva, I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +mucopurulenta, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hemitórax I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tope I-PRESENT_ILLNESS +inspiratorio, I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +~10%. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +período. I-PRESENT_ILLNESS +Inicialmente I-PRESENT_ILLNESS +recibió I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +claritromicina I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +días, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +buena I-PRESENT_ILLNESS +respuesta, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +hospitalizada I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +estudio. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +atelectasias I-EXPLORATION +bibasales I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +escasa I-EXPLORATION +efusión I-EXPLORATION +pleural I-EXPLORATION +derecha I-EXPLORATION +(no I-EXPLORATION +puncionable), I-EXPLORATION +sin I-EXPLORATION +consolidaciones I-EXPLORATION +ni I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +sustitución. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +asociación I-EXPLORATION +con I-EXPLORATION +poliartralgias I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +LES I-EXPLORATION +positiva I-EXPLORATION +(anti I-EXPLORATION +ADN I-EXPLORATION +Farr I-EXPLORATION +975 I-EXPLORATION +U) I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +fueron I-EXPLORATION +interpretados I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +actividad I-EXPLORATION +lúpica I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +el I-TREATMENT +metotrexato I-TREATMENT +por I-TREATMENT +azatioprina I-TREATMENT +75 I-TREATMENT +mg/día. I-TREATMENT +Durante B-EVOLUTION +los I-EVOLUTION +siguientes I-EVOLUTION +meses I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +afebril, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +tos I-EVOLUTION +persistente I-EVOLUTION +y I-EVOLUTION +ocasionalmente I-EVOLUTION +expectoración I-EVOLUTION +hemoptoica-purulenta, I-EVOLUTION +recibiendo B-TREATMENT +levofloxacina I-TREATMENT +500 I-TREATMENT +mg/día I-TREATMENT +durante I-TREATMENT +10 I-TREATMENT +días, I-TREATMENT +con B-EVOLUTION +lo I-EVOLUTION +cual I-EVOLUTION +disminuyó I-EVOLUTION +parcialmente I-EVOLUTION +la I-EVOLUTION +sintomatología. I-EVOLUTION +A B-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +carecer I-EXPLORATION +de I-EXPLORATION +factores I-EXPLORATION +de I-EXPLORATION +riesgo I-EXPLORATION +para I-EXPLORATION +adquirir I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +VIH I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +serológico I-EXPLORATION +de I-EXPLORATION +VIH-1 I-EXPLORATION +y I-EXPLORATION +VIH-2 I-EXPLORATION +(ELISA) I-EXPLORATION +con I-EXPLORATION +resultado I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Al B-EVOLUTION +séptimo I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +nuevamente I-EVOLUTION +hospitalizada I-EVOLUTION +por I-EVOLUTION +reagudización I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología, I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +fiebre I-EVOLUTION +hasta I-EVOLUTION +38º I-EVOLUTION +C. I-EVOLUTION +La B-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +evidenció I-EXPLORATION +esta I-EXPLORATION +vez I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +consolidación I-EXPLORATION +bilaterales, I-EXPLORATION +nódulos I-EXPLORATION +excavados, I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +mediastínicas. I-EXPLORATION +Laboratorio: I-EXPLORATION +PCR I-EXPLORATION +20, I-EXPLORATION +1 I-EXPLORATION +mg/dL I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +1, I-EXPLORATION +0 I-EXPLORATION +mg/dL) I-EXPLORATION +y I-EXPLORATION +VHS I-EXPLORATION +118 I-EXPLORATION +mm/h. I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +inflamación I-EXPLORATION +traqueo-bronquial I-EXPLORATION +proximal I-EXPLORATION +con I-EXPLORATION +deformación I-EXPLORATION +del I-EXPLORATION +bronquio I-EXPLORATION +segmentario I-EXPLORATION +apical I-EXPLORATION +derecho, I-EXPLORATION +lugar I-EXPLORATION +del I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +biopsia. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +lavado I-EXPLORATION +bronco-alveolar I-EXPLORATION +(LBA) I-EXPLORATION +resultó I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +bacterias I-EXPLORATION +incluyendo I-EXPLORATION +micobacterias I-EXPLORATION +y I-EXPLORATION +hongos I-EXPLORATION +incluyendo I-EXPLORATION +Pneumocystis I-EXPLORATION +jiroveci. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +bronquial I-EXPLORATION +demostró I-EXPLORATION +exudado I-EXPLORATION +fibrinoleucocitario I-EXPLORATION +con I-EXPLORATION +tejido I-EXPLORATION +necrótico. I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +cefotaxima+clindamicina I-TREATMENT +que I-TREATMENT +recibió I-TREATMENT +durante I-TREATMENT +siete I-TREATMENT +días I-TREATMENT +bajo I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +neumonía I-TREATMENT +cavitada I-TREATMENT +de I-TREATMENT +etiología I-TREATMENT +no I-TREATMENT +precisada. I-TREATMENT +Dada B-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +dio I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +para B-TREATMENT +completar I-TREATMENT +tres I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amoxicilina/ácido I-TREATMENT +clavulánico, I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +azatioprina I-TREATMENT +y I-TREATMENT +mantuvo I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +e I-TREATMENT +hidroxicloroquina. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +semanas I-EVOLUTION +siguientes I-EVOLUTION +se I-EVOLUTION +reagudizó I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +internada I-EVOLUTION +nuevamente. I-EVOLUTION +La B-EXPLORATION +evaluación I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +demostró I-EXPLORATION +esta I-EXPLORATION +vez I-EXPLORATION +leucopenia I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda, I-EXPLORATION +VHS I-EXPLORATION +119 I-EXPLORATION +mm/h I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +35 I-EXPLORATION +mg/dL. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +sospechosa I-EXPLORATION +de I-EXPLORATION +absceso I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +nódulos I-EXPLORATION +cavitados I-EXPLORATION +y I-EXPLORATION +consolidaciones I-EXPLORATION +masiformes. I-EXPLORATION +Se I-EXPLORATION +repitieron I-EXPLORATION +baciloscopias I-EXPLORATION +y I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Kinyoun I-EXPLORATION +en I-EXPLORATION +expectoración I-EXPLORATION +resultando I-EXPLORATION +negativas. I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +lesiones I-EXPLORATION +blanquecinas I-EXPLORATION +solevantadas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +traqueal, I-EXPLORATION +obteniéndose I-EXPLORATION +biopsia I-EXPLORATION +para I-EXPLORATION +estudios I-EXPLORATION +microbiológico I-EXPLORATION +e I-EXPLORATION +histológico. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +pulmonar I-EXPLORATION +percutánea I-EXPLORATION +bajo I-EXPLORATION +TAC, I-EXPLORATION +cuya I-EXPLORATION +histología I-EXPLORATION +evidenció I-EXPLORATION +gran I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +bacilos I-EXPLORATION +grampositivos I-EXPLORATION +intra-macrófagos. I-EXPLORATION +Tanto I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +corriente I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +recuperado I-EXPLORATION +por I-EXPLORATION +biopsia I-EXPLORATION +bajo I-EXPLORATION +TAC I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +obtenido I-EXPLORATION +por I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +hubo I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +bacilos I-EXPLORATION +grampositivos, I-EXPLORATION +diagnosticados I-EXPLORATION +como I-EXPLORATION +Rhodococcus I-EXPLORATION +sp. I-EXPLORATION +La I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +género I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Microbiología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Red I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +UC I-EXPLORATION +mediante I-EXPLORATION +una I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Kinyoun I-EXPLORATION +positiva I-EXPLORATION +(ácido-alcohol I-EXPLORATION +resistencia I-EXPLORATION +parcial), I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +morfología I-EXPLORATION +bifásica I-EXPLORATION +característica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +al I-EXPLORATION +incubar I-EXPLORATION +la I-EXPLORATION +colonia I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +BHI I-EXPLORATION +(infusión I-EXPLORATION +cerebro I-EXPLORATION +corazón): I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +6 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +incubación I-EXPLORATION +aeróbica I-EXPLORATION +a I-EXPLORATION +35º I-EXPLORATION +C I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +elementos I-EXPLORATION +bacilares I-EXPLORATION +al I-EXPLORATION +Gram I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +continuar I-EXPLORATION +la I-EXPLORATION +incubación I-EXPLORATION +hasta I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +elementos I-EXPLORATION +cocoideos. I-EXPLORATION +El I-EXPLORATION +desarrollo I-EXPLORATION +en I-EXPLORATION +placas I-EXPLORATION +de I-EXPLORATION +agar I-EXPLORATION +sangre I-EXPLORATION +de I-EXPLORATION +cordero I-EXPLORATION +mostró I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +incubación I-EXPLORATION +colonias I-EXPLORATION +mucoideas I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +coral. I-EXPLORATION +Con I-EXPLORATION +estas I-EXPLORATION +pruebas I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +al I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública I-EXPLORATION +de I-EXPLORATION +Chile I-EXPLORATION +(Laboratorio I-EXPLORATION +de I-EXPLORATION +Referencia) I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +presuntivo I-EXPLORATION +de I-EXPLORATION +Rhodococcus I-EXPLORATION +sp, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +morfología I-EXPLORATION +típica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +macroscópicas I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +colonias. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +bioquímicas I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +galería I-EXPLORATION +API I-EXPLORATION +Coryne® I-EXPLORATION +(Biomerieux) I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +resultados: I-EXPLORATION +reducción I-EXPLORATION +de I-EXPLORATION +nitratos I-EXPLORATION +negativa, I-EXPLORATION +pirazinamidasa I-EXPLORATION +negativa, I-EXPLORATION +pirrolidanil I-EXPLORATION +arilamidasa I-EXPLORATION +(PYR) I-EXPLORATION +negativa, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +(PAL) I-EXPLORATION +positiva, I-EXPLORATION +b-glucuronidasa I-EXPLORATION +(bGUR) I-EXPLORATION +negativa, I-EXPLORATION +b-galactosidasa I-EXPLORATION +((bGAL) I-EXPLORATION +negativa, I-EXPLORATION +a-glucosidasa I-EXPLORATION +(aGLU) I-EXPLORATION +positiva, I-EXPLORATION +n-acetil-b-glucosaminidasa I-EXPLORATION +(bNAG) I-EXPLORATION +negativa, I-EXPLORATION +esculina I-EXPLORATION +positiva, I-EXPLORATION +ureasa I-EXPLORATION +negativa, I-EXPLORATION +hidrólisis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +gelatina I-EXPLORATION +negativa, I-EXPLORATION +fermentación I-EXPLORATION +de I-EXPLORATION +ornitina, I-EXPLORATION +glucosa, I-EXPLORATION +ribosa, I-EXPLORATION +xilosa, I-EXPLORATION +manitol, I-EXPLORATION +maltosa, I-EXPLORATION +lactosa, I-EXPLORATION +sacarosa I-EXPLORATION +y I-EXPLORATION +glicógeno I-EXPLORATION +negativas I-EXPLORATION +y I-EXPLORATION +catalasa I-EXPLORATION +positiva. I-EXPLORATION +Por I-EXPLORATION +estas I-EXPLORATION +pruebas I-EXPLORATION +bioquímicas I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +macroscópicas I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +Rhodococcus I-EXPLORATION +equi I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +2 I-TREATMENT +gr/día I-TREATMENT +y I-TREATMENT +rifampicina I-TREATMENT +600 I-TREATMENT +mg/día, I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +inicial. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +6 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +terapia I-EVOLUTION +desarrolló I-EVOLUTION +un I-EVOLUTION +rash I-EVOLUTION +pruriginoso I-EVOLUTION +intenso I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +necesario I-EVOLUTION +cambiar I-EVOLUTION +el I-EVOLUTION +esquema. I-EVOLUTION +Para B-EXPLORATION +definir I-EXPLORATION +la I-EXPLORATION +siguiente I-EXPLORATION +terapia I-EXPLORATION +antimicrobiana I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +in I-EXPLORATION +vitro I-EXPLORATION +mediante I-EXPLORATION +dilución I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +y I-EXPLORATION +epsilometría I-EXPLORATION +(E-test®). I-EXPLORATION +Si I-EXPLORATION +bien I-EXPLORATION +no I-EXPLORATION +están I-EXPLORATION +descritos I-EXPLORATION +los I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +antimicrobianos I-EXPLORATION +para I-EXPLORATION +este I-EXPLORATION +microorganismo2, I-EXPLORATION +se I-EXPLORATION +midieron I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +CIM I-EXPLORATION +> I-EXPLORATION +32 I-EXPLORATION +µg/mL I-EXPLORATION +a I-EXPLORATION +cefotaxima, I-EXPLORATION +> I-EXPLORATION +40 I-EXPLORATION +µg/mL I-EXPLORATION +a I-EXPLORATION +cotrimoxazol I-EXPLORATION +y I-EXPLORATION +< I-EXPLORATION +2µg/mL I-EXPLORATION +para I-EXPLORATION +ciprofloxacina, I-EXPLORATION +imipenem I-EXPLORATION +y I-EXPLORATION +gentamicina3. I-EXPLORATION +Con B-TREATMENT +esta I-TREATMENT +información I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +fue I-TREATMENT +cambiado I-TREATMENT +a I-TREATMENT +ciprofloxacina+amikacina I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +ciprofloxacina+ I-TREATMENT +claritromicina I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +24 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +con I-EVOLUTION +lenta I-EVOLUTION +y I-EVOLUTION +progresiva I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +hasta I-EVOLUTION +desaparecer, I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +exámenes I-EVOLUTION +de I-EVOLUTION +laboratorio I-EVOLUTION +hasta I-EVOLUTION +su I-EVOLUTION +normalización, I-EVOLUTION +y I-EVOLUTION +regresión I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +imágenes I-EVOLUTION +de I-EVOLUTION +consolidación I-EVOLUTION +pulmonar I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +TAC I-EVOLUTION +de I-EVOLUTION +tórax. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia. I-PAST_MEDICAL_HISTORY +Presentaba B-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +periorbitario I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +hospitalizó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +TAC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +senos I-PRESENT_ILLNESS +paranasales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +órbita I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +demostró I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +pansinusitis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sospecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +absceso I-PRESENT_ILLNESS +orbitario I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +iniciándose I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +antimicrobiano I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ceftriaxona I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cloxacilina. I-PRESENT_ILLNESS +A B-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +horas I-EXPLORATION +del I-EXPLORATION +ingreso, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +cursó I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +cuadro I-EXPLORATION +confusional I-EXPLORATION +agudo I-EXPLORATION +y I-EXPLORATION +crisis I-EXPLORATION +de I-EXPLORATION +agitación I-EXPLORATION +psicomotora I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +meníngea, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +obteniéndose I-EXPLORATION +LCR I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +meningitis I-EXPLORATION +(490 I-EXPLORATION +células/mm3 I-EXPLORATION +60% I-EXPLORATION +PMN, I-EXPLORATION +glucorraquia I-EXPLORATION +y I-EXPLORATION +proteínas I-EXPLORATION +normales), I-EXPLORATION +pero I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +y I-EXPLORATION +sangre I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +con I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +evidenció I-EXPLORATION +edema I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +subdural I-EXPLORATION +bilateral I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trasladó I-EXPLORATION +a I-EXPLORATION +nuestro I-EXPLORATION +centro I-EXPLORATION +para I-EXPLORATION +evaluación I-EXPLORATION +neuro-quirúrgica I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +diagnósticos I-EXPLORATION +de I-EXPLORATION +pansinusitis, I-EXPLORATION +meningitis I-EXPLORATION +aguda I-EXPLORATION +secundaria I-EXPLORATION +y I-EXPLORATION +colección I-EXPLORATION +subdural. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +ingreso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +unidad I-EXPLORATION +de I-EXPLORATION +cuidados I-EXPLORATION +intensivos I-EXPLORATION +pediátricos I-EXPLORATION +destacaba I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico: I-EXPLORATION +T° I-EXPLORATION +axilar I-EXPLORATION +38, I-EXPLORATION +3 I-EXPLORATION +°C, I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +de I-EXPLORATION +65 I-EXPLORATION +por I-EXPLORATION +min, I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +140/90 I-EXPLORATION +mm I-EXPLORATION +Hg, I-EXPLORATION +escala I-EXPLORATION +de I-EXPLORATION +Glasgow: I-EXPLORATION +6, I-EXPLORATION +hiperreflexia, I-EXPLORATION +anisocoria I-EXPLORATION +midriática I-EXPLORATION +a I-EXPLORATION +derecha, I-EXPLORATION +rigidez I-EXPLORATION +de I-EXPLORATION +nuca, I-EXPLORATION +edema I-EXPLORATION +bipalpebral I-EXPLORATION +y I-EXPLORATION +quemosis, I-EXPLORATION +clonus I-EXPLORATION +bilateral I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +derecha. I-EXPLORATION +La I-EXPLORATION +PCR I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +215 I-EXPLORATION +mg/L, I-EXPLORATION +el I-EXPLORATION +recuento I-EXPLORATION +leucocitario I-EXPLORATION +de I-EXPLORATION +15.800/mm3, I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hipertensión I-TREATMENT +endocraneana I-TREATMENT +con I-TREATMENT +intubación I-TREATMENT +endotraqueal I-TREATMENT +y I-TREATMENT +conexión I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +manitol, I-TREATMENT +sedoanalgesia I-TREATMENT +con I-TREATMENT +midazolam-fentanilo I-TREATMENT +y I-TREATMENT +soporte I-TREATMENT +inotrópico I-TREATMENT +con I-TREATMENT +dopamina. I-TREATMENT +Se I-TREATMENT +instauró I-TREATMENT +terapia I-TREATMENT +anticonvulsivante I-TREATMENT +con I-TREATMENT +fenitoína I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +triasociado I-TREATMENT +con I-TREATMENT +ceftriaxona, I-TREATMENT +metronidazol I-TREATMENT +y I-TREATMENT +vancomicina. I-TREATMENT +Una B-EXPLORATION +nueva I-EXPLORATION +TAC I-EXPLORATION +cerebral I-EXPLORATION +con I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +contraste I-EXPLORATION +mostró I-EXPLORATION +edema I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +progresión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +colección I-EXPLORATION +subdural I-EXPLORATION +planteándose I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +empiema I-EXPLORATION +subdural I-EXPLORATION +con I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +inicial. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +fue I-EXPLORATION +evaluado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +de I-EXPLORATION +otorrinolaringología I-EXPLORATION +y I-EXPLORATION +neurocirugía I-EXPLORATION +realizándose I-EXPLORATION +exploración I-EXPLORATION +del I-EXPLORATION +meato I-EXPLORATION +medio I-EXPLORATION +y B-TREATMENT +drenaje I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +maxilar I-TREATMENT +derecho I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endoscópica I-TREATMENT +y I-TREATMENT +en I-TREATMENT +las I-TREATMENT +horas I-TREATMENT +siguientes I-TREATMENT +etmoidectomía I-TREATMENT +derecha, I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +un I-TREATMENT +absceso I-TREATMENT +orbitario I-TREATMENT +derecho I-TREATMENT +y I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +un I-TREATMENT +empiema I-TREATMENT +subdural I-TREATMENT +izquierdo I-TREATMENT +desde I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +abundante I-TREATMENT +material I-TREATMENT +purulento. I-TREATMENT +El B-EXPLORATION +cultivo I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +estas I-EXPLORATION +zonas I-EXPLORATION +para I-EXPLORATION +aerobios I-EXPLORATION +y I-EXPLORATION +anaerobios I-EXPLORATION +estrictos, I-EXPLORATION +procesado I-EXPLORATION +en I-EXPLORATION +sistema I-EXPLORATION +BACTEC/ALERT® I-EXPLORATION +FN I-EXPLORATION +con I-EXPLORATION +bajo I-EXPLORATION +potencial I-EXPLORATION +de I-EXPLORATION +oxido I-EXPLORATION +reducción I-EXPLORATION +y I-EXPLORATION +carbón I-EXPLORATION +activado, I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +en I-EVOLUTION +ventilación I-EVOLUTION +asistida I-EVOLUTION +durante I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +cursó I-EVOLUTION +con I-EVOLUTION +regresión I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +hipertensión I-EVOLUTION +endocraneana I-EVOLUTION +y I-EVOLUTION +recuperación I-EVOLUTION +progresiva I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +escala I-EVOLUTION +de I-EVOLUTION +Glasgow. I-EVOLUTION +Tras B-EXPLORATION +tres I-EXPLORATION +semanas I-EXPLORATION +de I-EXPLORATION +antibioterapia I-EXPLORATION +triasociada, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +nueva I-EXPLORATION +TAC I-EXPLORATION +cerebral I-EXPLORATION +con I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +dos I-EXPLORATION +colecciones I-EXPLORATION +encefálicas I-EXPLORATION +frontales I-EXPLORATION +derechas, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +debió I-TREATMENT +realizarse I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +intervención I-TREATMENT +quirúrgica: I-TREATMENT +cranectomía I-TREATMENT +con I-TREATMENT +vaciamiento I-TREATMENT +frontal I-TREATMENT +derecho, I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +empiema I-TREATMENT +con I-TREATMENT +dos I-TREATMENT +agujeros I-TREATMENT +de I-TREATMENT +trépano I-TREATMENT +y I-TREATMENT +durotomía I-TREATMENT +que I-TREATMENT +dio I-TREATMENT +salida I-TREATMENT +a I-TREATMENT +pus I-TREATMENT +abundante. I-TREATMENT +Los B-EXPLORATION +cultivos I-EXPLORATION +nuevamente I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +evolución I-EXPLORATION +posterior I-EXPLORATION +fue I-EXPLORATION +favorable, I-EXPLORATION +completando I-EXPLORATION +5 I-EXPLORATION +semanas I-EXPLORATION +de I-EXPLORATION +antibioterapia I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +seguimiento I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +cerebral I-EXPLORATION +con I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +nuevas I-EXPLORATION +colecciones. I-EXPLORATION +En B-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +clínicos I-EVOLUTION +post I-EVOLUTION +egreso I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentaba I-EVOLUTION +una I-EVOLUTION +afasia I-EVOLUTION +de I-EVOLUTION +expresión, I-EVOLUTION +logrando I-EVOLUTION +comunicación I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +escrita I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +hemiparesia I-EVOLUTION +derecha I-EVOLUTION +actualmente I-EVOLUTION +en I-EVOLUTION +regresión. I-EVOLUTION + I-EVOLUTION + +Recién B-PRESENT_ILLNESS +nacida I-PRESENT_ILLNESS +(RN) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +término, I-PRESENT_ILLNESS +segunda B-PAST_MEDICAL_HISTORY +hija I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +19 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +sana I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +controlado. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Parto I-PAST_MEDICAL_HISTORY +vaginal I-PAST_MEDICAL_HISTORY +espontáneo, I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +minuto I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +minutos, I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nacimiento: I-PAST_MEDICAL_HISTORY +3.370 I-PAST_MEDICAL_HISTORY +g. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +°C, I-PRESENT_ILLNESS +quejido I-PRESENT_ILLNESS +respiratorio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +decidió I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Neonatología I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Parroquial I-PRESENT_ILLNESS +San I-PRESENT_ILLNESS +Bernardo. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaban I-EXPLORATION +su I-EXPLORATION +hipoactividad, I-EXPLORATION +mala I-EXPLORATION +perfusión I-EXPLORATION +periférica, I-EXPLORATION +ictericia I-EXPLORATION +moderada I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +distendido I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +resistencia I-EXPLORATION +muscular. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraban I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +5.300/mm3 I-EXPLORATION +sin I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda, I-EXPLORATION +PCR: I-EXPLORATION +204 I-EXPLORATION +mg/l I-EXPLORATION +y I-EXPLORATION +gases I-EXPLORATION +sanguíneos I-EXPLORATION +con I-EXPLORATION +acidosis I-EXPLORATION +metabólica. I-EXPLORATION +Orina I-EXPLORATION +completa I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +dio I-EXPLORATION +un I-EXPLORATION +LCR I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +turbio. I-EXPLORATION +Citoquímico I-EXPLORATION +del I-EXPLORATION +LCR: I-EXPLORATION +glucosa I-EXPLORATION +49 I-EXPLORATION +mg/dl, I-EXPLORATION +proteínas I-EXPLORATION +266 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +leucocitos: I-EXPLORATION +950/mm3 I-EXPLORATION +con I-EXPLORATION +70% I-EXPLORATION +PMN, I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram: I-EXPLORATION +cocáceas I-EXPLORATION +grampositivas I-EXPLORATION +en I-EXPLORATION +pares I-EXPLORATION +(diplo). I-EXPLORATION +Los I-EXPLORATION +látex I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +LCR I-EXPLORATION +para I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +antígeno I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +agalactiae I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ampicilina I-TREATMENT +y I-TREATMENT +cefotaxima. I-TREATMENT +Los B-EXPLORATION +hemocultivos I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +hicieron I-EXPLORATION +positivos I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +7, I-EXPLORATION +3 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +incubación, I-EXPLORATION +informándose I-EXPLORATION +cocáceas I-EXPLORATION +grampositivas I-EXPLORATION +en I-EXPLORATION +cadena. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +RN I-EXPLORATION +persistió I-EXPLORATION +febril, I-EXPLORATION +hipoactiva I-EXPLORATION +y I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable. I-EXPLORATION +Un I-EXPLORATION +nuevo I-EXPLORATION +LCR I-EXPLORATION +obtenido I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +72 I-EXPLORATION +horas I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +turbio I-EXPLORATION +y I-EXPLORATION +tenía I-EXPLORATION +5.050 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +con I-EXPLORATION +100% I-EXPLORATION +PMN. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +muestra I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Se I-EXPLORATION +recibió I-EXPLORATION +informe I-EXPLORATION +de I-EXPLORATION +hemocultivos I-EXPLORATION +(2), I-EXPLORATION +urocultivo I-EXPLORATION +y I-EXPLORATION +LCR I-EXPLORATION +tomados I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +con I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +Streptococcus I-EXPLORATION +grupo I-EXPLORATION +viridans I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +penicilina I-EXPLORATION +y I-EXPLORATION +cefotaxima. I-EXPLORATION +El I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +microbiología I-EXPLORATION +comunicó I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +como I-EXPLORATION +preliminar I-EXPLORATION +y I-EXPLORATION +sujeta I-EXPLORATION +a I-EXPLORATION +confirmación. I-EXPLORATION + I-EXPLORATION +Al B-TREATMENT +cuarto I-TREATMENT +día I-TREATMENT +de I-TREATMENT +hospitalización I-TREATMENT +y I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +mala I-TREATMENT +evolución, I-TREATMENT +fue I-TREATMENT +evaluada I-TREATMENT +por I-TREATMENT +infectóloga, I-TREATMENT +suspendiéndose I-TREATMENT +ampicilina I-TREATMENT +y I-TREATMENT +agregando I-TREATMENT +en I-TREATMENT +su I-TREATMENT +reemplazo I-TREATMENT +penicilina I-TREATMENT +400.000 I-TREATMENT +UI/kg/día I-TREATMENT +y I-TREATMENT +gentamicina I-TREATMENT +4 I-TREATMENT +mg/kg/día I-TREATMENT +como I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +asociado I-TREATMENT +para I-TREATMENT +Streptococcus I-TREATMENT +grupo I-TREATMENT +viridans. I-TREATMENT +La I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +cefotaxima I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +de I-TREATMENT +100 I-TREATMENT +a I-TREATMENT +150 I-TREATMENT +mg/kg/día I-TREATMENT +para I-TREATMENT +optimizar I-TREATMENT +su I-TREATMENT +concentración I-TREATMENT +en I-TREATMENT +el I-TREATMENT +SNC I-TREATMENT +y I-TREATMENT +por I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +absceso I-TREATMENT +cerebral. I-TREATMENT + I-TREATMENT +Hemocultivos B-EXPLORATION +obtenidos I-EXPLORATION +intra-tratamiento I-EXPLORATION +resultaron I-EXPLORATION +negativos, I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +ecográfico I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +ecocardiografía I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +foramen I-EXPLORATION +oval I-EXPLORATION +permeable, I-EXPLORATION +descartándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +vegetaciones. I-EXPLORATION +La I-EXPLORATION +RN I-EXPLORATION +evolucionó I-EXPLORATION +afebril I-EXPLORATION +desde I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +cambiado I-EXPLORATION +el I-EXPLORATION +esquema I-EXPLORATION +antimicrobiano. I-EXPLORATION +Al I-EXPLORATION +séptimo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +vida I-EXPLORATION +se I-EXPLORATION +controló I-EXPLORATION +el I-EXPLORATION +LCR I-EXPLORATION +informándose: I-EXPLORATION +38 I-EXPLORATION +leucocitos/mm3, I-EXPLORATION +93% I-EXPLORATION +PMN, I-EXPLORATION +proteínas I-EXPLORATION +164 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +glucosa I-EXPLORATION +46 I-EXPLORATION +mg/dl, I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +sin I-EXPLORATION +bacterias I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +negativo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +control I-EXPLORATION +ulterior I-EXPLORATION +del I-EXPLORATION +LCR. I-EXPLORATION + I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +recibido, I-EXPLORATION +al I-EXPLORATION +octavo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +tratamiento, I-EXPLORATION +el I-EXPLORATION +informe I-EXPLORATION +microbiológico I-EXPLORATION +definitivo I-EXPLORATION +de I-EXPLORATION +Streptococcus I-EXPLORATION +pneumoniae I-EXPLORATION +y I-EXPLORATION +susceptibilidad I-EXPLORATION +corregida I-EXPLORATION +según I-EXPLORATION +los I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +para I-EXPLORATION +meningitis, I-EXPLORATION +se B-TREATMENT +completó I-TREATMENT +tratamiento I-TREATMENT +sólo I-TREATMENT +con I-TREATMENT +cefotaxima. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +recibiendo I-EVOLUTION +cefotaxima I-EVOLUTION +durante I-EVOLUTION +21 I-EVOLUTION +días, I-EVOLUTION +duración I-EVOLUTION +determinada I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +lenta I-EVOLUTION +recuperación I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +laboratorio. I-EVOLUTION +Fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +22 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida, I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones, I-EVOLUTION +no I-EVOLUTION +siendo I-EVOLUTION +posible I-EVOLUTION +realizar I-EVOLUTION +seguimiento I-EVOLUTION +post I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION +Informe B-EXPLORATION +microbiológico. I-EXPLORATION +Dos I-EXPLORATION +hemocultivos, I-EXPLORATION +un I-EXPLORATION +urocultivo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +LCR I-EXPLORATION +obtenidos I-EXPLORATION +al I-EXPLORATION +ingresar I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +resultaron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +cocáceas I-EXPLORATION +grampositivas I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +diplo. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +se I-EXPLORATION +hicieron I-EXPLORATION +positivos I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +7, I-EXPLORATION +3 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +incubación I-EXPLORATION +(sistema I-EXPLORATION +BacT/Alert®, I-EXPLORATION +bioMérieux). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +subcultivo I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +sangre I-EXPLORATION +de I-EXPLORATION +cordero I-EXPLORATION +5% I-EXPLORATION +y I-EXPLORATION +agar I-EXPLORATION +chocolate I-EXPLORATION +(bioMérieux). I-EXPLORATION +Las I-EXPLORATION +placas I-EXPLORATION +se I-EXPLORATION +incubaron I-EXPLORATION +por I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +a I-EXPLORATION +35°C I-EXPLORATION +en I-EXPLORATION +atmósfera I-EXPLORATION +con I-EXPLORATION +3 I-EXPLORATION +a I-EXPLORATION +5% I-EXPLORATION +de I-EXPLORATION +CO2 I-EXPLORATION +obteniéndose I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +colonias I-EXPLORATION +a I-EXPLORATION +hemolíticas I-EXPLORATION +umbilicadas. I-EXPLORATION +Dado I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +colonias I-EXPLORATION +fenotípicamente I-EXPLORATION +similares I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +cultivos, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +del I-EXPLORATION +crecimiento I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +hemocultivos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +a I-EXPLORATION +optoquina I-EXPLORATION +detectó I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +ella, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +emitió I-EXPLORATION +un I-EXPLORATION +informe I-EXPLORATION +preliminar I-EXPLORATION +de: I-EXPLORATION +Streptococcus I-EXPLORATION +grupo I-EXPLORATION +viridans. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +para I-EXPLORATION +penicilina I-EXPLORATION +y I-EXPLORATION +cefotaxima I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +mediante I-EXPLORATION +E- I-EXPLORATION +test I-EXPLORATION +y I-EXPLORATION +fue I-EXPLORATION +interpretado I-EXPLORATION +utilizando I-EXPLORATION +los I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +NCCLS/CLSI I-EXPLORATION +vigentes4 I-EXPLORATION +para I-EXPLORATION +Streptococcus I-EXPLORATION +no I-EXPLORATION +pneumoniae I-EXPLORATION +resultando I-EXPLORATION +sensible I-EXPLORATION +para I-EXPLORATION +penicilina I-EXPLORATION +y I-EXPLORATION +cefotaxima I-EXPLORATION +(penicilina I-EXPLORATION +0, I-EXPLORATION +015 I-EXPLORATION +µg/ml I-EXPLORATION +y I-EXPLORATION +cefotaxima I-EXPLORATION +0, I-EXPLORATION +032 I-EXPLORATION +µg/ml). I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +colonia I-EXPLORATION +era I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +pneumoniae, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +identificación I-EXPLORATION +mediante I-EXPLORATION +API I-EXPLORATION +20 I-EXPLORATION +Strep I-EXPLORATION +(bioMérieux) I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +no I-EXPLORATION +arrojó I-EXPLORATION +resultados I-EXPLORATION +concluyentes I-EXPLORATION +(S. I-EXPLORATION +mitis I-EXPLORATION +(33%), I-EXPLORATION +S. I-EXPLORATION +oralis I-EXPLORATION +(20%), I-EXPLORATION +S. I-EXPLORATION +sanguis I-EXPLORATION +(29%)). I-EXPLORATION +La I-EXPLORATION +cepa I-EXPLORATION +fue I-EXPLORATION +enviada I-EXPLORATION +al I-EXPLORATION +Programa I-EXPLORATION +de I-EXPLORATION +Microbiología, I-EXPLORATION +I.C.B.M., I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Chile, I-EXPLORATION +donde I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +autores I-EXPLORATION +(MTUF) I-EXPLORATION +realizó I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +solubilidad I-EXPLORATION +en I-EXPLORATION +bilis I-EXPLORATION +(soluble), I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +antígeno I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +celular I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +pneumoniae I-EXPLORATION +por I-EXPLORATION +inmunocromatografía I-EXPLORATION +(BinaxNow®)(positivo) I-EXPLORATION +y I-EXPLORATION +RPC I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +de I-EXPLORATION +neumolisina I-EXPLORATION +(positivo), I-EXPLORATION +identificándose I-EXPLORATION +el I-EXPLORATION +microorganismo I-EXPLORATION +definitivamente I-EXPLORATION +como I-EXPLORATION +Streptococcus I-EXPLORATION +pneumoniae. I-EXPLORATION +La I-EXPLORATION +cepa I-EXPLORATION +fue I-EXPLORATION +enviada I-EXPLORATION +al I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública I-EXPLORATION +cumpliendo I-EXPLORATION +la I-EXPLORATION +normativa I-EXPLORATION +vigente I-EXPLORATION +de I-EXPLORATION +envío I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +pneumoniae I-EXPLORATION +invasores I-EXPLORATION +al I-EXPLORATION +centro I-EXPLORATION +de I-EXPLORATION +referencia. I-EXPLORATION +Se I-EXPLORATION +recibió I-EXPLORATION +informe I-EXPLORATION +de I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +como I-EXPLORATION +Streptococcus I-EXPLORATION +pneumoniae I-EXPLORATION +serotipo I-EXPLORATION +5, I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +penicilina. I-EXPLORATION + I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +hecho I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +microbiológico, I-EXPLORATION +se I-EXPLORATION +corrigió I-EXPLORATION +la I-EXPLORATION +interpretación I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +para I-EXPLORATION +cefotaxima I-EXPLORATION +según I-EXPLORATION +los I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +correspondientes I-EXPLORATION +a I-EXPLORATION +S. I-EXPLORATION +pneumoniae I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +meníngea, I-EXPLORATION +permaneciendo I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +categoría I-EXPLORATION +de I-EXPLORATION +susceptible I-EXPLORATION +tanto I-EXPLORATION +a I-EXPLORATION +penicilina I-EXPLORATION +como I-EXPLORATION +a I-EXPLORATION +cefotaxima. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +residente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Santiago, I-PAST_MEDICAL_HISTORY +soltero I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +heterosexual, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +septiembre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2003 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +serología I-PAST_MEDICAL_HISTORY +confirmatoria I-PAST_MEDICAL_HISTORY +efectuada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +laboratorio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +referencia I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Instituto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Salud I-PAST_MEDICAL_HISTORY +Pública I-PAST_MEDICAL_HISTORY +(ISP). I-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +catalogado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +etapa I-PAST_MEDICAL_HISTORY +A, I-PAST_MEDICAL_HISTORY +nunca I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +determinación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +linfocitos I-PAST_MEDICAL_HISTORY +CD4 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +irregulares I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +policlínica. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +vivía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +calle, I-PAST_MEDICAL_HISTORY +dedicado I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +comercio I-PAST_MEDICAL_HISTORY +ambulante I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alojaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +residencia I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +individuos I-PAST_MEDICAL_HISTORY +indigentes. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +abril I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2005 I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +volumen I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +frontal, I-PAST_MEDICAL_HISTORY +asociándose, I-PAST_MEDICAL_HISTORY +además, I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +papulares I-PAST_MEDICAL_HISTORY +eritematosas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +extremidades, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +consultó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +policlínica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Infectología-VIH, I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Hospital I-PAST_MEDICAL_HISTORY +San I-PAST_MEDICAL_HISTORY +Juan I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Dios, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +agosto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2005. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +observaba I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +absceso I-PAST_MEDICAL_HISTORY +frontal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +forúnculos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ambas I-PAST_MEDICAL_HISTORY +extremidades, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +enviado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +urgencia I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +debridamiento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +absceso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +obtención I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cultivos. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +progresión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +absceso I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +(5 I-PRESENT_ILLNESS +x I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro), I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +área I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +necrosis I-PRESENT_ILLNESS +central I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +borde I-PRESENT_ILLNESS +eritematoso I-PRESENT_ILLNESS +extenso, I-PRESENT_ILLNESS +coincidiendo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuevas I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +papulares I-PRESENT_ILLNESS +eritematosas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +cm. I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara, I-PRESENT_ILLNESS +principalmente, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +barba, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores- I-PRESENT_ILLNESS +algunas I-PRESENT_ILLNESS +subcutáneas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +consistencia I-PRESENT_ILLNESS +blanda, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +dolorosas- I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +violáceas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tórax I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores. I-PRESENT_ILLNESS +También I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +apreció I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +mucoso, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +exofiticas I-PRESENT_ILLNESS +costrosas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ángulo I-PRESENT_ILLNESS +interno I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ojo, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +conjuntivas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +exofíticas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ulceración I-PRESENT_ILLNESS +central I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mucosa I-PRESENT_ILLNESS +oral, I-PRESENT_ILLNESS +localizadas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +vestibular I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +labio I-PRESENT_ILLNESS +inferior, I-PRESENT_ILLNESS +paladar I-PRESENT_ILLNESS +duro I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +blando. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +general I-EXPLORATION +se I-EXPLORATION +destacó I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +malas I-EXPLORATION +condiciones I-EXPLORATION +higiénicas, I-EXPLORATION +pálido, I-EXPLORATION +con I-EXPLORATION +candidiasis I-EXPLORATION +orofaríngea, I-EXPLORATION +T° I-EXPLORATION +axilar I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +5° I-EXPLORATION +C, I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +18, I-EXPLORATION +sin I-EXPLORATION +adenopatías I-EXPLORATION +regionales. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +cardiovascular I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +alteraciones I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +visceromegalia I-EXPLORATION +abdominal. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +compromiso I-EXPLORATION +neurológico I-EXPLORATION +clínico. I-EXPLORATION + I-EXPLORATION +Otros B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +relevantes I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +aparecieron I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +viajes I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +mochilero I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Perú I-PAST_MEDICAL_HISTORY +(Tacna) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2001 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Bolivia I-PAST_MEDICAL_HISTORY +(Ororuro) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2003. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +mascotas; I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +embargo, I-PAST_MEDICAL_HISTORY +refirió I-PAST_MEDICAL_HISTORY +tener I-PAST_MEDICAL_HISTORY +contacto, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +frecuente, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +gatos I-PAST_MEDICAL_HISTORY +callejeros I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +todas I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +edades, I-PAST_MEDICAL_HISTORY +habiendo I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +rasguñado I-PAST_MEDICAL_HISTORY +ocasionalmente. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Se B-EVOLUTION +decidió, I-EVOLUTION +entonces, I-EVOLUTION +su I-EVOLUTION +hospitalización I-EVOLUTION +para I-EVOLUTION +realizar I-EVOLUTION +estudios. I-EVOLUTION +De B-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +generales I-EXPLORATION +destacó I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +31% I-EXPLORATION +con I-EXPLORATION +VCM I-EXPLORATION +80 I-EXPLORATION +fl I-EXPLORATION +y I-EXPLORATION +CHCM I-EXPLORATION +32%, I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +5.700 I-EXPLORATION +céls/mm3, I-EXPLORATION +sin I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +310.000 I-EXPLORATION +céls/mmm3, I-EXPLORATION +VHS I-EXPLORATION +81 I-EXPLORATION +mm/h, I-EXPLORATION +sin I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática, I-EXPLORATION +con I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +de I-EXPLORATION +85 I-EXPLORATION +U/L I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +185 I-EXPLORATION +U/L. I-EXPLORATION +Del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +patología I-EXPLORATION +de I-EXPLORATION +base, I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +(Nuclisens I-EXPLORATION +HIV-1 I-EXPLORATION +QT, I-EXPLORATION +Biomérieux) I-EXPLORATION +de I-EXPLORATION +130.000 I-EXPLORATION +copias I-EXPLORATION +ARN I-EXPLORATION +viral/ml I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +CD4 I-EXPLORATION +de I-EXPLORATION +83 I-EXPLORATION +céls/mm3. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +automatizados I-EXPLORATION +aeróbicos I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +siete I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +incubación, I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +secreción I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +lesión I-EXPLORATION +frontal I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +bacterias, I-EXPLORATION +lo I-EXPLORATION +mismo I-EXPLORATION +la I-EXPLORATION +baciloscopia I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +micobacterias. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +realizado I-EXPLORATION +mostró: I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +normal, I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +osteolíticas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +envió I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +suero I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +IgG I-EXPLORATION +para I-EXPLORATION +B. I-EXPLORATION +henselae I-EXPLORATION +y I-EXPLORATION +B. I-EXPLORATION +quintana I-EXPLORATION +por I-EXPLORATION +inmunofluorescencia I-EXPLORATION +(Focus®) I-EXPLORATION +al I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Infectología I-EXPLORATION +y I-EXPLORATION +Virología I-EXPLORATION +Molecular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Pontificia I-EXPLORATION +Universidad I-EXPLORATION +Católica I-EXPLORATION +de I-EXPLORATION +Chile, I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +con I-EXPLORATION +títulos I-EXPLORATION +> I-EXPLORATION +1/256 I-EXPLORATION +para I-EXPLORATION +B. I-EXPLORATION +henselae I-EXPLORATION +y I-EXPLORATION +> I-EXPLORATION +1: I-EXPLORATION +64 I-EXPLORATION +para I-EXPLORATION +B. I-EXPLORATION +quintana. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +efectuó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +cutánea I-EXPLORATION +frontal I-EXPLORATION +cuyo I-EXPLORATION +informe I-EXPLORATION +indicó: I-EXPLORATION +piel I-EXPLORATION +ulcerada I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +escamoso I-EXPLORATION +maduro, I-EXPLORATION +proliferación I-EXPLORATION +lobulillar I-EXPLORATION +de I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +calibre, I-EXPLORATION +abundantes I-EXPLORATION +polimorfos I-EXPLORATION +nucleares I-EXPLORATION +intersticiales, I-EXPLORATION +algunos I-EXPLORATION +con I-EXPLORATION +cariorrexis. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Warthin I-EXPLORATION +Starry I-EXPLORATION +demostró I-EXPLORATION +estructuras I-EXPLORATION +cocobacilares I-EXPLORATION +en I-EXPLORATION +acúmulos I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +Bartonella I-EXPLORATION +sp. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +alta I-TREATMENT +sospecha I-TREATMENT +clínica, I-TREATMENT +después I-TREATMENT +de I-TREATMENT +tomar I-TREATMENT +cultivos I-TREATMENT +y I-TREATMENT +biopsia, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +azitromicina I-TREATMENT +500 I-TREATMENT +mg/d I-TREATMENT +v.o. I-TREATMENT +más I-TREATMENT +ciprofloxacina I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +c/12 I-TREATMENT +hs I-TREATMENT +v.o. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +exofiticas I-TREATMENT +conjuntivales I-TREATMENT +bilaterales, I-TREATMENT +las B-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +enviaron I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +que I-EXPLORATION +concluyó: I-EXPLORATION +tejido I-EXPLORATION +conectivo I-EXPLORATION +con I-EXPLORATION +epitelio I-EXPLORATION +escamoso I-EXPLORATION +y I-EXPLORATION +cilíndrico I-EXPLORATION +hiperplásico, I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +agudo I-EXPLORATION +y I-EXPLORATION +crónico, I-EXPLORATION +abundantes I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +neoformación, I-EXPLORATION +material I-EXPLORATION +amorfo I-EXPLORATION +intersticial. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Warthin I-EXPLORATION +Starry I-EXPLORATION +demostró I-EXPLORATION +estructuras I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +Bartonella I-EXPLORATION +spp, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +angiomatosis I-EXPLORATION +bacilar. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +molecular I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +violáceo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +abdominal I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +al I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Biología I-EXPLORATION +Molecular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Pontificia I-EXPLORATION +Universidad I-EXPLORATION +Católica I-EXPLORATION +de I-EXPLORATION +Chile. I-EXPLORATION +La I-EXPLORATION +extracción I-EXPLORATION +del I-EXPLORATION +ADN I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +subcutáneo I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +utilizando I-EXPLORATION +un I-EXPLORATION +método I-EXPLORATION +comercial I-EXPLORATION +(QIAamp I-EXPLORATION +Tissue I-EXPLORATION +kit, I-EXPLORATION +Qiagen®), I-EXPLORATION +según I-EXPLORATION +las I-EXPLORATION +recomendaciones I-EXPLORATION +del I-EXPLORATION +fabricante. I-EXPLORATION +La I-EXPLORATION +amplificación I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +que I-EXPLORATION +codifica I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +16S I-EXPLORATION +ARNr I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +con I-EXPLORATION +partidores I-EXPLORATION +universales15. I-EXPLORATION +Posteriormente, I-EXPLORATION +se I-EXPLORATION +secuenció I-EXPLORATION +el I-EXPLORATION +producto I-EXPLORATION +amplificado I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +evaluó I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +analizador I-EXPLORATION +genético I-EXPLORATION +ABI I-EXPLORATION +310. I-EXPLORATION +Para I-EXPLORATION +la I-EXPLORATION +comparación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +nucleotídica I-EXPLORATION +obtenida I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +secuencias I-EXPLORATION +depositadas I-EXPLORATION +en I-EXPLORATION +banco I-EXPLORATION +de I-EXPLORATION +genes I-EXPLORATION +Genebank, I-EXPLORATION +se I-EXPLORATION +utilizó I-EXPLORATION +al I-EXPLORATION +programa I-EXPLORATION +BLAST. I-EXPLORATION +Se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +homología I-EXPLORATION +de I-EXPLORATION +100% I-EXPLORATION +sobre I-EXPLORATION +418 I-EXPLORATION +pares I-EXPLORATION +de I-EXPLORATION +bases I-EXPLORATION +depositadas I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +especie I-EXPLORATION +B. I-EXPLORATION +quintana I-EXPLORATION +subespecie I-EXPLORATION +Toulouse, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó, I-EXPLORATION +posteriormente, I-EXPLORATION +por I-EXPLORATION +amplificación I-EXPLORATION +y I-EXPLORATION +secuenciación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +ITS I-EXPLORATION +y I-EXPLORATION +336, I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +específicos I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +género I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +especie, I-EXPLORATION +respectivamente. I-EXPLORATION + I-EXPLORATION +Previo B-TREATMENT +al I-TREATMENT +alta, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +antiretroviral I-TREATMENT +con I-TREATMENT +zidovudina, I-TREATMENT +lamivudina I-TREATMENT +y I-TREATMENT +efavirenz I-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +infección I-TREATMENT +por I-TREATMENT +VIH I-TREATMENT +en I-TREATMENT +etapa I-TREATMENT +B-3 I-TREATMENT +y I-TREATMENT +angiomatosis I-TREATMENT +bacilar I-TREATMENT +por I-TREATMENT +B. I-TREATMENT +quintana. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +al I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +antibioterapia I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +satisfactoria, I-EVOLUTION +con I-EVOLUTION +regresión I-EVOLUTION +del I-EVOLUTION +compromiso I-EVOLUTION +cutáneo I-EVOLUTION +y I-EVOLUTION +mucoso I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +cuatro I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Adolescente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +campamento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +verano I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +carpa I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +familia, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +localidad I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Quisco, I-PRESENT_ILLNESS +Vª I-PRESENT_ILLNESS +Región, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +agachó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +recoger I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +pelota I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +matorrales. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +sintió I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +algo I-PRESENT_ILLNESS +apretaba I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +retirar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +vio I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +culebra I-PRESENT_ILLNESS +prendada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano, I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dedos I-PRESENT_ILLNESS +pulgar I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +índice. I-PRESENT_ILLNESS +Ella I-PRESENT_ILLNESS +cogió I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cabeza I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +culebra I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +detrás, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +libre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +cabo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +algunos I-PRESENT_ILLNESS +segundos I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +reptil I-PRESENT_ILLNESS +soltó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano, I-PRESENT_ILLNESS +alcanzando I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +enrollarse I-PRESENT_ILLNESS +alrededor I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +brazo I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +Para I-PRESENT_ILLNESS +evitar I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +culebra I-PRESENT_ILLNESS +escapara, I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +padres I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mataron I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +guardaron I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +recipiente. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +culebra I-PRESENT_ILLNESS +medía I-PRESENT_ILLNESS +137 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +longitud, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +cola I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +cm. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +franja I-PRESENT_ILLNESS +oscura I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +flanqueada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +franjas I-PRESENT_ILLNESS +claras I-PRESENT_ILLNESS +laterales. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +logró I-PRESENT_ILLNESS +encontrar I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dientes I-PRESENT_ILLNESS +inocu-ladores I-PRESENT_ILLNESS +posteriores. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +mordedura I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +provocó I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +logró I-PRESENT_ILLNESS +apreciar I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sitio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inoculación. I-PRESENT_ILLNESS +Aproximadamente I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +cabo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +minutos, I-PRESENT_ILLNESS +inició I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sitio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mordedura. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +llevada I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +Carlos I-PRESENT_ILLNESS +van I-PRESENT_ILLNESS +Buren, I-PRESENT_ILLNESS +Valparaíso, I-PRESENT_ILLNESS +Vª I-PRESENT_ILLNESS +Región. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +un I-EXPLORATION +edema I-EXPLORATION +circunferencial I-EXPLORATION +que I-EXPLORATION +abarcaba I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +brazo, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +herida I-EXPLORATION +puntiforme I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +erosión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +vecina, I-EXPLORATION +los I-EXPLORATION +dedos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +afectada I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +fríos, I-EXPLORATION +no I-EXPLORATION +refería I-EXPLORATION +mialgias. I-EXPLORATION + I-EXPLORATION +Fue B-TREATMENT +hospitalizada I-TREATMENT +con I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +mordedura I-TREATMENT +por I-TREATMENT +ofidio I-TREATMENT +y I-TREATMENT +observación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +síndrome I-TREATMENT +com-partamental. I-TREATMENT +Se I-TREATMENT +indicó I-TREATMENT +como I-TREATMENT +tratamiento I-TREATMENT +corticoste-roides I-TREATMENT +y I-TREATMENT +anti-histamínicos I-TREATMENT +endovenosos, I-TREATMENT +analgésicos I-TREATMENT +tipo I-TREATMENT +AINE I-TREATMENT +y I-TREATMENT +ampicilina I-TREATMENT +parenteral. I-TREATMENT +Las I-TREATMENT +medidas I-TREATMENT +locales I-TREATMENT +indicadas I-TREATMENT +fueron I-TREATMENT +brazo I-TREATMENT +en I-TREATMENT +alto I-TREATMENT +y I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +hielo. I-TREATMENT + I-TREATMENT +De B-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +solicitados I-EXPLORATION +destacaban: I-EXPLORATION +protrombinemia: I-EXPLORATION +57% I-EXPLORATION +(VN= I-EXPLORATION +70-100%), I-EXPLORATION +TTPK: I-EXPLORATION +41 I-EXPLORATION +seg I-EXPLORATION +(VN= I-EXPLORATION +26-36 I-EXPLORATION +seg), I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas: I-EXPLORATION +300.000 I-EXPLORATION +(VN= I-EXPLORATION +150.000-400.000/mm3), I-EXPLORATION +hematocrito: I-EXPLORATION +44% I-EXPLORATION +(VN= I-EXPLORATION +34-44%); I-EXPLORATION +hemoglobinemia: I-EXPLORATION +14, I-EXPLORATION +6 I-EXPLORATION +gr/dL I-EXPLORATION +(VN= I-EXPLORATION +11, I-EXPLORATION +6-15 I-EXPLORATION +gr/ I-EXPLORATION +dL). I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos. I-EXPLORATION + I-EXPLORATION +Evolucionó B-EVOLUTION +en I-EVOLUTION +regulares I-EVOLUTION +condiciones I-EVOLUTION +generales I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +24 I-EVOLUTION +horas, I-EVOLUTION +sin I-EVOLUTION +fiebre, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +intenso I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +superior I-EVOLUTION +izquierda. I-EVOLUTION +El I-EVOLUTION +edema I-EVOLUTION +se I-EVOLUTION +extendió I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +del I-EVOLUTION +hombro I-EVOLUTION +y I-EVOLUTION +zona I-EVOLUTION +pectoral I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +dedos I-EVOLUTION +tomaron I-EVOLUTION +un I-EVOLUTION +aspecto I-EVOLUTION +equimótico. I-EVOLUTION +Destacó B-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +el I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +afectada I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +consistencia I-EXPLORATION +acartonada I-EXPLORATION +del I-EXPLORATION +edema. I-EXPLORATION +Presentó I-EXPLORATION +cefalea I-EXPLORATION +intensa, I-EXPLORATION +náuseas I-EXPLORATION +y I-EXPLORATION +febrículas, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +sangramientos. I-EXPLORATION +La I-EXPLORATION +orina I-EXPLORATION +fue I-EXPLORATION +evaluada I-EXPLORATION +diariamente I-EXPLORATION +por I-EXPLORATION +colorometría I-EXPLORATION +a I-EXPLORATION +ojo I-EXPLORATION +desnudo, I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +hemoglobinuria. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +mantuvo I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +analgésicos I-TREATMENT +y I-TREATMENT +corti-costeroides I-TREATMENT +endovenosos I-TREATMENT +y I-TREATMENT +el I-TREATMENT +edema I-TREATMENT +del I-TREATMENT +antebrazo I-TREATMENT +y I-TREATMENT +brazo I-TREATMENT +comenzó I-TREATMENT +a I-TREATMENT +disminuir. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +aparecieron I-EVOLUTION +bulas I-EVOLUTION +serohemorrágicas I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +del I-EVOLUTION +pliegue I-EVOLUTION +del I-EVOLUTION +codo I-EVOLUTION +derecho, I-EVOLUTION +disminuyó I-EVOLUTION +la I-EVOLUTION +cefalea, I-EVOLUTION +desaparecieron I-EVOLUTION +las I-EVOLUTION +náuseas I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +fiebre, I-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +extremidad. I-EVOLUTION +La I-EVOLUTION +movilidad I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +dedos I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +muñeca I-EVOLUTION +estaban I-EVOLUTION +limitadas, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +palpación I-EVOLUTION +de I-EVOLUTION +pulsos I-EVOLUTION +arteriales I-EVOLUTION +normales. I-EVOLUTION +Los I-EVOLUTION +cirujanos I-EVOLUTION +descartaron I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +compartamental. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +tanto I-EVOLUTION +el I-EVOLUTION +edema I-EVOLUTION +como I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +se I-EVOLUTION +encontraban I-EVOLUTION +en I-EVOLUTION +franca I-EVOLUTION +regresión I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +suspendieron I-EVOLUTION +los I-EVOLUTION +corticosteroides I-EVOLUTION +y I-EVOLUTION +anti-histamínicos. I-EVOLUTION +Al I-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta, I-EVOLUTION +casi I-EVOLUTION +sin I-EVOLUTION +molestias, I-EVOLUTION +con B-TREATMENT +indicación I-TREATMENT +de I-TREATMENT +completar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +predni-sona I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +y I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +por I-TREATMENT +seis I-TREATMENT +días. I-TREATMENT + I-TREATMENT + +Un B-PRESENT_ILLNESS +RN I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +raza I-PAST_MEDICAL_HISTORY +negra I-PAST_MEDICAL_HISTORY +y B-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5°C, I-PRESENT_ILLNESS +rechazo I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +pecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +manifestaciones I-PRESENT_ILLNESS +catarrales I-PRESENT_ILLNESS +respiratorias. I-PRESENT_ILLNESS +Los B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +-ocurrido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +39 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gestación- I-PAST_MEDICAL_HISTORY +eran I-PAST_MEDICAL_HISTORY +normales; I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +puntaje I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +9-9 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pesó I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacer I-PAST_MEDICAL_HISTORY +2.880 I-PAST_MEDICAL_HISTORY +g. I-PAST_MEDICAL_HISTORY +Egresó I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +hospital I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lactancia I-PAST_MEDICAL_HISTORY +materna I-PAST_MEDICAL_HISTORY +exclusiva. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +reingreso I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +buena I-EXPLORATION +vitalidad I-EXPLORATION +y I-EXPLORATION +coloración, I-EXPLORATION +pesaba I-EXPLORATION +3.580 I-EXPLORATION +g, I-EXPLORATION +tenía I-EXPLORATION +escasa I-EXPLORATION +rinorrea I-EXPLORATION +serosa I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +para I-EXPLORATION +pesquisa I-EXPLORATION +de I-EXPLORATION +sepsis I-EXPLORATION +se I-EXPLORATION +estableció: I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +8.500/mm3 I-EXPLORATION +(PMN I-EXPLORATION +68%), I-EXPLORATION +VHS I-EXPLORATION +26 I-EXPLORATION +mm/h, I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +normal, I-EXPLORATION +examen I-EXPLORATION +citoquímico I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +con I-EXPLORATION +6 I-EXPLORATION +leucocitos/mm3, I-EXPLORATION +86 I-EXPLORATION +hematíes I-EXPLORATION +/mm3, I-EXPLORATION +proteína I-EXPLORATION +60 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +glucosa I-EXPLORATION +26 I-EXPLORATION +mg/dl; I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +pleuro-pulmonares. I-EXPLORATION +Por B-TREATMENT +sus I-TREATMENT +buenas I-TREATMENT +condiciones I-TREATMENT +clínicas I-TREATMENT +y I-TREATMENT +exámenes I-TREATMENT +de I-TREATMENT +laboratorio I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +rangos I-TREATMENT +normales, I-TREATMENT +se I-TREATMENT +ingresó I-TREATMENT +sin I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano. I-TREATMENT + I-TREATMENT +Al I-TREATMENT +segundo I-TREATMENT +día I-TREATMENT +reapareció I-TREATMENT +la I-TREATMENT +fiebre, I-TREATMENT +hasta I-TREATMENT +38, I-TREATMENT +0 I-TREATMENT +°C I-TREATMENT +y I-TREATMENT +se I-TREATMENT +informó I-TREATMENT +un I-TREATMENT +resultado I-TREATMENT +positivo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +urocultivo, I-TREATMENT +(más I-TREATMENT +tarde, I-TREATMENT +se I-TREATMENT +identificó I-TREATMENT +una I-TREATMENT +Serratia I-TREATMENT +sp), I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +gentamicina I-TREATMENT +(7 I-TREATMENT +mg/kg/día) I-TREATMENT +ev. I-TREATMENT +El B-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Entre B-EVOLUTION +el I-EVOLUTION +tercer I-EVOLUTION +y I-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +apareció I-EVOLUTION +deterioro I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +condición I-EVOLUTION +clínica, I-EVOLUTION +con I-EVOLUTION +quejido, I-EVOLUTION +rechazo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lactancia I-EVOLUTION +materna, I-EVOLUTION +adinamia I-EVOLUTION +e I-EVOLUTION +hiporreflexia, I-EVOLUTION +somnolencia I-EVOLUTION +con I-EVOLUTION +irritabilidad, I-EVOLUTION +distensión I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +vómitos, I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +dificultad I-EVOLUTION +respiratoria, I-EVOLUTION +palidez, I-EVOLUTION +cianosis I-EVOLUTION +distal, I-EVOLUTION +taquicardia, I-EVOLUTION +oligoanuria I-EVOLUTION +y I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +hipoperfusión I-EVOLUTION +tisular, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +aspecto I-EVOLUTION +tóxico-infeccioso, I-EVOLUTION +presentando I-EVOLUTION +convulsiones I-EVOLUTION +y I-EVOLUTION +bregma I-EVOLUTION +nor-motenso. I-EVOLUTION +Reevaluado B-EXPLORATION +con I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +se I-EXPLORATION +encontró: I-EXPLORATION +leucocitos I-EXPLORATION +12.300/mm3 I-EXPLORATION +(PMN I-EXPLORATION +34% I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +granulaciones I-EXPLORATION +tóxicas), I-EXPLORATION +VHS I-EXPLORATION +16 I-EXPLORATION +mm/h, I-EXPLORATION +plaquetas I-EXPLORATION +de I-EXPLORATION +110.000/mm3, I-EXPLORATION +gasometría I-EXPLORATION +con I-EXPLORATION +acidosis I-EXPLORATION +metabólica; I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +normal, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +aparecieron I-EXPLORATION +imágenes I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +dificultad I-EXPLORATION +respiratoria I-EXPLORATION +del I-EXPLORATION +adulto. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +apoyado I-TREATMENT +con I-TREATMENT +cuidados I-TREATMENT +intensivos: I-TREATMENT +reposición I-TREATMENT +de I-TREATMENT +volumen, I-TREATMENT +inotrópicos, I-TREATMENT +ventilación I-TREATMENT +mecánica, I-TREATMENT +inmuno-moduladores I-TREATMENT +(inmunoglobulina I-TREATMENT +IV I-TREATMENT +y I-TREATMENT +corticosteroides) I-TREATMENT +y I-TREATMENT +recibió I-TREATMENT +fenobarbital. I-TREATMENT +Se I-TREATMENT +indicó I-TREATMENT +penicilina I-TREATMENT +G I-TREATMENT +sódica I-TREATMENT +(200.000 I-TREATMENT +U/kg/día) I-TREATMENT +ev I-TREATMENT +al I-TREATMENT +conocerse I-TREATMENT +resultado I-TREATMENT +del I-TREATMENT +hemocultivo I-TREATMENT +de I-TREATMENT +ingreso I-TREATMENT +positivo I-TREATMENT +a I-TREATMENT +S. I-TREATMENT +pyogenes. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +iniciado I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +antimicrobiano I-EVOLUTION +se I-EVOLUTION +repitió I-EVOLUTION +la I-EVOLUTION +punción I-EVOLUTION +lumbar I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +informó I-EVOLUTION +el I-EVOLUTION +examen I-EVOLUTION +citoquímico I-EVOLUTION +del I-EVOLUTION +LCR I-EVOLUTION +con I-EVOLUTION +47 I-EVOLUTION +leucocitos/mm3, I-EVOLUTION +2.304 I-EVOLUTION +hematíes/mm3, I-EVOLUTION +proteína I-EVOLUTION +87 I-EVOLUTION +mg/dl I-EVOLUTION +y I-EVOLUTION +glucosa I-EVOLUTION +18 I-EVOLUTION +mg/dl. I-EVOLUTION +El I-EVOLUTION +cultivo I-EVOLUTION +del I-EVOLUTION +LCR I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +punción I-EVOLUTION +lumbar I-EVOLUTION +resultó I-EVOLUTION +negativo. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posteriores, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +deterioro I-EVOLUTION +clínico I-EVOLUTION +progresivo I-EVOLUTION +con I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +convulsiones, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +incrementó I-EVOLUTION +la I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +anticon-vulsivantes, I-EVOLUTION +cayó I-EVOLUTION +en I-EVOLUTION +coma I-EVOLUTION +profundo, I-EVOLUTION +con I-EVOLUTION +midriasis I-EVOLUTION +y I-EVOLUTION +respuesta I-EVOLUTION +pupilar I-EVOLUTION +débil, I-EVOLUTION +postura I-EVOLUTION +de I-EVOLUTION +descerebración I-EVOLUTION +y I-EVOLUTION +bregma I-EVOLUTION +tenso. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +ultrasonido I-EVOLUTION +cerebral I-EVOLUTION +se I-EVOLUTION +apreciaba I-EVOLUTION +una I-EVOLUTION +hemorragia I-EVOLUTION +periventricular I-EVOLUTION +e I-EVOLUTION +intraventricular. I-EVOLUTION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +la I-TREATMENT +hipertensión I-TREATMENT +intracraneal I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +los I-TREATMENT +antimicrobianos I-TREATMENT +iniciales I-TREATMENT +por I-TREATMENT +ceftriaxona I-TREATMENT +(130 I-TREATMENT +mg/kg/día) I-TREATMENT +ev. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +el I-EVOLUTION +RN I-EVOLUTION +falleció. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +necropsia I-EXPLORATION +se I-EXPLORATION +comprobaron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +meningitis I-EXPLORATION +con I-EXPLORATION +hemorragias I-EXPLORATION +y I-EXPLORATION +daño I-EXPLORATION +cerebral I-EXPLORATION +grave, I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +shock I-EXPLORATION +séptico I-EXPLORATION +y I-EXPLORATION +pulmones I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +dificultad I-EXPLORATION +respiratoria I-EXPLORATION +del I-EXPLORATION +adulto. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +recién I-PRESENT_ILLNESS +nacida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pretérmino, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +gestacional I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nacimiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +685 I-PRESENT_ILLNESS +g. I-PRESENT_ILLNESS +Embarazo I-PRESENT_ILLNESS +gemelar I-PRESENT_ILLNESS +controlado, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fecundación I-PRESENT_ILLNESS +in I-PRESENT_ILLNESS +vitro. I-PRESENT_ILLNESS +Tras I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +parto I-PRESENT_ILLNESS +vaginal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +presentación I-PRESENT_ILLNESS +cefálica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sufrimiento I-PRESENT_ILLNESS +fetal I-PRESENT_ILLNESS +(Apgar I-PRESENT_ILLNESS +4-6), I-PRESENT_ILLNESS +debió I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +intubada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +sala I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +parto. I-PRESENT_ILLNESS +Se B-TREATMENT +trasladó I-TREATMENT +a I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +de I-TREATMENT +cuidados I-TREATMENT +intensivos I-TREATMENT +siendo I-TREATMENT +conectada I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica. I-TREATMENT +Permaneció I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +día I-TREATMENT +con I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +y I-TREATMENT +catéter I-TREATMENT +venoso I-TREATMENT +central I-TREATMENT +y I-TREATMENT +precisando I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +surfactante I-TREATMENT +pulmonar I-TREATMENT +exógeno I-TREATMENT +con I-TREATMENT +escasa I-TREATMENT +respuesta. I-TREATMENT +Se B-EXPLORATION +obtuvieron I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +hemocultivo I-EXPLORATION +y I-EXPLORATION +urocultivo I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +e B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +de I-TREATMENT +sepsis I-TREATMENT +neonatal I-TREATMENT +precoz I-TREATMENT +(ampi-cilina I-TREATMENT +y I-TREATMENT +gentamicina). I-TREATMENT +Tras B-EVOLUTION +cinco I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antimicrobiano I-EVOLUTION +presentó I-EVOLUTION +empeoramiento I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +alteración I-EVOLUTION +de I-EVOLUTION +exámenes I-EVOLUTION +laboratorio I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +la I-TREATMENT +antibioterapia I-TREATMENT +para I-TREATMENT +cobertura I-TREATMENT +de I-TREATMENT +sepsis I-TREATMENT +nosocomial I-TREATMENT +(vancomicina I-TREATMENT +y I-TREATMENT +ceftazidima) I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +obtuvieron I-EXPLORATION +nuevas I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +cultivo I-EXPLORATION +(sangre, I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +LCR). I-EXPLORATION + I-EXPLORATION +A B-TREATMENT +la I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +el I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +umbilical, I-TREATMENT +en B-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +Staphylococcus I-EXPLORATION +epider-midis I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +vancomicina. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +ceftazidima I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +vancomicina I-TREATMENT +durante I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +más. I-TREATMENT +Los B-EXPLORATION +cultivos I-EXPLORATION +realizados I-EXPLORATION +(sangre, I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +LCR) I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Persistieron B-EVOLUTION +las I-EVOLUTION +alteraciones I-EVOLUTION +hemodi-námicas, I-EVOLUTION +respiratorias I-EVOLUTION +y I-EVOLUTION +hematológicas, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +progresivo I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +fallecimiento I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +20 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida. I-EVOLUTION +Tras B-EXPLORATION +su I-EXPLORATION +deceso I-EXPLORATION +se I-EXPLORATION +cultivaron I-EXPLORATION +los I-EXPLORATION +catéteres I-EXPLORATION +(venoso I-EXPLORATION +central I-EXPLORATION +y I-EXPLORATION +arterial) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tubo I-EXPLORATION +endotraqueal I-EXPLORATION +en I-EXPLORATION +caldo I-EXPLORATION +de I-EXPLORATION +enriquecimiento I-EXPLORATION +tioglicolato I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +chocolate. I-EXPLORATION +En I-EXPLORATION +todos I-EXPLORATION +ellos, I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +incubación I-EXPLORATION +a I-EXPLORATION +37 I-EXPLORATION +°C I-EXPLORATION +se I-EXPLORATION +observó, I-EXPLORATION +en I-EXPLORATION +cultivo I-EXPLORATION +puro, I-EXPLORATION +colonias I-EXPLORATION +secas I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +crema I-EXPLORATION +y I-EXPLORATION +superficie I-EXPLORATION +rugosa I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +resembradas I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +Albicans I-EXPLORATION +(Biomerieux®) I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +SGC2 I-EXPLORATION +(Biomerieux®) I-EXPLORATION +e I-EXPLORATION +incubadas I-EXPLORATION +a I-EXPLORATION +30 I-EXPLORATION +°C I-EXPLORATION +Posteriormente, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +su I-EXPLORATION +identificación I-EXPLORATION +mediante I-EXPLORATION +tarjeta I-EXPLORATION +ID I-EXPLORATION +Yeast I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +sistema I-EXPLORATION +automatizado I-EXPLORATION +Vitek I-EXPLORATION +(Biomerieux I-EXPLORATION +®), I-EXPLORATION +obteniéndose I-EXPLORATION +como I-EXPLORATION +resultado I-EXPLORATION +T. I-EXPLORATION +asahii. I-EXPLORATION +Paralelamente, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +visión I-EXPLORATION +directa I-EXPLORATION +al I-EXPLORATION +microscopio I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +hifas I-EXPLORATION +ramificadas I-EXPLORATION +con I-EXPLORATION +artroconidios I-EXPLORATION +intercalares I-EXPLORATION +y I-EXPLORATION +terminales I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +rectangular. I-EXPLORATION +Por I-EXPLORATION +último, I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +positividad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ureasa I-EXPLORATION +como I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +con I-EXPLORATION +Geotrichum I-EXPLORATION +sp. I-EXPLORATION +Para I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +susceptibilidad I-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +un I-EXPLORATION +Sensititre I-EXPLORATION +YeastOne I-EXPLORATION +Y I-EXPLORATION +07 I-EXPLORATION +(Trek I-EXPLORATION +Diagnostic I-EXPLORATION +Systems®) I-EXPLORATION +que, I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +lectura I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +horas, I-EXPLORATION +arrojó I-EXPLORATION +una I-EXPLORATION +CIM I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +μg/ml I-EXPLORATION +para I-EXPLORATION +flucona-zol, I-EXPLORATION +0, I-EXPLORATION +25 I-EXPLORATION +μg/ml I-EXPLORATION +para I-EXPLORATION +itraconazol I-EXPLORATION +y I-EXPLORATION +1 I-EXPLORATION +μg/ml I-EXPLORATION +para I-EXPLORATION +keto-conazol, I-EXPLORATION +para I-EXPLORATION +5-fluocitosina I-EXPLORATION +una I-EXPLORATION +CIM I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +μg/ml I-EXPLORATION +y I-EXPLORATION +para I-EXPLORATION +anfotericina I-EXPLORATION +B I-EXPLORATION +una I-EXPLORATION +CIM, I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +horas, I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +μg/ml. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +del I-EXPLORATION +otro I-EXPLORATION +gemelo, I-EXPLORATION +que I-EXPLORATION +también I-EXPLORATION +ingresó I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Unidad I-EXPLORATION +de I-EXPLORATION +Ciudados I-EXPLORATION +Intensivos I-EXPLORATION +Neonatales, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +patógeno I-EXPLORATION +de I-EXPLORATION +interés I-EXPLORATION +alguno, I-EXPLORATION +teniendo B-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +estadía I-EVOLUTION +hospitalaria. I-EVOLUTION + I-EVOLUTION + +Preescolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +sano, B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia, I-PAST_MEDICAL_HISTORY +con B-PRESENT_ILLNESS +controles I-PRESENT_ILLNESS +ocasionales I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +pediatra I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +año. I-PRESENT_ILLNESS +Estado B-EXPLORATION +nutricional I-EXPLORATION +eutrófico I-EXPLORATION +según I-EXPLORATION +P/E I-EXPLORATION +y I-EXPLORATION +P/T. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +el I-EXPLORATION +desaseo I-EXPLORATION +personal. I-EXPLORATION + I-EXPLORATION +La B-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +procedía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Casablanca, I-PAST_MEDICAL_HISTORY +Región I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Valparaíso, I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +dedicaban I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +crianza I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vacunos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aves. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +casa I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +piso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +madera, I-PAST_MEDICAL_HISTORY +disponía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +agua I-PAST_MEDICAL_HISTORY +potable I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alcantarillado, I-PAST_MEDICAL_HISTORY +patio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tierra. I-PAST_MEDICAL_HISTORY +Tenían I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +perros, I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ellos I-PAST_MEDICAL_HISTORY +adulto I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +gato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Las I-PAST_MEDICAL_HISTORY +mascotas I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +contaban I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +veterinario. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +niño I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +abundantes I-PAST_MEDICAL_HISTORY +pulgas. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +niño I-PAST_MEDICAL_HISTORY +jugaba I-PAST_MEDICAL_HISTORY +frecuentemente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +mascotas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Cátedra I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Parasitología I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +control I-DERIVED_FROM/TO +post I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +Hymenolepis I-DERIVED_FROM/TO +diminuta, I-DERIVED_FROM/TO +diagnosticada I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +centro, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +había I-DERIVED_FROM/TO +consultado I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +abdominal. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Al B-PAST_MEDICAL_HISTORY +interrogar I-PAST_MEDICAL_HISTORY +dirigidamente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +eliminación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +elementos I-PAST_MEDICAL_HISTORY +blanquecinos I-PAST_MEDICAL_HISTORY +móviles I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +deposiciones. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +copro-parasitológico I-EXPLORATION +y I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Graham, I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +elementos I-EXPLORATION +eliminados I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +deposiciones I-EXPLORATION +del I-EXPLORATION +niño. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +observación I-EXPLORATION +macro I-EXPLORATION +y I-EXPLORATION +microscópica I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +elementos I-EXPLORATION +permitió I-EXPLORATION +la I-EXPLORATION +visualización I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +doble I-EXPLORATION +poro I-EXPLORATION +genital I-EXPLORATION +característico I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +huevos I-EXPLORATION +agrupados I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +membrana I-EXPLORATION +o I-EXPLORATION +cápsula I-EXPLORATION +ovígera, I-EXPLORATION +con I-EXPLORATION +liberación I-EXPLORATION +de I-EXPLORATION +huevos. I-EXPLORATION +De I-EXPLORATION +acuerdo I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +macro I-EXPLORATION +y I-EXPLORATION +microscópico I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +dipilidiosis. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +medidas I-TREATMENT +preventivas I-TREATMENT +para I-TREATMENT +dipilidiosis I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +praziquantel I-TREATMENT +por I-TREATMENT +una I-TREATMENT +vez. I-TREATMENT +Acudió B-EVOLUTION +a I-EVOLUTION +control I-EVOLUTION +con I-EVOLUTION +estudio I-EVOLUTION +copro-parasitológico I-EVOLUTION +de I-EVOLUTION +deposiciones I-EVOLUTION +post I-EVOLUTION +tratamiento, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +y I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +que I-EVOLUTION +fueron I-EVOLUTION +todos I-EVOLUTION +negativos. I-EVOLUTION +No I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +eliminar I-EVOLUTION +proglótidas I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +actualmente I-EVOLUTION +asinto-mático. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +último I-EVOLUTION +control I-EVOLUTION +se I-EVOLUTION +informó I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +muerte I-EVOLUTION +del I-EVOLUTION +perro I-EVOLUTION +adulto. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sano, I-PAST_MEDICAL_HISTORY +derivado B-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Urgencia I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Dermatología I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Barros I-DERIVED_FROM/TO +Luco I-DERIVED_FROM/TO +Trudeau, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +cuadro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +dos I-DERIVED_FROM/TO +semanas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución, I-DERIVED_FROM/TO +caracterizado I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +aparición I-DERIVED_FROM/TO +aguda I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +progresiva I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +cutáneas I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +tronco. I-DERIVED_FROM/TO +En B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +erupción I-PAST_MEDICAL_HISTORY +recurrente I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tronco I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +caracterizada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +pápulas I-PAST_MEDICAL_HISTORY +eritematosas I-PAST_MEDICAL_HISTORY +asintomáticas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +preesternal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +brazos. I-PAST_MEDICAL_HISTORY +Sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +infecciones I-FAMILY_HISTORY +herpéticas I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +piel I-FAMILY_HISTORY +o I-FAMILY_HISTORY +genitales, I-FAMILY_HISTORY +ni I-FAMILY_HISTORY +enfermedades I-FAMILY_HISTORY +cutáneas I-FAMILY_HISTORY +familiares. I-FAMILY_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +afebril I-EXPLORATION +y I-EXPLORATION +presentaba I-EXPLORATION +múltiples I-EXPLORATION +pápulas I-EXPLORATION +y I-EXPLORATION +pústulas I-EXPLORATION +umbilicadas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tronco, I-EXPLORATION +confluentes, I-EXPLORATION +con I-EXPLORATION +algunas I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +etapa I-EXPLORATION +de I-EXPLORATION +costra. I-EXPLORATION +Sin I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara, I-EXPLORATION +genitales I-EXPLORATION +ni I-EXPLORATION +mucosas. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +manos I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +pápulas I-EXPLORATION +aplanadas I-EXPLORATION +color I-EXPLORATION +piel I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso, I-EXPLORATION +pits I-EXPLORATION +palmares I-EXPLORATION +y I-EXPLORATION +alternancia I-EXPLORATION +de I-EXPLORATION +líneas I-EXPLORATION +rojas I-EXPLORATION +y I-EXPLORATION +blancas I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +uñas, I-EXPLORATION +hallazgos I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Darier. I-EXPLORATION +Se I-EXPLORATION +hospitalizó I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +presuntivo I-EXPLORATION +de I-EXPLORATION +eccema I-EXPLORATION +herpético I-EXPLORATION +y I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Darier. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +exámenes I-EXPLORATION +generales, I-EXPLORATION +cultivo I-EXPLORATION +corriente I-EXPLORATION +y I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC) I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simplex I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pústulas, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Darier. I-EXPLORATION +Empíricamente B-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +aciclovir I-TREATMENT +oral I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +5 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +y I-TREATMENT +cloxacilina I-TREATMENT +ev I-TREATMENT +1 I-TREATMENT +gr I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +hrs, I-TREATMENT +el I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +durante I-TREATMENT +10 I-TREATMENT +días. I-TREATMENT +Entre B-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +generales I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +normal, I-EXPLORATION +VHS I-EXPLORATION +29 I-EXPLORATION +mm/h, I-EXPLORATION +PCR I-EXPLORATION +123 I-EXPLORATION +mg/L, I-EXPLORATION +GGT I-EXPLORATION +108 I-EXPLORATION +U/L. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +del I-EXPLORATION +VDRL I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +y I-EXPLORATION +VHB I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Staphylococcus I-EXPLORATION +aureus I-EXPLORATION +resistente I-EXPLORATION +sólo I-EXPLORATION +a I-EXPLORATION +clindamicina I-EXPLORATION +y I-EXPLORATION +eritromicina, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +RPC I-EXPLORATION +en I-EXPLORATION +tiempo I-EXPLORATION +real, I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Virología I-EXPLORATION +del I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Ciencias I-EXPLORATION +Biomédicas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Facultad I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Chile, I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +VHS I-EXPLORATION +2. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +histopatológicos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Darier. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +respondió I-EVOLUTION +rápidamente I-EVOLUTION +al I-EVOLUTION +tratamiento, I-EVOLUTION +siendo I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +oriundo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Montevideo. I-PRESENT_ILLNESS +Buen I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +desarrollo. I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Calendario B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inmunizaciones I-PRESENT_ILLNESS +completo. I-PRESENT_ILLNESS +Ingresó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +°C I-PRESENT_ILLNESS +axilar. I-PRESENT_ILLNESS +Alas I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +iniciada I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +instaló I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lumbalgia I-PRESENT_ILLNESS +permanente, I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +irradiaciones, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +componente I-PRESENT_ILLNESS +nocturno, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +exacerbaba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +movimientos. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +tenía I-PRESENT_ILLNESS +limitación I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +movilidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +columna I-PRESENT_ILLNESS +tóraco-lumbar I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +deambulación. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +esfinteriano. I-PRESENT_ILLNESS +Había B-TREATMENT +consultado I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +ambulatoria I-TREATMENT +donde I-TREATMENT +le I-TREATMENT +fuera I-TREATMENT +indicada I-TREATMENT +amoxicilina I-TREATMENT +por I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +a I-TREATMENT +continuación I-TREATMENT +cotrimoxazol I-TREATMENT +durante I-TREATMENT +48 I-TREATMENT +horas. I-TREATMENT +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +con I-EXPLORATION +mialgias, I-EXPLORATION +febril I-EXPLORATION +38, I-EXPLORATION +5 I-EXPLORATION +°C I-EXPLORATION +axilar, I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +ni I-EXPLORATION +mucosas I-EXPLORATION +o I-EXPLORATION +adenopatías. I-EXPLORATION +La I-EXPLORATION +columna I-EXPLORATION +presentaba I-EXPLORATION +rigidez I-EXPLORATION +y I-EXPLORATION +limitación I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +movilidad I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +flexión: I-EXPLORATION +actitud I-EXPLORATION +escoliótica I-EXPLORATION +del I-EXPLORATION +tronco, I-EXPLORATION +con I-EXPLORATION +desvío I-EXPLORATION +axial I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +a I-EXPLORATION +izquierda. I-EXPLORATION +Dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +masas I-EXPLORATION +musculares I-EXPLORATION +paravertebrales. I-EXPLORATION +Abdomen I-EXPLORATION +simétrico, I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +del I-EXPLORATION +hipogastrio, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +ni I-EXPLORATION +visceromegalias. I-EXPLORATION +Fosas I-EXPLORATION +lumbares I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio: I-EXPLORATION +leucocitos I-EXPLORATION +9.900/mm3 I-EXPLORATION +(neu-trófilos I-EXPLORATION +4.800/mm3, I-EXPLORATION +linfocitos I-EXPLORATION +3.700/mm3), I-EXPLORATION +hemoglobina I-EXPLORATION +11, I-EXPLORATION +1 I-EXPLORATION +g/dl, I-EXPLORATION +hematocnto I-EXPLORATION +38%, I-EXPLORATION +plaquetas I-EXPLORATION +407.000/mm3; I-EXPLORATION +PCR I-EXPLORATION +7, I-EXPLORATION +6 I-EXPLORATION +mg/1. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemocultivo I-EXPLORATION +se I-EXPLORATION +desarrolló I-EXPLORATION +Staphylococcus I-EXPLORATION +coagulasa I-EXPLORATION +negativa. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +escoliosis I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +estructurales, I-EXPLORATION +sin I-EXPLORATION +componente I-EXPLORATION +rotacional. I-EXPLORATION +El I-EXPLORATION +cintigrama I-EXPLORATION +óseo I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hiperémica I-EXPLORATION +leve, I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +precoz, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +2a I-EXPLORATION +vértebra I-EXPLORATION +lumbar. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +sustitutivo I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +2a I-EXPLORATION +vértebra I-EXPLORATION +lumbar I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +medular I-EXPLORATION +y I-EXPLORATION +foramen I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +indemnidad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +discos I-EXPLORATION +intervertebrales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +del I-EXPLORATION +pedículo I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +dicha I-EXPLORATION +vértebra. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informó I-EXPLORATION +proliferación I-EXPLORATION +polimorfa I-EXPLORATION +con I-EXPLORATION +linfocitos, I-EXPLORATION +polimorfonucleares I-EXPLORATION +y I-EXPLORATION +escasos I-EXPLORATION +eosinófilos; I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +osteomielitis. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +bacteriológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +biopsia I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cefuroxima I-TREATMENT +ev I-TREATMENT +100 I-TREATMENT +mg/kg/día I-TREATMENT +el I-TREATMENT +que I-TREATMENT +mantuvo I-TREATMENT +durante I-TREATMENT +23 I-TREATMENT +días; I-TREATMENT +vancomicina I-TREATMENT +40 I-TREATMENT +mg/kg/ I-TREATMENT +día I-TREATMENT +por I-TREATMENT +3 I-TREATMENT +días, I-TREATMENT +ceftriaxona I-TREATMENT +100 I-TREATMENT +mg/kg/día I-TREATMENT +durante I-TREATMENT +8 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +finalmente I-TREATMENT +rifampicina I-TREATMENT +10 I-TREATMENT +mg/kg/día I-TREATMENT +más I-TREATMENT +ciprofloxacina I-TREATMENT +20 I-TREATMENT +mg/kg/día I-TREATMENT +por I-TREATMENT +11 I-TREATMENT +días. I-TREATMENT +En I-TREATMENT +total I-TREATMENT +recibió I-TREATMENT +45 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +imágenes I-EXPLORATION +hipodensas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hígado, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +micro-abscesos. I-EXPLORATION +Frente I-EXPLORATION +a I-EXPLORATION +este I-EXPLORATION +hallazgo I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +efectuar I-EXPLORATION +una I-EXPLORATION +tinción I-EXPLORATION +argéntica I-EXPLORATION +con I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Warthin-Starry I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +vertebral, I-EXPLORATION +lográndose I-EXPLORATION +detectar I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +bacilos I-EXPLORATION +gramnegativos I-EXPLORATION +con I-EXPLORATION +morfología I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +B. I-EXPLORATION +henselae. I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +persistió I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +lumbar I-EVOLUTION +y I-EVOLUTION +fiebre I-EVOLUTION +durante I-EVOLUTION +30 I-EVOLUTION +días. I-EVOLUTION +Se I-EVOLUTION +otorgó I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +estando I-EVOLUTION +afebril I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +movilidad I-EVOLUTION +prácticamente I-EVOLUTION +normal I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +columna I-EVOLUTION +vertebral. I-EVOLUTION +La B-EXPLORATION +PCR I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +se I-EXPLORATION +normalizaron I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +evolución. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +mayores; I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +27 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +extirpado I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuerpo I-PAST_MEDICAL_HISTORY +extraño I-PAST_MEDICAL_HISTORY +(cuesco I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cereza) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +fosa I-PAST_MEDICAL_HISTORY +nasal I-PAST_MEDICAL_HISTORY +derecha. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +consistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +descarga I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +recurrente, I-PRESENT_ILLNESS +muco-purulenta I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +restos I-PRESENT_ILLNESS +hemáticos, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +terapia I-PRESENT_ILLNESS +antibacteriana. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +desviación I-EXPLORATION +del I-EXPLORATION +tabique I-EXPLORATION +nasal I-EXPLORATION +a I-EXPLORATION +derecha, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +imagenológico I-EXPLORATION +con I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +paranasales I-EXPLORATION +mostró I-EXPLORATION +opacidad I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +paranasales I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como: I-EXPLORATION +"seno I-EXPLORATION +maxilar I-EXPLORATION +derecho I-EXPLORATION +ocupado I-EXPLORATION +por I-EXPLORATION +material I-EXPLORATION +con I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +burbujas I-EXPLORATION +de I-EXPLORATION +gas, I-EXPLORATION +con I-EXPLORATION +extensión I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +canal I-EXPLORATION +osteo-infundibular I-EXPLORATION +y I-EXPLORATION +levemente I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +ipsilateral, I-EXPLORATION +ensanchamiento I-EXPLORATION +y I-EXPLORATION +remodelación I-EXPLORATION +ósea I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +infundibular, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +erosiones". I-EXPLORATION +La I-EXPLORATION +naso-fibro-broncoscopia I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +polipoidea I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +derecha I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +del I-EXPLORATION +meato I-EXPLORATION +medio, I-EXPLORATION +hacia I-EXPLORATION +posterior, I-EXPLORATION +sin I-EXPLORATION +alcanzar I-EXPLORATION +la I-EXPLORATION +coana, I-EXPLORATION +vascularizada. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +rinofaringe I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +tejido I-EXPLORATION +adenoideo I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +orofaringe I-EXPLORATION +e I-EXPLORATION +hipofaringe I-EXPLORATION +tenían I-EXPLORATION +aspecto I-EXPLORATION +normal. I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacables: I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +hemoglobina I-EXPLORATION +12, I-EXPLORATION +5 I-EXPLORATION +g/dl, I-EXPLORATION +leucocitos I-EXPLORATION +4.500 I-EXPLORATION +céls/mm3 I-EXPLORATION +(eosinófilos I-EXPLORATION +2%, I-EXPLORATION +segmentados I-EXPLORATION +58%, I-EXPLORATION +linfocitos I-EXPLORATION +31%y I-EXPLORATION +monocitos I-EXPLORATION +8%), I-EXPLORATION +plaquetas I-EXPLORATION +312.000 I-EXPLORATION +céls/mm3, I-EXPLORATION +VHS I-EXPLORATION +44 I-EXPLORATION +mm/h. I-EXPLORATION + B-TREATMENT +Se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +remoción I-TREATMENT +del I-TREATMENT +contenido I-TREATMENT +sinusal I-TREATMENT +mediante I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +Caldwell-Luc, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +por I-TREATMENT +el I-TREATMENT +reborde I-TREATMENT +alveolar I-TREATMENT +superior I-TREATMENT +derecho I-TREATMENT +y I-TREATMENT +apertura I-TREATMENT +de I-TREATMENT +una I-TREATMENT +ventana I-TREATMENT +ósea I-TREATMENT +en I-TREATMENT +el I-TREATMENT +seno I-TREATMENT +maxilar, I-TREATMENT +dando I-TREATMENT +salida I-TREATMENT +a I-TREATMENT +secreción I-TREATMENT +negruzca I-TREATMENT +barrosa I-TREATMENT +de I-TREATMENT +gran I-TREATMENT +cantidad. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +lesiones I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fosa I-TREATMENT +nasal I-TREATMENT +derecha I-TREATMENT +ni I-TREATMENT +tejido I-TREATMENT +adenoideo I-TREATMENT +anómalo I-TREATMENT +en I-TREATMENT +las I-TREATMENT +coanas I-TREATMENT +o I-TREATMENT +rinofaringe. I-TREATMENT +Evolucionó B-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +satisfactoria I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +post-operatorio. I-EVOLUTION +El B-EXPLORATION +material I-EXPLORATION +obtenido I-EXPLORATION +fue I-EXPLORATION +enviado I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +e I-EXPLORATION +histopatológico. I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +anátomo-patológico I-EXPLORATION +fue: I-EXPLORATION +"sinusitis I-EXPLORATION +crónica I-EXPLORATION +erosiva, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +hongo I-EXPLORATION +filamentoso I-EXPLORATION +con I-EXPLORATION +hifas I-EXPLORATION +hialinas I-EXPLORATION +septadasy I-EXPLORATION +ramificadas, I-EXPLORATION +sugerente I-EXPLORATION +deAspergillus I-EXPLORATION +sp. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +invasión I-EXPLORATION +micótica I-EXPLORATION +ni I-EXPLORATION +atiplas".. I-EXPLORATION +Se I-EXPLORATION +aisló I-EXPLORATION +un I-EXPLORATION +hongo I-EXPLORATION +filamentoso I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +rápido I-EXPLORATION +a I-EXPLORATION +25 I-EXPLORATION +°C, I-EXPLORATION +con I-EXPLORATION +colonias I-EXPLORATION +de I-EXPLORATION +textura I-EXPLORATION +aterciopelada I-EXPLORATION +a I-EXPLORATION +algodonosa, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +crema I-EXPLORATION +a I-EXPLORATION +café I-EXPLORATION +canela, I-EXPLORATION +bordes I-EXPLORATION +irregulares I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +pigmento I-EXPLORATION +café. I-EXPLORATION +Microscópicamente I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +hifas I-EXPLORATION +hialinas I-EXPLORATION +septadas I-EXPLORATION +con I-EXPLORATION +conidióforos I-EXPLORATION +rectos, I-EXPLORATION +de I-EXPLORATION +largo I-EXPLORATION +variable I-EXPLORATION +con I-EXPLORATION +generación I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +porción I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +aneloconidio I-EXPLORATION +unicelular I-EXPLORATION +oval I-EXPLORATION +y I-EXPLORATION +base I-EXPLORATION +trunca, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +identificado I-EXPLORATION +como I-EXPLORATION +S. I-EXPLORATION +apios-permum, I-EXPLORATION +forma I-EXPLORATION +anamorfa I-EXPLORATION +o I-EXPLORATION +asexuada I-EXPLORATION +de I-EXPLORATION +Pseudallescheria I-EXPLORATION +boydii. I-EXPLORATION +Se I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Micología I-EXPLORATION +del I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Ciencias I-EXPLORATION +Biomédicas I-EXPLORATION +(ICBM), I-EXPLORATION +Facultad I-EXPLORATION +de I-EXPLORATION +Medicina, I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Chile. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +su I-TREATMENT +larga I-TREATMENT +evolución I-TREATMENT +sintomática I-TREATMENT +y I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +una I-TREATMENT +lesión I-TREATMENT +polipoidea I-TREATMENT +de I-TREATMENT +tipo I-TREATMENT +invasora I-TREATMENT +se I-TREATMENT +dejó I-TREATMENT +inicialmente I-TREATMENT +tratamiento I-TREATMENT +antifúngico I-TREATMENT +con I-TREATMENT +200 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +itraconazol I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas, I-TREATMENT +siendo I-TREATMENT +bien I-TREATMENT +tolerado, I-TREATMENT +sin I-TREATMENT +alteración I-TREATMENT +de I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +hepáticas, I-TREATMENT +el I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +suspendido I-TREATMENT +al I-TREATMENT +no I-TREATMENT +evidenciarse I-TREATMENT +compromiso I-TREATMENT +micótico I-TREATMENT +invasor I-TREATMENT +en I-TREATMENT +la I-TREATMENT +biopsia. I-TREATMENT + B-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +a I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +plazo I-EVOLUTION +fue I-EVOLUTION +satisfactoria; I-EVOLUTION +una B-EXPLORATION +nueva I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +paranasales I-EXPLORATION +mostró I-EXPLORATION +su I-EXPLORATION +total I-EXPLORATION +neumatización I-EXPLORATION +y I-EXPLORATION +simetría, I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +maxilectomía I-EXPLORATION +medial I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +elementos I-EXPLORATION +inflamatorios I-EXPLORATION +marginales I-EXPLORATION +con I-EXPLORATION +pequeño I-EXPLORATION +nivel I-EXPLORATION +hidro-aéreo I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +HLC I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +junio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +2007. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +colecistectomizado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +inguinal. I-PAST_MEDICAL_HISTORY +Era I-PAST_MEDICAL_HISTORY +casado, I-PAST_MEDICAL_HISTORY +jubilado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +trabajado, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +parte I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vida, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +criaderos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aves I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +zonas I-PAST_MEDICAL_HISTORY +rurales I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Área I-PAST_MEDICAL_HISTORY +Metropolitana. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Su B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +iniciado I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +moderado I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +vespertina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +cuantificaba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +kilos. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +ambulatoria I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +oportunidades I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +realizaron I-PRESENT_ILLNESS +diversos I-PRESENT_ILLNESS +exámenes I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +llegar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +diagnóstico. I-PRESENT_ILLNESS +Destacaban I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +ecograñay I-PRESENT_ILLNESS +tomograña I-PRESENT_ILLNESS +axial I-PRESENT_ILLNESS +computariza-da I-PRESENT_ILLNESS +(TAC) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +abdomen I-PRESENT_ILLNESS +"sin I-PRESENT_ILLNESS +hallazgos I-PRESENT_ILLNESS +significativos" I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +ecocardiograma I-PRESENT_ILLNESS +trans-torácico I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +informaba I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +aórtica I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dilatación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cavidades I-PRESENT_ILLNESS +izquierdas. I-PRESENT_ILLNESS +Fue B-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +HLC I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +completar I-DERIVED_FROM/TO +estudio. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Al B-EXPLORATION +ingreso I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +refería I-EXPLORATION +molestias I-EXPLORATION +específicas I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +no I-EXPLORATION +contribuía I-EXPLORATION +para I-EXPLORATION +orientar I-EXPLORATION +el I-EXPLORATION +diagnóstico. I-EXPLORATION +No I-EXPLORATION +tenía I-EXPLORATION +soplo I-EXPLORATION +cardíaco, I-EXPLORATION +visceromegalia, I-EXPLORATION +lesiones I-EXPLORATION +cutáneas I-EXPLORATION +ni I-EXPLORATION +mucosas, I-EXPLORATION +alteraciones I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +pulmonar I-EXPLORATION +ni I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +sistemas. I-EXPLORATION +Sólo I-EXPLORATION +se I-EXPLORATION +verificó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +fiebre I-EXPLORATION +irregular, I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +38°C, I-EXPLORATION +y I-EXPLORATION +decaimiento. I-EXPLORATION +Se I-EXPLORATION +inició I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +síndrome I-EXPLORATION +febril I-EXPLORATION +prolongado. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +mostraba I-EXPLORATION +anemia I-EXPLORATION +moderada I-EXPLORATION +(hematocrito I-EXPLORATION +34, I-EXPLORATION +1%, I-EXPLORATION +hemoglobina I-EXPLORATION +11, I-EXPLORATION +3 I-EXPLORATION +gr%), I-EXPLORATION +leucocitos I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal, I-EXPLORATION +neutrofilia I-EXPLORATION +de I-EXPLORATION +76%) I-EXPLORATION +sin I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +VHS I-EXPLORATION +de I-EXPLORATION +36 I-EXPLORATION +mm/h. I-EXPLORATION +La I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +renal I-EXPLORATION +estaban I-EXPLORATION +normales, I-EXPLORATION +la I-EXPLORATION +albuminemia I-EXPLORATION +disminuida I-EXPLORATION +(3, I-EXPLORATION +3 I-EXPLORATION +gr%), I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +moderadamente I-EXPLORATION +elevada I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +no I-EXPLORATION +evidenciaba I-EXPLORATION +alteraciones I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +pulmonar I-EXPLORATION +ni I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +silueta I-EXPLORATION +cardíaca. I-EXPLORATION +Tanto I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecograña I-EXPLORATION +abdominal I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen, I-EXPLORATION +realizadas I-EXPLORATION +durante I-EXPLORATION +su I-EXPLORATION +hospitalización, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +nodulos I-EXPLORATION +espíemeos. I-EXPLORATION +Estaba I-EXPLORATION +solicitado I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +trans-esofágico. I-EXPLORATION +Por I-EXPLORATION +no I-EXPLORATION +presentar I-EXPLORATION +expectoración, I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +hicieron I-EXPLORATION +baciloscopias I-EXPLORATION +de I-EXPLORATION +contenido I-EXPLORATION +gástrico I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +negativas. I-EXPLORATION +El I-EXPLORATION +urocultivo I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +tomados I-EXPLORATION +al I-EXPLORATION +ingreso, I-EXPLORATION +no I-EXPLORATION +presentaron I-EXPLORATION +desarrollo. I-EXPLORATION +Como I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +febril I-EXPLORATION +prolongado I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +también I-EXPLORATION +exámenes I-EXPLORATION +inmunológicos: I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares, I-EXPLORATION +factor I-EXPLORATION +reumatold I-EXPLORATION +eo, I-EXPLORATION +cuantificación I-EXPLORATION +de I-EXPLORATION +C3 I-EXPLORATION +y I-EXPLORATION +C4, I-EXPLORATION +anticuerpos I-EXPLORATION +anti-cardiolipina, I-EXPLORATION +todo I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +electroforesis I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +hipoalbuminemia I-EXPLORATION +e I-EXPLORATION +hipergamaglobulinemia I-EXPLORATION +difusa I-EXPLORATION +moderada. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +11° I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización, I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +petequias I-EXPLORATION +subconjuntivales. I-EXPLORATION +Con B-TREATMENT +este I-TREATMENT +nuevo I-TREATMENT +hallazgo I-TREATMENT +al I-TREATMENT +examen I-TREATMENT +físico, I-TREATMENT +se I-TREATMENT +planteó I-TREATMENT +la I-TREATMENT +hipótesis I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +endocarditis I-TREATMENT +infecciosa I-TREATMENT +y, I-TREATMENT +previa I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +nueva I-TREATMENT +serie I-TREATMENT +de I-TREATMENT +hemocultivos, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +y I-TREATMENT +gentamicina I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endovenosa. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +estable I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +condición, I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +irregular I-EVOLUTION +y, I-EVOLUTION +posteriormente, I-EVOLUTION +se I-EVOLUTION +pesquisó I-EVOLUTION +un I-EVOLUTION +soplo I-EVOLUTION +cardíaco. I-EVOLUTION + I-EVOLUTION +Al B-EXPLORATION +14° I-EXPLORATION +día I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +crecimiento I-EXPLORATION +bacteriano I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +tomados I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +tres I-EXPLORATION +días I-EXPLORATION +antes. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +directamente I-EXPLORATION +del I-EXPLORATION +vial I-EXPLORATION +de I-EXPLORATION +cultivo, I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +cocobacilos I-EXPLORATION +grampositivos. I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +aclaró I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +cocobacilos I-EXPLORATION +gramnegativos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +17° I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +ingresado I-EXPLORATION +se I-EXPLORATION +emitió I-EXPLORATION +un I-EXPLORATION +pre-informe I-EXPLORATION +dando I-EXPLORATION +cuenta I-EXPLORATION +del I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +bacilo I-EXPLORATION +gramnegativo, I-EXPLORATION +probablemente I-EXPLORATION +del I-EXPLORATION +grupo I-EXPLORATION +HACEK. I-EXPLORATION +Por I-EXPLORATION +la I-EXPLORATION +dificultad I-EXPLORATION +en I-EXPLORATION +llegar I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +diagnóstico I-EXPLORATION +microbiológico I-EXPLORATION +exacto, I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +al I-EXPLORATION +ISP I-EXPLORATION +para I-EXPLORATION +identificación. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +de I-TREATMENT +este I-TREATMENT +examen I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +antimicrobiano I-TREATMENT +a I-TREATMENT +ampicilina, I-TREATMENT +gentamicina I-TREATMENT +y I-TREATMENT +ceftriaxona. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +22° I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +ecocardiograma I-EXPLORATION +trans-esofágico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +cardiología I-EXPLORATION +del I-EXPLORATION +Hospital I-EXPLORATION +Barros I-EXPLORATION +Luco I-EXPLORATION +Trudeau. I-EXPLORATION +En I-EXPLORATION +dicho I-EXPLORATION +examen I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +múltiples I-EXPLORATION +vegetaciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +aórtica I-EXPLORATION +con I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +absceso I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +aneurismática I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +coronario I-EXPLORATION +derecho, I-EXPLORATION +insuficiencia I-EXPLORATION +aórtica, I-EXPLORATION +dilatación I-EXPLORATION +auricular I-EXPLORATION +izquierda, I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +hipertrofia I-EXPLORATION +excéntrica I-EXPLORATION +dilatada I-EXPLORATION +y I-EXPLORATION +disfunción I-EXPLORATION +sistólica I-EXPLORATION +leve. I-EXPLORATION + I-EXPLORATION +Ese B-DERIVED_FROM/TO +mismo I-DERIVED_FROM/TO +día I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +trasladado I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Instituto I-DERIVED_FROM/TO +Nacional I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Enfermedades I-DERIVED_FROM/TO +Respiratorias I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Tórax I-DERIVED_FROM/TO +(INERYCT) I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +quirúrgico. I-DERIVED_FROM/TO +Al B-EVOLUTION +ingreso I-EVOLUTION +a I-EVOLUTION +dicho I-EVOLUTION +centro I-EVOLUTION +asistencial I-EVOLUTION +se I-EVOLUTION +verificó I-EVOLUTION +un I-EVOLUTION +paciente I-EVOLUTION +tranquilo I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +refería I-EVOLUTION +molestias I-EVOLUTION +específicas, I-EVOLUTION +enflaquecido, I-EVOLUTION +he-modinámicamente I-EVOLUTION +estable, I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +cardíaca, I-EVOLUTION +con I-EVOLUTION +soplo I-EVOLUTION +cardíaco I-EVOLUTION +4/6 I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +foco I-EVOLUTION +aórtico. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +agravó I-EVOLUTION +bruscamente I-EVOLUTION +presentando I-EVOLUTION +dolor I-EVOLUTION +retro-esternal, I-EVOLUTION +disnea, I-EVOLUTION +ingurgitación I-EVOLUTION +yugular, I-EVOLUTION +hipotensión, I-EVOLUTION +shock I-EVOLUTION +y I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +conciencia. I-EVOLUTION +Fue B-TREATMENT +trasladado I-TREATMENT +a I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +de I-TREATMENT +cuidados I-TREATMENT +intensivos I-TREATMENT +y, I-TREATMENT +al I-TREATMENT +día I-TREATMENT +siguiente, I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +urgencia. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +acto I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +verificó I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +una I-TREATMENT +válvula I-TREATMENT +aórtica I-TREATMENT +bicúspide I-TREATMENT +con I-TREATMENT +gran I-TREATMENT +destrucción I-TREATMENT +de I-TREATMENT +los I-TREATMENT +velos I-TREATMENT +coronarios I-TREATMENT +y I-TREATMENT +del I-TREATMENT +anillo, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +cavidad I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +por I-TREATMENT +3 I-TREATMENT +cm I-TREATMENT +en I-TREATMENT +relación I-TREATMENT +al I-TREATMENT +seno I-TREATMENT +coronario I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +gran I-TREATMENT +cantidad I-TREATMENT +de I-TREATMENT +vegetaciones. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +reemplazo I-TREATMENT +valvular, I-TREATMENT +con I-TREATMENT +prótesis I-TREATMENT +Edwards I-TREATMENT +Lifesciences I-TREATMENT +de I-TREATMENT +23 I-TREATMENT +mm, I-TREATMENT +y I-TREATMENT +reparación I-TREATMENT +del I-TREATMENT +anillo I-TREATMENT +con I-TREATMENT +parche I-TREATMENT +de I-TREATMENT +pericardio I-TREATMENT +bovino. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +post-operatorio I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +muy I-EVOLUTION +grave I-EVOLUTION +durante I-EVOLUTION +cuatro I-EVOLUTION +a I-EVOLUTION +cinco I-EVOLUTION +días, I-EVOLUTION +debió B-TREATMENT +ser I-TREATMENT +re-intervenido I-TREATMENT +por I-TREATMENT +sangrado I-TREATMENT +local, I-TREATMENT +presentó B-EVOLUTION +insuficiencia I-EVOLUTION +renal I-EVOLUTION +aguda, I-EVOLUTION +fibrilación I-EVOLUTION +auricular I-EVOLUTION +paroxística, I-EVOLUTION +estuvo B-TREATMENT +conectado I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasora I-TREATMENT +durante I-TREATMENT +cinco I-TREATMENT +días, I-TREATMENT +recibió I-TREATMENT +aminas I-TREATMENT +vasoactivas I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +y I-TREATMENT +cloxacilina I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endovenosa. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +33° I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +internado I-EXPLORATION +se I-EXPLORATION +conoció I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +del I-EXPLORATION +bacilo I-EXPLORATION +gramnegativo I-EXPLORATION +aislado I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +HLC; I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +Brucella I-EXPLORATION +abortus. I-EXPLORATION +En B-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +antimicrobiano I-TREATMENT +a I-TREATMENT +doxiciclina I-TREATMENT +más I-TREATMENT +rifampicina I-TREATMENT +y I-TREATMENT +gentamicina. I-TREATMENT +El B-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +operatoria I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +tórpida I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +tendencia I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +modo I-EVOLUTION +que, I-EVOLUTION +cumplidos I-EVOLUTION +54 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +hospitalización, I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +relativa I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +y B-TREATMENT +con I-TREATMENT +indicación I-TREATMENT +de I-TREATMENT +continuar I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +doxiciclina I-TREATMENT +y I-TREATMENT +rifampicina. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +día I-EVOLUTION +88° I-EVOLUTION +desde I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +fue I-EVOLUTION +controlado I-EVOLUTION +por I-EVOLUTION +cardio-cirujano I-EVOLUTION +encontrándose I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales. I-EVOLUTION +Se B-EXPLORATION +le I-EXPLORATION +solicitó I-EXPLORATION +ecocardiograma I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +le I-TREATMENT +suspendieron I-TREATMENT +los I-TREATMENT +antimicrobianos. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +cinco I-EVOLUTION +meses I-EVOLUTION +post I-EVOLUTION +alta I-EVOLUTION +fue I-EVOLUTION +evaluado I-EVOLUTION +en I-EVOLUTION +HLC. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +estaba I-EVOLUTION +asintomático, I-EVOLUTION +en I-EVOLUTION +muy I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +cardíaca. I-EVOLUTION +Traía B-EXPLORATION +exámenes I-EXPLORATION +obtenidos I-EXPLORATION +un I-EXPLORATION +mes I-EXPLORATION +antes: I-EXPLORATION +creatininemia: I-EXPLORATION +1, I-EXPLORATION +01 I-EXPLORATION +mg/dL, I-EXPLORATION +albuminemia: I-EXPLORATION +4, I-EXPLORATION +62 I-EXPLORATION +g/%, I-EXPLORATION +VHS: I-EXPLORATION +15 I-EXPLORATION +mm/h, I-EXPLORATION +orina I-EXPLORATION +completa: I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +reciente I-EXPLORATION +indicaba I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +36, I-EXPLORATION +4%, I-EXPLORATION +hemoglobina I-EXPLORATION +12, I-EXPLORATION +5 I-EXPLORATION +g/% I-EXPLORATION +y I-EXPLORATION +leucocitos I-EXPLORATION +9.500/mm3. I-EXPLORATION +Se B-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +seguimiento I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +cardiólogo. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +INERYCT I-EVOLUTION +se I-EVOLUTION +pesquisaron I-EVOLUTION +síntomas I-EVOLUTION +y I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +cardíaca I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +ecocardiograña I-EVOLUTION +evidenció I-EVOLUTION +reflujo I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +válvula I-EVOLUTION +protésica. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Luego B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estar I-PRESENT_ILLNESS +consumiendo I-PRESENT_ILLNESS +drogas I-PRESENT_ILLNESS +(clorhidrato I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pasta I-PRESENT_ILLNESS +base) I-PRESENT_ILLNESS +notó I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +AV I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ojos I-PRESENT_ILLNESS +rojos. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acompañó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fotopsias I-PRESENT_ILLNESS +bilaterales. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +después. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +oftalmológico I-EXPLORATION +destacaba: I-EXPLORATION +AVMC I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +igual I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +05 I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí I-EXPLORATION +igual I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +1. I-EXPLORATION +Visión I-EXPLORATION +de I-EXPLORATION +colores I-EXPLORATION +alterada I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos. I-EXPLORATION +Reflejos I-EXPLORATION +pupilares I-EXPLORATION +lentos I-EXPLORATION +bilaterales I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +DPAR. I-EXPLORATION +PIÓ I-EXPLORATION +igual I-EXPLORATION +a I-EXPLORATION +24 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +23 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +al I-EXPLORATION +biomicroscopio I-EXPLORATION +destacaba I-EXPLORATION +Tyndall I-EXPLORATION ++++ I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos. I-EXPLORATION +Presentaba I-EXPLORATION +al I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +vitreítis I-EXPLORATION +++ I-EXPLORATION +bilateral. I-EXPLORATION +Ambas I-EXPLORATION +papilas I-EXPLORATION +estaban I-EXPLORATION +levemente I-EXPLORATION +pálidas. I-EXPLORATION +El I-EXPLORATION +campo I-EXPLORATION +visual I-EXPLORATION +de I-EXPLORATION +Goldmann I-EXPLORATION +mostró I-EXPLORATION +escotomas I-EXPLORATION +centro I-EXPLORATION +centrales I-EXPLORATION +bilaterales. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +Se I-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +neuritis I-EXPLORATION +óptica I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +panuveitis. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +mostró I-EXPLORATION +VDRL I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +(+), I-EXPLORATION +título: I-EXPLORATION +1/128, I-EXPLORATION +FTA-ABS I-EXPLORATION +(+) I-EXPLORATION +y I-EXPLORATION +VDRL I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +(-). I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +citoquímico I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +según I-TREATMENT +pautas. I-TREATMENT +Diez B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +iniciada I-EVOLUTION +la I-EVOLUTION +terapia I-EVOLUTION +los I-EVOLUTION +campos I-EVOLUTION +visuales I-EVOLUTION +mostraron I-EVOLUTION +una I-EVOLUTION +importante I-EVOLUTION +mejoría I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +agudeza I-EVOLUTION +visual I-EVOLUTION +mejoró I-EVOLUTION +a I-EVOLUTION +0, I-EVOLUTION +67 I-EVOLUTION +en I-EVOLUTION +ambos I-EVOLUTION +ojos. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +antecedente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +visión I-PRESENT_ILLNESS +borrosa I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +ya I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sífilis. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +oftalmológico I-EXPLORATION +destacaba I-EXPLORATION +AVMC I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +025 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +0, I-EXPLORATION +05 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí. I-EXPLORATION +Pupilas I-EXPLORATION +isocóricas I-EXPLORATION +reactivas I-EXPLORATION +y I-EXPLORATION +simétricas. I-EXPLORATION +Disociación I-EXPLORATION +luz-cerca I-EXPLORATION +positiva, I-EXPLORATION +con I-EXPLORATION +DPAR I-EXPLORATION +(+) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +al I-EXPLORATION +biomicroscopio I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +cornea I-EXPLORATION +clara, I-EXPLORATION +cámara I-EXPLORATION +anterior I-EXPLORATION +amplia I-EXPLORATION +y I-EXPLORATION +cristalino I-EXPLORATION +claro. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +papilas I-EXPLORATION +pálidas, I-EXPLORATION +excavación I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +revelaron I-EXPLORATION +concentraciones I-EXPLORATION +de I-EXPLORATION +vitamina I-EXPLORATION +B-12 I-EXPLORATION +normales, I-EXPLORATION +VDRL I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +(+), I-EXPLORATION +título I-EXPLORATION +1/32, I-EXPLORATION +FTA-ABS I-EXPLORATION +(+), I-EXPLORATION +VDRL I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +(+), I-EXPLORATION +ELISA I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +(-). I-EXPLORATION +RM I-EXPLORATION +cerebral I-EXPLORATION +normal. I-EXPLORATION +Campo I-EXPLORATION +visual I-EXPLORATION +de I-EXPLORATION +Goldmann I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +defecto I-EXPLORATION +altitudinal I-EXPLORATION +bilateral. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +una I-EXPLORATION +neuritis I-EXPLORATION +óptica I-EXPLORATION +bilateral I-EXPLORATION +luética. I-EXPLORATION +Se B-TREATMENT +hospitalizó I-TREATMENT +e I-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +en I-TREATMENT +esquema I-TREATMENT +habitual. I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +AV I-EVOLUTION +(AVMC: I-EVOLUTION +0, I-EVOLUTION +2 I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +OD I-EVOLUTION +y I-EVOLUTION +0, I-EVOLUTION +3 I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Oí) I-EVOLUTION +y I-EVOLUTION +del I-EVOLUTION +campo I-EVOLUTION +visual I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +iniciado I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +portador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +VIH, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +anti-retro I-PAST_MEDICAL_HISTORY +viral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sífilis I-PAST_MEDICAL_HISTORY +genital. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +evolucionaba I-PRESENT_ILLNESS +hacían I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +semanas, I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +rojo I-PRESENT_ILLNESS +bilateral, I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +OD. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +oftalmológico I-EXPLORATION +presentaba I-EXPLORATION +AVMC I-EXPLORATION +igual I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +05 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +0, I-EXPLORATION +1 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí. I-EXPLORATION +PIÓ I-EXPLORATION +de I-EXPLORATION +27 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +25 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +al I-EXPLORATION +biomicroscopio I-EXPLORATION +presentaba I-EXPLORATION +hiperemia I-EXPLORATION +conjuntival I-EXPLORATION +bilateral, I-EXPLORATION +cornea I-EXPLORATION +con I-EXPLORATION +precipitados I-EXPLORATION +queráticos I-EXPLORATION +pequeños, I-EXPLORATION +mayor I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD, I-EXPLORATION +sinequias I-EXPLORATION +posteriores I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí, I-EXPLORATION +Tyndall I-EXPLORATION +++ I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION ++ I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Oí. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +del I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +destacaba I-EXPLORATION +vitreítis I-EXPLORATION +bilateral, I-EXPLORATION +papila I-EXPLORATION +rosada, I-EXPLORATION +bordes I-EXPLORATION +netos, I-EXPLORATION +excavación I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +3 I-EXPLORATION +bilateral. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +VDRL I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +(+), I-EXPLORATION +título I-EXPLORATION +1/32, I-EXPLORATION +VDRL I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +(+), I-EXPLORATION +estudio I-EXPLORATION +cito-químico I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +normal, I-EXPLORATION +FTA-ABS I-EXPLORATION +(+). I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +Se B-TREATMENT +diagnosticó I-TREATMENT +una.panuveítis I-TREATMENT +bilateral I-TREATMENT +por I-TREATMENT +sífilis I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +practicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +habitual I-TREATMENT +de I-TREATMENT +penicilina. I-TREATMENT +Evoluciono B-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +inflamación I-EVOLUTION +bilateral I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +iniciado I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +y I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +AV. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +residencia I-PAST_MEDICAL_HISTORY +urbana I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Región I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Araucanía, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Dr. I-PRESENT_ILLNESS +Hernán I-PRESENT_ILLNESS +Henríquez I-PRESENT_ILLNESS +Aravena I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Temuco I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +mialgias I-PRESENT_ILLNESS +generalizadas, I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esfuerzos I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días, I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +habitado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +sector I-PRESENT_ILLNESS +rural I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +recientemente. I-PRESENT_ILLNESS +Los B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +mostraban I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +47%, I-EXPLORATION +leucocitos I-EXPLORATION +5.600/mm3 I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +60.000/mm3 I-EXPLORATION +con I-EXPLORATION +infiltrados I-EXPLORATION +intersticiales I-EXPLORATION +difusos I-EXPLORATION +bilaterales I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax. I-EXPLORATION +Dado I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +clínico I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +antecedentes I-EXPLORATION +epidemiológicos I-EXPLORATION +se I-EXPLORATION +planteó I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +cardiopulmonar I-EXPLORATION +por I-EXPLORATION +hantavirus I-EXPLORATION +confirmándose I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +mediante I-EXPLORATION +test I-EXPLORATION +rápido I-EXPLORATION +específico I-EXPLORATION +(inmunocromatografía I-EXPLORATION +para I-EXPLORATION +IgM). I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +soporte I-TREATMENT +e I-TREATMENT +indicó I-TREATMENT +1 I-TREATMENT +g/día I-TREATMENT +de I-TREATMENT +metilprednisolona I-TREATMENT +iv I-TREATMENT +durante I-TREATMENT +5 I-TREATMENT +días. I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +disfunción I-EVOLUTION +miocárdica, I-EVOLUTION +requiriendo B-TREATMENT +altas I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +fármacos I-TREATMENT +vasoactivos. I-TREATMENT +Desarrolló I-TREATMENT +durante I-TREATMENT +su I-TREATMENT +estadía I-TREATMENT +hospitalaria I-TREATMENT +una I-TREATMENT +neumonía I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +tratada I-TREATMENT +inicialmente I-TREATMENT +con I-TREATMENT +imipenem, I-TREATMENT +vancomicina I-TREATMENT +y I-TREATMENT +amikacina. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +secreción I-EXPLORATION +bronquial I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +Staphylococcus I-EXPLORATION +aureus I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +meticilina, I-EXPLORATION +cambiándose I-EXPLORATION +vancomicina I-EXPLORATION +por I-EXPLORATION +linezolid. I-EXPLORATION + I-EXPLORATION +Al B-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +inició I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +ictericia I-EVOLUTION +progresiva I-EVOLUTION +con I-EVOLUTION +hiperbilirrubinemia I-EVOLUTION +(13, I-EVOLUTION +9 I-EVOLUTION +mg/dL) I-EVOLUTION +de I-EVOLUTION +predominio I-EVOLUTION +directa I-EVOLUTION +(12, I-EVOLUTION +4 I-EVOLUTION +mg/dL), I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +fosfatasas I-EVOLUTION +alcalinas I-EVOLUTION +(854 I-EVOLUTION +U/l) I-EVOLUTION +y B-EXPLORATION +una I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +colecistitis I-EXPLORATION +aguda I-EXPLORATION +alitiásica, I-EXPLORATION +la B-TREATMENT +que I-TREATMENT +fue I-TREATMENT +resuelta I-TREATMENT +quirúrgicamente I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +día. I-TREATMENT + I-TREATMENT +Durante B-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +y I-EVOLUTION +tercera I-EVOLUTION +semana, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +continuó I-EVOLUTION +febril I-EVOLUTION +con I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +lesiones I-EVOLUTION +costrosas I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tronco I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +cara, I-EVOLUTION +una I-EVOLUTION +de I-EVOLUTION +ellas I-EVOLUTION +de I-EVOLUTION +localización I-EVOLUTION +nasal. I-EVOLUTION +Se B-EXPLORATION +obtuvieron I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +aspirado I-EXPLORATION +endotraqueal, I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +informados I-EXPLORATION +como I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Candida I-EXPLORATION +albicans I-EXPLORATION +y I-EXPLORATION +Pseudomonas I-EXPLORATION +aeruginosa I-EXPLORATION +respectivamente, I-EXPLORATION +agregándose I-EXPLORATION +al I-EXPLORATION +esquema I-EXPLORATION +antimicrobiano I-EXPLORATION +cobertura I-EXPLORATION +con I-EXPLORATION +anidulafungina I-EXPLORATION +para I-EXPLORATION +C. I-EXPLORATION +albicans I-EXPLORATION +y I-EXPLORATION +cefoperazona/sulbactam I-EXPLORATION +para I-EXPLORATION +Pseudomonas I-EXPLORATION +aeruginosa. I-EXPLORATION +Permaneció B-EVOLUTION +grave, I-EVOLUTION +aunque I-EVOLUTION +afebril I-EVOLUTION +y, I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +cardiopulmonar, I-EVOLUTION +requiriendo I-EVOLUTION +menor I-EVOLUTION +apoyo I-EVOLUTION +ventilatorio, I-EVOLUTION +con I-EVOLUTION +modificación I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +soporte I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +aminas I-EVOLUTION +vasoactivas. I-EVOLUTION +Durante I-EVOLUTION +la I-EVOLUTION +cuarta I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +se I-EVOLUTION +describió I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +lesión I-EVOLUTION +ulcerada I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +dorso I-EVOLUTION +nasal, I-EVOLUTION +de I-EVOLUTION +fondo I-EVOLUTION +necrótico I-EVOLUTION +y I-EVOLUTION +bordes I-EVOLUTION +irregulares, I-EVOLUTION +además I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +escara I-EVOLUTION +sacra I-EVOLUTION +y I-EVOLUTION +otras I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +talones. I-EVOLUTION + I-EVOLUTION +Continuó I-EVOLUTION +afebril I-EVOLUTION +y B-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cefoperazona/ I-TREATMENT +sulbactam I-TREATMENT +y I-TREATMENT +anidulafungina. I-TREATMENT +Un B-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +nasal I-EXPLORATION +fue I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +C. I-EXPLORATION +albicans. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +lesión I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +abundantes I-EXPLORATION +elementos I-EXPLORATION +micóticos I-EXPLORATION +tipo I-EXPLORATION +hifas I-EXPLORATION +no I-EXPLORATION +septadas, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +mucor, I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +del I-EXPLORATION +ala I-EXPLORATION +nasal. I-EXPLORATION +Con B-TREATMENT +estos I-TREATMENT +resultados I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +anidulafungina I-TREATMENT +e I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +desoxicolato I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +ajustada I-TREATMENT +según I-TREATMENT +función I-TREATMENT +renal I-TREATMENT +(creatininemia: I-TREATMENT +3 I-TREATMENT +mg/dL). I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo, I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +paranasales I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +concomitancia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +profundas. I-EXPLORATION + I-EXPLORATION +Permaneció B-EVOLUTION +grave, I-EVOLUTION +con I-EVOLUTION +ictericia I-EVOLUTION +intensa I-EVOLUTION +(bilirrubinemia I-EVOLUTION +total: I-EVOLUTION +21 I-EVOLUTION +mg/dL, I-EVOLUTION +bilirrubinemia I-EVOLUTION +directa: I-EVOLUTION +19 I-EVOLUTION +mg/dL, I-EVOLUTION +fosfatasas I-EVOLUTION +alcalinas: I-EVOLUTION +854 I-EVOLUTION +U/l, I-EVOLUTION +GOT: I-EVOLUTION +83 I-EVOLUTION +U/L, I-EVOLUTION +GPT: I-EVOLUTION +8 I-EVOLUTION +U/L). I-EVOLUTION +La B-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen-pélvis I-EXPLORATION +demostró I-EXPLORATION +hepatomegalia I-EXPLORATION +difusa I-EXPLORATION +sin I-EXPLORATION +abscedación, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +de I-EXPLORATION +estructura I-EXPLORATION +conservada. I-EXPLORATION +Una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +extensa I-EXPLORATION +efusión I-EXPLORATION +pleural I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +colapso I-EXPLORATION +pulmonar I-EXPLORATION +ipsilateral. I-EXPLORATION +La I-EXPLORATION +punción I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +efusión I-EXPLORATION +dio I-EXPLORATION +salida I-EXPLORATION +a I-EXPLORATION +líquido I-EXPLORATION +hemático I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +coagulaba I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +instaló I-TREATMENT +un I-TREATMENT +tubo I-TREATMENT +de I-TREATMENT +drenaje I-TREATMENT +pleural. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posteriores I-EVOLUTION +evolucionó I-EVOLUTION +febril, I-EVOLUTION +en I-EVOLUTION +anuria, I-EVOLUTION +con I-EVOLUTION +altos I-EVOLUTION +requerimientos I-EVOLUTION +de I-EVOLUTION +apoyo I-EVOLUTION +ventilatorio I-EVOLUTION +y I-EVOLUTION +hemodinámico. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +falleció, I-EVOLUTION +habiendo B-TREATMENT +completado I-TREATMENT +cinco I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +efectuarse I-TREATMENT +dos I-TREATMENT +aseos I-TREATMENT +quirúrgicos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +nasal. I-TREATMENT + I-TREATMENT + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +irregular I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +metabólico I-PAST_MEDICAL_HISTORY +(amaurosis I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +hospitalizaciones I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cetoacidosis I-PAST_MEDICAL_HISTORY +diabética), I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +inicialmente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +glibenclamida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +luego I-PAST_MEDICAL_HISTORY +insulina I-PAST_MEDICAL_HISTORY +NPH. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pierna I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +caída, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +somnolencia, I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +respiratoria, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +primario I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +administró I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +millones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +UI I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +penicilina I-PRESENT_ILLNESS +G I-PRESENT_ILLNESS +sódica. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +al I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +constató I-EXPLORATION +en I-EXPLORATION +sopor, I-EXPLORATION +afebril, I-EXPLORATION +hipotenso I-EXPLORATION +y I-EXPLORATION +deshidratado. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +necrótica I-EXPLORATION +y I-EXPLORATION +flictenas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +pretibial I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +30 I-EXPLORATION +x I-EXPLORATION +10 I-EXPLORATION +cm, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulsos I-EXPLORATION +poplíteo I-EXPLORATION +y I-EXPLORATION +pedio I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +mostraron I-EXPLORATION +leucocitosis I-EXPLORATION +(20.400/mm3), I-EXPLORATION +hiperglicemia I-EXPLORATION +(539 I-EXPLORATION +mg/dL), I-EXPLORATION +acidosis I-EXPLORATION +metabólica I-EXPLORATION +(pH I-EXPLORATION +6, I-EXPLORATION +9), I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +elevada I-EXPLORATION +(189 I-EXPLORATION +mg/L) I-EXPLORATION +y I-EXPLORATION +disfunción I-EXPLORATION +renal I-EXPLORATION +(creatininemia: I-EXPLORATION +1, I-EXPLORATION +87 I-EXPLORATION +mg/dL, I-EXPLORATION +potasio: I-EXPLORATION +5, I-EXPLORATION +5 I-EXPLORATION +mmol/L). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +efectuó I-TREATMENT +aseo I-TREATMENT +quirúrgico I-TREATMENT +encontrándose I-TREATMENT +una I-TREATMENT +necrosis I-TREATMENT +muscular I-TREATMENT +del I-TREATMENT +compartimiento I-TREATMENT +antero I-TREATMENT +lateral I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pierna I-TREATMENT +izquierda; I-TREATMENT +se B-EXPLORATION +envió I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +cultivo I-EXPLORATION +y I-EXPLORATION +biopsia. I-EXPLORATION +Ingresó B-TREATMENT +a I-TREATMENT +la I-TREATMENT +UCI I-TREATMENT +con I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +fascitis I-TREATMENT +necrosante I-TREATMENT +y I-TREATMENT +sepsis I-TREATMENT +grave, I-TREATMENT +iniciando I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +y I-TREATMENT +clindamicina, I-TREATMENT +analgesia I-TREATMENT +con I-TREATMENT +fentanilo I-TREATMENT +y I-TREATMENT +corrección I-TREATMENT +metabólica I-TREATMENT +con I-TREATMENT +bicarbonato I-TREATMENT +de I-TREATMENT +sodio, I-TREATMENT +gluconato I-TREATMENT +de I-TREATMENT +calcio, I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +volumen I-TREATMENT +e I-TREATMENT +insulina. I-TREATMENT + I-TREATMENT +Evolucionó B-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +estabilidad, I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +parámetros I-EVOLUTION +metabólicos I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +y I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +necrótica I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +pierna I-EVOLUTION +izquierda. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +informó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +fibroconectivo I-EXPLORATION +denso I-EXPLORATION +y I-EXPLORATION +muscular I-EXPLORATION +esquelético I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +agudo I-EXPLORATION +necrosante I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +elementos I-EXPLORATION +micóticos I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +hifas I-EXPLORATION +no I-EXPLORATION +septadas, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +mucor, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +indicó I-EXPLORATION +anfotericina I-EXPLORATION +B I-EXPLORATION +desoxicolato. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +resultó I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +elementos I-EXPLORATION +micóticos. I-EXPLORATION + I-EXPLORATION +Luego I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +antifúngico I-EXPLORATION +y I-EXPLORATION +tres I-EXPLORATION +aseos I-EXPLORATION +quirúrgicos, I-EXPLORATION +la I-EXPLORATION +RM I-EXPLORATION +evidenciaba I-EXPLORATION +un I-EXPLORATION +compromiso I-EXPLORATION +infeccioso I-EXPLORATION +necrosante I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +tuberosidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tibia I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +amputación I-EXPLORATION +suprapatelar I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pierna I-EXPLORATION +izquierda. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +biopsia I-EXPLORATION +intra-operatoria I-EXPLORATION +del I-EXPLORATION +margen I-EXPLORATION +de I-EXPLORATION +sección I-EXPLORATION +proximal I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +elementos I-EXPLORATION +micóticos I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +mucor. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +quirúrgico I-EVOLUTION +e I-EVOLUTION +infeccioso I-EVOLUTION +completando I-EVOLUTION +30 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +anfotericina I-EVOLUTION +B. I-EVOLUTION +Fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +encontrándose, I-EVOLUTION +al I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +preparar I-EVOLUTION +este I-EVOLUTION +reporte, I-EVOLUTION +bajo I-EVOLUTION +controles I-EVOLUTION +con I-EVOLUTION +fisiatra I-EVOLUTION +y I-EVOLUTION +terapia I-EVOLUTION +ocupacional. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +42 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +soltero B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +comerciante, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +marzo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2009 I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Dr. I-PRESENT_ILLNESS +Sótero I-PRESENT_ILLNESS +Del I-PRESENT_ILLNESS +Río I-PRESENT_ILLNESS +(HSDR) I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Refería I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +progresivo, I-PRESENT_ILLNESS +indoloro, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +lógica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +nocturna I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +intermitente I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +temperatura I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cuantificada. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +sistemas I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +destacaban I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +síntomas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +relevantes I-PAST_MEDICAL_HISTORY +destacaban I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +sexuales I-PAST_MEDICAL_HISTORY +previas I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hombres I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +preservativo. I-PAST_MEDICAL_HISTORY +Negaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +drogas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +buenas I-EXPLORATION +condiciones I-EXPLORATION +generales, I-EXPLORATION +afebril, I-EXPLORATION +piel I-EXPLORATION +con I-EXPLORATION +descamación I-EXPLORATION +fina I-EXPLORATION +difusa, I-EXPLORATION +algorra I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +paladar I-EXPLORATION +y I-EXPLORATION +leucoplaquia I-EXPLORATION +vellosa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +lengua. I-EXPLORATION +Destacaba I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +cervical I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cms, I-EXPLORATION +indolora, I-EXPLORATION +pétrea, I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +profundos, I-EXPLORATION +de I-EXPLORATION +textura I-EXPLORATION +nodular I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +hospitalizar I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +por I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +inmunosupresión. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +principales I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +fueron I-EXPLORATION +anemia I-EXPLORATION +normocítica I-EXPLORATION +- I-EXPLORATION +normocrómica I-EXPLORATION +con I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +31, I-EXPLORATION +1%, I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +5.900 I-EXPLORATION +céls/mm3 I-EXPLORATION +con I-EXPLORATION +65, I-EXPLORATION +6% I-EXPLORATION +de I-EXPLORATION +granulocitos I-EXPLORATION +y I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +de I-EXPLORATION +161.000 I-EXPLORATION +céls/mm3, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +56 I-EXPLORATION +mg/L I-EXPLORATION +(N I-EXPLORATION +< I-EXPLORATION +5 I-EXPLORATION +mg/L). I-EXPLORATION +Creatininemia, I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +coagulación, I-EXPLORATION +electrolitos I-EXPLORATION +plasmáticos, I-EXPLORATION +perfil I-EXPLORATION +bioquímico I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +sedimento I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Baciloscopias I-EXPLORATION +de I-EXPLORATION +expectoración I-EXPLORATION +y I-EXPLORATION +urocultivo I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +ELISA I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +positivo I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VHB I-EXPLORATION +y I-EXPLORATION +VHC, I-EXPLORATION +ambas I-EXPLORATION +negativas. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +solicitó I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cerebro, I-EXPLORATION +cuello, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +cervical I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +depender I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +submandibular I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +8, I-EXPLORATION +4 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +neoplásico I-EXPLORATION +infiltrativo, I-EXPLORATION +en I-EXPLORATION +cuyo I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +se I-EXPLORATION +sugería I-EXPLORATION +considerar I-EXPLORATION +carcinoma I-EXPLORATION +adenoide I-EXPLORATION +quístico I-EXPLORATION +con I-EXPLORATION +baja I-EXPLORATION +probabilidad I-EXPLORATION +de I-EXPLORATION +linfoma. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +recibieron I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +del I-EXPLORATION +hemocultivo I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Salmonella I-EXPLORATION +grupo I-EXPLORATION +B I-EXPLORATION +multisensible I-EXPLORATION +(sensible I-EXPLORATION +a I-EXPLORATION +cefo-taxima, I-EXPLORATION +ciprofloxacina, I-EXPLORATION +ácido I-EXPLORATION +nalidíxico, I-EXPLORATION +cloranfenicol I-EXPLORATION +y I-EXPLORATION +cotrimoxazol) I-EXPLORATION +posterior I-EXPLORATION +a I-EXPLORATION +3, I-EXPLORATION +8 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +incubación I-EXPLORATION +(automatizados). I-EXPLORATION + I-EXPLORATION +Además, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +quirúrgica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +cervical I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +tejido I-EXPLORATION +tumoral I-EXPLORATION +cerebroideo I-EXPLORATION +con I-EXPLORATION +sangrado I-EXPLORATION +profuso I-EXPLORATION +y I-EXPLORATION +gran I-EXPLORATION +compromiso I-EXPLORATION +inflamatorio I-EXPLORATION +circundante. I-EXPLORATION +Se I-EXPLORATION +enviaron I-EXPLORATION +muestras I-EXPLORATION +a I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +corriente I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +Koch, I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +directa I-EXPLORATION +y I-EXPLORATION +baciloscopia. I-EXPLORATION +Los I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Salmonella I-EXPLORATION +grupo I-EXPLORATION +B I-EXPLORATION +multisensible, I-EXPLORATION +al I-EXPLORATION +tercer I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +incubación. I-EXPLORATION +Ambos I-EXPLORATION +cultivos I-EXPLORATION +fueron I-EXPLORATION +enviados I-EXPLORATION +al I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública I-EXPLORATION +(ISP) I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +confirmación I-EXPLORATION +y I-EXPLORATION +tipificación, I-EXPLORATION +correspondiendo I-EXPLORATION +a I-EXPLORATION +Salmonella I-EXPLORATION +Typhimurium. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +ev I-TREATMENT +2 I-TREATMENT +g/día I-TREATMENT +por I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +seguido I-TREATMENT +por I-TREATMENT +ciprofloxacina I-TREATMENT +oral I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +por I-TREATMENT +30 I-TREATMENT +días. I-TREATMENT +El B-EXPLORATION +examen I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +cervical I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +crónico I-EXPLORATION +granulomatoso I-EXPLORATION +no I-EXPLORATION +necrosante I-EXPLORATION +con I-EXPLORATION +focos I-EXPLORATION +supurativos. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +elementos I-EXPLORATION +celulares I-EXPLORATION +malignos I-EXPLORATION +ni I-EXPLORATION +microorganismos I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +microscópico. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +Koch I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +masa I-EVOLUTION +cervical I-EVOLUTION +y I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +febril, I-EVOLUTION +no I-EVOLUTION +requiriendo I-EVOLUTION +nuevas I-EVOLUTION +intervenciones I-EVOLUTION +quirúrgicas. I-EVOLUTION +Fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +44 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +con I-EVOLUTION +indicación I-EVOLUTION +de I-EVOLUTION +mantener I-EVOLUTION +ciprofloxacina I-EVOLUTION +oral I-EVOLUTION +hasta I-EVOLUTION +completar I-EVOLUTION +30 I-EVOLUTION +días. I-EVOLUTION +Se I-EVOLUTION +controló I-EVOLUTION +posteriormente I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +policlínica I-EVOLUTION +de I-EVOLUTION +Infectología I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +HSDR I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones, I-EVOLUTION +con I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +síntomas I-EVOLUTION +sistémicos; I-EVOLUTION +PCR I-EVOLUTION +3 I-EVOLUTION +mg/L. I-EVOLUTION +Con B-TREATMENT +confirmación I-TREATMENT +del I-TREATMENT +Instituto I-TREATMENT +de I-TREATMENT +Salud I-TREATMENT +Pública I-TREATMENT +de I-TREATMENT +la I-TREATMENT +serología I-TREATMENT +positiva I-TREATMENT +para I-TREATMENT +VIH I-TREATMENT +y I-TREATMENT +confirmación I-TREATMENT +de I-TREATMENT +identidad I-TREATMENT +informada I-TREATMENT +luego I-TREATMENT +del I-TREATMENT +alta, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +ingreso I-TREATMENT +al I-TREATMENT +Programa I-TREATMENT +de I-TREATMENT +VIH/SIDA I-TREATMENT +para I-TREATMENT +iniciar I-TREATMENT +terapia I-TREATMENT +anti-retroviral I-TREATMENT +(TARV) I-TREATMENT +con I-TREATMENT +tenofovir, I-TREATMENT +lamivudina I-TREATMENT +y I-TREATMENT +atazanavir/ritonavir I-TREATMENT +con I-TREATMENT +un I-TREATMENT +recuento I-TREATMENT +de I-TREATMENT +linfocitos I-TREATMENT +CD4 I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +céls/mL I-TREATMENT +y I-TREATMENT +carga I-TREATMENT +viral I-TREATMENT +de I-TREATMENT +1.800 I-TREATMENT +copias I-TREATMENT +ARN/ml. I-TREATMENT +La I-TREATMENT +decisión I-TREATMENT +de I-TREATMENT +utilizar I-TREATMENT +este I-TREATMENT +esquema, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +no I-TREATMENT +es I-TREATMENT +el I-TREATMENT +de I-TREATMENT +uso I-TREATMENT +habitual I-TREATMENT +como I-TREATMENT +primera I-TREATMENT +línea, I-TREATMENT +fue I-TREATMENT +decisión I-TREATMENT +del I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +Infectología I-TREATMENT +para I-TREATMENT +mejorar I-TREATMENT +la I-TREATMENT +adherencia I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +es I-TREATMENT +mejor I-TREATMENT +tolerado I-TREATMENT +en I-TREATMENT +pacientes I-TREATMENT +operados I-TREATMENT +y I-TREATMENT +con I-TREATMENT +un I-TREATMENT +nivel I-TREATMENT +avanzado I-TREATMENT +de I-TREATMENT +inmunosupresión. I-TREATMENT +Una B-EXPLORATION +nuevo I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +y I-EXPLORATION +cuello I-EXPLORATION +posterior I-EXPLORATION +a I-EXPLORATION +18 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +antimicrobiano, I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +adenopatías I-EXPLORATION +susceptibles I-EXPLORATION +de I-EXPLORATION +ser I-EXPLORATION +biopsiadas I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +dado I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +de I-EXPLORATION +Cirugía I-EXPLORATION +de I-EXPLORATION +Cabeza I-EXPLORATION +y I-EXPLORATION +Cuello. I-EXPLORATION + I-EXPLORATION +Un B-EVOLUTION +año I-EVOLUTION +después I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones, I-EVOLUTION +con I-EVOLUTION +resolución I-EVOLUTION +definitiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +masa I-EVOLUTION +cervical I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +mismo I-EVOLUTION +esquema I-EVOLUTION +de I-EVOLUTION +TARV I-EVOLUTION +A I-EVOLUTION +15 I-EVOLUTION +meses I-EVOLUTION +plazo I-EVOLUTION +presentaba I-EVOLUTION +carga I-EVOLUTION +viral I-EVOLUTION +indetectable, I-EVOLUTION +con I-EVOLUTION +recuento I-EVOLUTION +de I-EVOLUTION +linfocitos I-EVOLUTION +CD4 I-EVOLUTION +de I-EVOLUTION +181 I-EVOLUTION +céls/mL I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +nuevas I-EVOLUTION +infecciones I-EVOLUTION +bacterianas I-EVOLUTION +graves. I-EVOLUTION + I-EVOLUTION + +Prescolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +asfixia I-PAST_MEDICAL_HISTORY +neonatal I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +circular I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cuello, I-PAST_MEDICAL_HISTORY +bronconeumonía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +virus I-PAST_MEDICAL_HISTORY +respiratorio I-PAST_MEDICAL_HISTORY +sincicial I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +calendario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vacunación I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +nacional I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inmunizaciones I-PAST_MEDICAL_HISTORY +completo I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +inició I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +diagnóstico, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +gastrointestinales I-PRESENT_ILLNESS +caracterizados I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +constipación, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso, I-PRESENT_ILLNESS +intermitente, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +intensificó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +siguientes. I-PRESENT_ILLNESS +Consultó B-TREATMENT +reiteradamente I-TREATMENT +a I-TREATMENT +pediatra I-TREATMENT +y I-TREATMENT +gastroenterólogo I-TREATMENT +infantil, I-TREATMENT +indicándose I-TREATMENT +dieta I-TREATMENT +y I-TREATMENT +lactulosa; I-TREATMENT +además B-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +eco-grafía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +tres I-EVOLUTION +semanas I-EVOLUTION +se I-EVOLUTION +agregó I-EVOLUTION +decaimiento, I-EVOLUTION +irritabilidad I-EVOLUTION +nocturna, I-EVOLUTION +dolor I-EVOLUTION +lumbar I-EVOLUTION +y I-EVOLUTION +posteriormente I-EVOLUTION +postración I-EVOLUTION +relativa I-EVOLUTION +(no I-EVOLUTION +caminaba, I-EVOLUTION +no I-EVOLUTION +jugaba) I-EVOLUTION +y I-EVOLUTION +dificultad I-EVOLUTION +para I-EVOLUTION +mantenerse I-EVOLUTION +sentado. I-EVOLUTION +Se B-EXPLORATION +le I-EXPLORATION +solicitó I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +lumbar I-EXPLORATION +con I-EXPLORATION +resultado I-EXPLORATION +normal. I-EXPLORATION +Por B-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +sintomatología, I-TREATMENT +fue I-TREATMENT +hospitalizada I-TREATMENT +con I-TREATMENT +la I-TREATMENT +hipótesis I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +Guillain I-TREATMENT +Barré. I-TREATMENT +Una B-EXPLORATION +segunda I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +lumbar I-EXPLORATION +y I-EXPLORATION +evaluación I-EXPLORATION +neurológica I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Hemograma I-EXPLORATION +con I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +7%, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +9.300/mm3, I-EXPLORATION +sin I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda, I-EXPLORATION +plaquetas I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +VHS I-EXPLORATION +de I-EXPLORATION +48 I-EXPLORATION +mm/hora, I-EXPLORATION +con I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +mg/dL I-EXPLORATION +(normal: I-EXPLORATION +0-1). I-EXPLORATION +Un I-EXPLORATION +cintigrama I-EXPLORATION +óseo I-EXPLORATION +mostró I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +captación I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +L2-L3. I-EXPLORATION +En I-EXPLORATION +virtud I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +hallazgo, I-EXPLORATION +se I-EXPLORATION +reevaluó I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +obtenida I-EXPLORATION +con I-EXPLORATION +anterioridad, I-EXPLORATION +evidenciándose I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +intervertebral I-EXPLORATION +L2-L3. I-EXPLORATION +Una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +espondilodiscitis. I-EXPLORATION +La I-EXPLORATION +punción I-EXPLORATION +del I-EXPLORATION +disco I-EXPLORATION +vertebral I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +L2- I-EXPLORATION +L3 I-EXPLORATION +bajo I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TC), I-EXPLORATION +mostró I-EXPLORATION +líquido I-EXPLORATION +con I-EXPLORATION +abundantes I-EXPLORATION +polimorfonucleares. I-EXPLORATION +Se I-EXPLORATION +envió I-EXPLORATION +a I-EXPLORATION +cultivo I-EXPLORATION +corriente, I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +Koch I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC) I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +ARN I-EXPLORATION +16S I-EXPLORATION +universal. I-EXPLORATION +Se B-TREATMENT +tomaron I-TREATMENT +hemocultivos I-TREATMENT +que I-TREATMENT +resultaron I-TREATMENT +negativos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +empírico I-TREATMENT +iv I-TREATMENT +con I-TREATMENT +cloxacilina I-TREATMENT +y I-TREATMENT +cefotaxima, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +analgesia I-TREATMENT +con I-TREATMENT +ketoprofeno. I-TREATMENT +Evolucionó B-EVOLUTION +favorablemente, I-EVOLUTION +afebril I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +dolor. I-EVOLUTION +Los B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostraron I-EXPLORATION +lenta I-EXPLORATION +regresión I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +infecciosos I-EXPLORATION +inflamatorios, I-EXPLORATION +con I-EXPLORATION +8.900 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +sin I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda, I-EXPLORATION +VHS I-EXPLORATION +de I-EXPLORATION +35 I-EXPLORATION +mm/hora I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +4, I-EXPLORATION +4 I-EXPLORATION +mg/dL. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +articular I-EXPLORATION +resultó I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +RPC I-EXPLORATION +universal I-EXPLORATION +demostró I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +K. I-EXPLORATION +kingae. I-EXPLORATION + I-EXPLORATION +Una B-TREATMENT +vez I-TREATMENT +completado I-TREATMENT +los I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +iv, I-TREATMENT +y I-TREATMENT +dada I-TREATMENT +la I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +tanto I-TREATMENT +clínica I-TREATMENT +como I-TREATMENT +de I-TREATMENT +laboratorio, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +dar I-TREATMENT +el I-TREATMENT +alta, I-TREATMENT +con I-TREATMENT +inmovilización I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +un I-TREATMENT +corset I-TREATMENT +y I-TREATMENT +con I-TREATMENT +indicación I-TREATMENT +de I-TREATMENT +completar I-TREATMENT +cuatro I-TREATMENT +semanas I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +amoxicilina. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sana, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia, I-PAST_MEDICAL_HISTORY +en B-PRESENT_ILLNESS +proceso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +amamantamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hijo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +Procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +suburbana I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Villa I-PAST_MEDICAL_HISTORY +Alemana, I-PAST_MEDICAL_HISTORY +Región I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Valparaíso. I-PAST_MEDICAL_HISTORY +Vive I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +casa I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +dispone I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +agua I-PAST_MEDICAL_HISTORY +potable I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alcantarillado; I-PAST_MEDICAL_HISTORY +posee I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +perro, I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +gatos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +conejo I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +mascotas. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +dueña I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +casa, I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +ella I-PAST_MEDICAL_HISTORY +quien I-PAST_MEDICAL_HISTORY +prepara I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +alimentos. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +mes, I-PAST_MEDICAL_HISTORY +separado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +quince I-PAST_MEDICAL_HISTORY +dias, I-PAST_MEDICAL_HISTORY +habia I-PAST_MEDICAL_HISTORY +efectuado I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +viajes I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ciudad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Talcahuano, I-PAST_MEDICAL_HISTORY +Concepción, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +consecuencias I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +desastre I-PAST_MEDICAL_HISTORY +ocurrido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +casa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +familiar I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +terremoto I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tsunami I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +febrero I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2010. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Consultorio I-PRESENT_ILLNESS +Periférico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Villa I-PRESENT_ILLNESS +Alemana I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +ejemplares I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gusanos I-PRESENT_ILLNESS +eliminados I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +boca I-PRESENT_ILLNESS +hacia I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +dias. I-PRESENT_ILLNESS +Relató I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +durmiendo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +despertó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +sentir I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +extraña I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +garganta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +boca; I-PRESENT_ILLNESS +frente I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +movimiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +extraño I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +boca, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +lengua I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +aprisionó I-PRESENT_ILLNESS +contra I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paladar I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +retirarlo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +dedos. I-PRESENT_ILLNESS +Lo I-PRESENT_ILLNESS +dejó I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +velador I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +observó I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +enroscaba. I-PRESENT_ILLNESS +Posteriormente I-PRESENT_ILLNESS +eliminó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +ejemplar; I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +casos I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +tos, I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +vómito. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dia I-PRESENT_ILLNESS +habia I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +acuosa, I-PRESENT_ILLNESS +hiporexia, I-PRESENT_ILLNESS +dispepsia, I-PRESENT_ILLNESS +meteorismo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Relató I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +consumido I-PRESENT_ILLNESS +merluza I-PRESENT_ILLNESS +cruda I-PRESENT_ILLNESS +(cebiche) I-PRESENT_ILLNESS +once I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +atrás I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +negó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +consumo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +verduras I-PRESENT_ILLNESS +crudas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +familia. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +familia I-PRESENT_ILLNESS +integrada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +componentes: I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +esposo, I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hermana I-PRESENT_ILLNESS +(18 I-PRESENT_ILLNESS +años), I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +hijos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nueve I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +menor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +presentaron I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +síntomas. I-PRESENT_ILLNESS +El B-TREATMENT +médico I-TREATMENT +tratante I-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +mebendazol I-TREATMENT +100 I-TREATMENT +mg, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +por I-TREATMENT +tres I-TREATMENT +días. I-TREATMENT + I-TREATMENT +En I-TREATMENT +el I-TREATMENT +laboratorio I-TREATMENT +del I-TREATMENT +consultorio, I-TREATMENT +por I-TREATMENT +las I-TREATMENT +características I-TREATMENT +morfométricas I-TREATMENT +se I-TREATMENT +sospechó I-TREATMENT +que I-TREATMENT +los I-TREATMENT +ejemplares I-TREATMENT +correspondían I-TREATMENT +a I-TREATMENT +A. I-TREATMENT +lumbricoides I-TREATMENT +en I-TREATMENT +estado I-TREATMENT +juvenil. I-TREATMENT +Por B-EXPLORATION +igual I-EXPLORATION +motivo I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +examen I-EXPLORATION +copro-parasitario I-EXPLORATION +seriado, I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +ejemplares I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +gusanos I-EXPLORATION +eliminados I-EXPLORATION +fue I-EXPLORATION +derivado I-EXPLORATION +al I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +Parasitología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Escuela I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Valparaíso I-EXPLORATION +para I-EXPLORATION +comprobar I-EXPLORATION +el I-EXPLORATION +diagnóstico. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +morfométrico, I-EXPLORATION +destacando I-EXPLORATION +su I-EXPLORATION +color I-EXPLORATION +amarillento, I-EXPLORATION +una I-EXPLORATION +forma I-EXPLORATION +cilíndrica I-EXPLORATION +de I-EXPLORATION +extremos I-EXPLORATION +aguzados I-EXPLORATION +rojizos, I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +9 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +y I-EXPLORATION +1, I-EXPLORATION +0 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +ancho. I-EXPLORATION +Microscópicamente, I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tres I-EXPLORATION +labios I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +extremo I-EXPLORATION +anterior; I-EXPLORATION +uno I-EXPLORATION +dorsal I-EXPLORATION +con I-EXPLORATION +dos I-EXPLORATION +papilas I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +sólo I-EXPLORATION +una I-EXPLORATION +cada I-EXPLORATION +uno I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +labios I-EXPLORATION +ventrolaterales3 I-EXPLORATION +rodeando I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +oral. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +objeto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +mejor I-EXPLORATION +observación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +del I-EXPLORATION +gusano, I-EXPLORATION +el I-EXPLORATION +ejemplar I-EXPLORATION +fue I-EXPLORATION +sometido I-EXPLORATION +a I-EXPLORATION +diafanización I-EXPLORATION +en I-EXPLORATION +lactofenol I-EXPLORATION +de I-EXPLORATION +Amann. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +fue I-EXPLORATION +corroborado I-EXPLORATION +al I-EXPLORATION +visualizar I-EXPLORATION +microscópicamente I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +labios I-EXPLORATION +que I-EXPLORATION +rodean I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +oral I-EXPLORATION +triangular I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +extremo I-EXPLORATION +anterior, I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +del I-EXPLORATION +tubo I-EXPLORATION +digestivo I-EXPLORATION +por I-EXPLORATION +transparencia I-EXPLORATION +(esófago I-EXPLORATION +corto, I-EXPLORATION +intestino I-EXPLORATION +aplanado I-EXPLORATION +recorriendo I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +longitud I-EXPLORATION +del I-EXPLORATION +cuerpo, I-EXPLORATION +terminado I-EXPLORATION +en I-EXPLORATION +recto). I-EXPLORATION + I-EXPLORATION +Obtenido I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +certeza, I-EXPLORATION +se I-EXPLORATION +sostuvo I-EXPLORATION +entrevista I-EXPLORATION +telefónica I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +paciente: I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +indicó I-EXPLORATION +las I-EXPLORATION +medidas I-EXPLORATION +profilácticas I-EXPLORATION +para I-EXPLORATION +evitar I-EXPLORATION +la I-EXPLORATION +reinfección I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +sugirió I-EXPLORATION +control I-EXPLORATION +mediante I-EXPLORATION +examen I-EXPLORATION +copro-parasitario I-EXPLORATION +seriado, I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +formas I-EXPLORATION +vacuoladas I-EXPLORATION +de I-EXPLORATION +Blastocystis I-EXPLORATION +hominis. I-EXPLORATION +Como I-EXPLORATION +investigación I-EXPLORATION +complementaria I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +examen I-EXPLORATION +copro-parasitario I-EXPLORATION +seriado I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +integrantes I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +grupo I-EXPLORATION +familiar, I-EXPLORATION +evidenciándose I-EXPLORATION +formas I-EXPLORATION +vacuoladas I-EXPLORATION +de I-EXPLORATION +B. I-EXPLORATION +hominis I-EXPLORATION +y I-EXPLORATION +quistes I-EXPLORATION +de I-EXPLORATION +Entamoeba I-EXPLORATION +coli I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +hermana; I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +integrantes I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION + +Un B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diabético, B-PAST_MEDICAL_HISTORY +fue B-PRESENT_ILLNESS +internado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rigidez I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuca I-PRESENT_ILLNESS +aparecidos I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cursar I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +aguda. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +diagnosticó I-EXPLORATION +una I-EXPLORATION +meningoencefalitis I-EXPLORATION +aséptica I-EXPLORATION +(LCR I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +claro, I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +H2O; I-EXPLORATION +leucocitos: I-EXPLORATION +200/mm3; I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +directa I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +bacteriano: I-EXPLORATION +negativos) I-EXPLORATION +y B-TREATMENT +recibió I-TREATMENT +ceftriaxona I-TREATMENT +más I-TREATMENT +vancomicina I-TREATMENT +y I-TREATMENT +corticoterapia I-TREATMENT +(dexametasona, I-TREATMENT +10 I-TREATMENT +mg I-TREATMENT +iv I-TREATMENT +cada I-TREATMENT +6-horas I-TREATMENT +durante I-TREATMENT +4 I-TREATMENT +días). I-TREATMENT +Inicialmente B-EVOLUTION +ingresó I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +UCI I-EVOLUTION +y I-EVOLUTION +estuvo I-EVOLUTION +en I-EVOLUTION +ventilación I-EVOLUTION +mecánica, I-EVOLUTION +siendo I-EVOLUTION +desconectado I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION +Desarrolló I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +tos I-EVOLUTION +productiva I-EVOLUTION +tras I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +evolución. I-EVOLUTION +Una B-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +detectó I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +pulmonar I-EXPLORATION +bilateral. I-EXPLORATION +Tres I-EXPLORATION +días I-EXPLORATION +más I-EXPLORATION +tarde, I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +Rx I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +abscesos I-EXPLORATION +pulmonares I-EXPLORATION +con I-EXPLORATION +niveles I-EXPLORATION +hidro-aéreos. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +cavitarias I-EXPLORATION +con I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +gas. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +toracoscopia I-EXPLORATION +video-asistida I-EXPLORATION +e B-TREATMENT +inserción I-TREATMENT +de I-TREATMENT +drenaje. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +entonces I-TREATMENT +terapia I-TREATMENT +asociada I-TREATMENT +con I-TREATMENT +linezolid I-TREATMENT +(600 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12h I-TREATMENT +iv) I-TREATMENT +y I-TREATMENT +meropenem I-TREATMENT +(1, I-TREATMENT +0 I-TREATMENT +gm I-TREATMENT +cada I-TREATMENT +8h I-TREATMENT +iv), I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +por I-TREATMENT +dos I-TREATMENT +semanas. I-TREATMENT +La B-EXPLORATION +efusión I-EXPLORATION +pleural I-EXPLORATION +(de I-EXPLORATION +aspecto I-EXPLORATION +purulento, I-EXPLORATION +glucosa: I-EXPLORATION +40 I-EXPLORATION +mg/dL, I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +18) I-EXPLORATION +dio I-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +para I-EXPLORATION +P I-EXPLORATION +aeruginosa I-EXPLORATION +(susceptible I-EXPLORATION +a I-EXPLORATION +amikacina, I-EXPLORATION +gentamicina, I-EXPLORATION +ciprofloxacina, I-EXPLORATION +cefepime, I-EXPLORATION +ceftazidima I-EXPLORATION +e I-EXPLORATION +imipenem). I-EXPLORATION +Hubo B-EVOLUTION +recuperación I-EVOLUTION +ad I-EVOLUTION +integrum I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +completarse I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +antibioterapia. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +nacido B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Buenos I-PAST_MEDICAL_HISTORY +Aires, I-PAST_MEDICAL_HISTORY +vendedor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +comercio I-PAST_MEDICAL_HISTORY +céntrico, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +efectuado I-PAST_MEDICAL_HISTORY +viajes I-PAST_MEDICAL_HISTORY +fuera I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ciudad I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +poseía I-PAST_MEDICAL_HISTORY +mascotas, I-PAST_MEDICAL_HISTORY +realizaba I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +alimentación I-PAST_MEDICAL_HISTORY +balanceada, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +comidas I-PAST_MEDICAL_HISTORY +diarias. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +significación. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Sanatorio I-PRESENT_ILLNESS +IPENSA I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +Plata I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +omalgia I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +abducción, I-PRESENT_ILLNESS +aducción I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rotación I-PRESENT_ILLNESS +interna, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +data I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana. I-PRESENT_ILLNESS +Posteriormente B-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +placa I-EXPLORATION +eritematosa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +torácica I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +cuatro I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +no I-EXPLORATION +indurada, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios I-EXPLORATION +superficiales. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +fiebre, I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +peso, I-EXPLORATION +hemoptisis, I-EXPLORATION +ni I-EXPLORATION +historia I-EXPLORATION +previa I-EXPLORATION +de I-EXPLORATION +traumatismo. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +hemitórax I-EXPLORATION +derecho I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +heterogénea I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +89 I-EXPLORATION +cm, I-EXPLORATION +ubicada I-EXPLORATION +a I-EXPLORATION +2, I-EXPLORATION +46 I-EXPLORATION +cm I-EXPLORATION +bajo I-EXPLORATION +la I-EXPLORATION +piel, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +celulitis. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +miembro I-EXPLORATION +superior I-EXPLORATION +ipsilateral, I-EXPLORATION +adenopatías, I-EXPLORATION +soplo I-EXPLORATION +cardíaco I-EXPLORATION +ni I-EXPLORATION +dolores I-EXPLORATION +óseos. I-EXPLORATION + I-EXPLORATION +Comenzó B-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +(cefalexina I-TREATMENT +1 I-TREATMENT +gramo I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +hs); I-TREATMENT +a B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +registro I-EVOLUTION +febril I-EVOLUTION +de I-EVOLUTION +38, I-EVOLUTION +6°C I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +tumoración I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +pectoral I-EVOLUTION +derecha. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +laboratorio I-EXPLORATION +mostró I-EXPLORATION +leucocitos I-EXPLORATION +16.600/mm3 I-EXPLORATION +(81% I-EXPLORATION +neutró I-EXPLORATION +filos I-EXPLORATION +segmentados), I-EXPLORATION +hematocrito I-EXPLORATION +40%, I-EXPLORATION +hemoglobina I-EXPLORATION +12, I-EXPLORATION +3 I-EXPLORATION +g%, I-EXPLORATION +(VCM I-EXPLORATION +89, I-EXPLORATION +7 I-EXPLORATION +fl), I-EXPLORATION +250.000 I-EXPLORATION +plaquetas/mm3, I-EXPLORATION +glicemia I-EXPLORATION +85 I-EXPLORATION +mg/dL, I-EXPLORATION +VHS I-EXPLORATION +110 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +primer I-EXPLORATION +hora, I-EXPLORATION +TGO I-EXPLORATION +40 I-EXPLORATION +U/L I-EXPLORATION +y I-EXPLORATION +TGP I-EXPLORATION +70 I-EXPLORATION +U/L. I-EXPLORATION +La I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +creatin-fosfoquinasa I-EXPLORATION +(CPK) I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +ensanchamiento I-EXPLORATION +mediastinal, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +cuello I-EXPLORATION +con I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +ev I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +hemitórax I-EXPLORATION +derecho I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +con I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos, I-EXPLORATION +que I-EXPLORATION +provocaba I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +espesor I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +pectorales. I-EXPLORATION +Dicha I-EXPLORATION +lesión I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +mediastino I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +superior, I-EXPLORATION +en I-EXPLORATION +proximidad I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +grandes I-EXPLORATION +vasos I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +asociaba I-EXPLORATION +a I-EXPLORATION +cambios I-EXPLORATION +densitométricos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +mediastinal. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +punción-aspirativa I-TREATMENT +guiada I-TREATMENT +por I-TREATMENT +TAC, I-TREATMENT +obteniéndose I-TREATMENT +25 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +material I-TREATMENT +purulento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +colección I-TREATMENT +parietal I-TREATMENT +y I-TREATMENT +7 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mediastinal I-TREATMENT +Se I-TREATMENT +remitieron I-TREATMENT +a I-TREATMENT +estudio I-TREATMENT +microbiológico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +ajustó I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +anti-infeccioso I-TREATMENT +a I-TREATMENT +vancomicina I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +(dosis I-TREATMENT +máxima), I-TREATMENT +clindamicina I-TREATMENT +600 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +ceftazidima I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +ev. I-TREATMENT + I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +drenó I-TREATMENT +quirúrgicamente I-TREATMENT +el I-TREATMENT +absceso I-TREATMENT +pectoral. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +cocáceas I-EXPLORATION +grampositivas I-EXPLORATION +agrupadas I-EXPLORATION +en I-EXPLORATION +racimos I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +tercer I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +aureus I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +oxacilina, I-EXPLORATION +cefalotina, I-EXPLORATION +eritromicina, I-EXPLORATION +clindamicina, I-EXPLORATION +cotri-moxazol, I-EXPLORATION +vancomicina I-EXPLORATION +y I-EXPLORATION +ciprofloxacina. I-EXPLORATION +Las I-EXPLORATION +tinciones I-EXPLORATION +de I-EXPLORATION +Ziehl-Neelsen, I-EXPLORATION +Giemsa I-EXPLORATION +y I-EXPLORATION +Gomori-Grocott I-EXPLORATION +resultaron I-EXPLORATION +negativas. I-EXPLORATION +Se B-TREATMENT +modificó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +indicado I-TREATMENT +a I-TREATMENT +cefazolina I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +ev. I-TREATMENT +Las B-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana I-EXPLORATION +(VIH) I-EXPLORATION +y I-EXPLORATION +VDRL I-EXPLORATION +fueron I-EXPLORATION +no I-EXPLORATION +reactivas. I-EXPLORATION +El I-EXPLORATION +urocultivo, I-EXPLORATION +hemocultivos, I-EXPLORATION +cultivos I-EXPLORATION +para I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +micobacterias I-EXPLORATION +del I-EXPLORATION +material I-EXPLORATION +purulento I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +Un I-EXPLORATION +ecocardiograma I-EXPLORATION +bidimensional I-EXPLORATION +transtorácico I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +vegetaciones I-EXPLORATION +valvulares. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +alteraciones. I-EXPLORATION +Al B-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +72 I-EVOLUTION +hs I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +evidente. I-EVOLUTION +Dada B-TREATMENT +la I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +postquirúrgica I-TREATMENT +y I-TREATMENT +habiendo I-TREATMENT +aislado I-TREATMENT +en I-TREATMENT +todas I-TREATMENT +las I-TREATMENT +muestras I-TREATMENT +S. I-TREATMENT +aureus I-TREATMENT +sensible I-TREATMENT +a I-TREATMENT +meticilina I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +cefalexina I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +evolucionando B-EVOLUTION +favorablemente. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +nacionalidad I-PAST_MEDICAL_HISTORY +chilena, I-PAST_MEDICAL_HISTORY +residente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Italia I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +aproximadamente. I-PAST_MEDICAL_HISTORY +Presentó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +coxalgia I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +realizándose B-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +neo-formación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ala I-EXPLORATION +ilíaca I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +infiltración I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +muscular I-EXPLORATION +adyacente. I-EXPLORATION +Una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +linfoma I-EXPLORATION +no-Hodgkin, I-EXPLORATION +isotipo I-EXPLORATION +linfo-plasmocitario. I-EXPLORATION +Asociado I-EXPLORATION +a I-EXPLORATION +esto, I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +falla I-EXPLORATION +renal I-EXPLORATION +aguda I-EXPLORATION +con I-EXPLORATION +hipercalcemia I-EXPLORATION +y I-EXPLORATION +proteinuria, I-EXPLORATION +principalmente I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +Bence I-EXPLORATION +Jones, I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +componente I-EXPLORATION +monoclonal I-EXPLORATION +tipo I-EXPLORATION +IgD-lambda. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +junio I-EVOLUTION +del I-EVOLUTION +año I-EVOLUTION +2011 I-EVOLUTION +ingresó I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Hemato-Oncología I-EVOLUTION +del I-EVOLUTION +Hospital I-EVOLUTION +de I-EVOLUTION +Lucca, I-EVOLUTION +Italia, I-EVOLUTION +iniciándose B-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +bortezomib I-TREATMENT +más I-TREATMENT +dexame-tasona, I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +ácido I-TREATMENT +zolendrónico. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +julio I-EXPLORATION +de I-EXPLORATION +2011 I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +debido I-EXPLORATION +al I-EXPLORATION +deterioro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +nefropatía I-EXPLORATION +tubulo-intersticial, I-EXPLORATION +comenzando I-EXPLORATION +con I-EXPLORATION +terapia I-EXPLORATION +de I-EXPLORATION +sustitución I-EXPLORATION +renal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +centro. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +agosto I-EVOLUTION +de I-EVOLUTION +2011 I-EVOLUTION +se I-EVOLUTION +reevaluó I-EVOLUTION +al I-EVOLUTION +paciente, I-EVOLUTION +el I-EVOLUTION +que I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión, I-EVOLUTION +siendo I-EVOLUTION +internado I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +Hematología I-EVOLUTION +del I-EVOLUTION +Hospital I-EVOLUTION +Universitario I-EVOLUTION +de I-EVOLUTION +Pisa. I-EVOLUTION +Se B-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +un I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +VDT-PACE I-TREATMENT +(bortezomib, I-TREATMENT +talidomida, I-TREATMENT +dexametasona, I-TREATMENT +cisplatino, I-TREATMENT +doxorrubicina, I-TREATMENT +ciclofosfamida I-TREATMENT +y I-TREATMENT +etopósido). I-TREATMENT +Previo B-EVOLUTION +a I-EVOLUTION +esto, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +habría I-EVOLUTION +sufrido I-EVOLUTION +una I-EVOLUTION +gastrectomía I-EVOLUTION +parcial I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +úlcera I-EVOLUTION +péptica I-EVOLUTION +perforada. I-EVOLUTION + I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +luego I-TREATMENT +continuar I-TREATMENT +con I-TREATMENT +un I-TREATMENT +esquema I-TREATMENT +CHOP I-TREATMENT +(ciclofosfamida, I-TREATMENT +doxirrubicinada, I-TREATMENT +vincristina, I-TREATMENT +prednisona), I-TREATMENT +recibiendo I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +ciclo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +centro. I-TREATMENT +En B-EXPLORATION +evaluaciones I-EXPLORATION +sucesivas I-EXPLORATION +durante I-EXPLORATION +su I-EXPLORATION +hospitalización, I-EXPLORATION +la I-EXPLORATION +ecotomografía I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +compromiso I-EXPLORATION +infiltrativo I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +ala I-EXPLORATION +ilíaca I-EXPLORATION +derecha I-EXPLORATION +hasta I-EXPLORATION +las I-EXPLORATION +asas I-EXPLORATION +intestinales, I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +tamizaje I-EXPLORATION +con I-EXPLORATION +hisopado I-EXPLORATION +rectal I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +Klebsiella I-EXPLORATION +pneumoniae I-EXPLORATION +multi-resistente. I-EXPLORATION + I-EXPLORATION +Estando B-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +domicilio I-EVOLUTION +en I-EVOLUTION +Italia, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +varias I-EVOLUTION +crisis I-EVOLUTION +convulsivas I-EVOLUTION +que I-EVOLUTION +fueron I-EVOLUTION +atribuidas I-EVOLUTION +a I-EVOLUTION +trastornos I-EVOLUTION +metabólicos. I-EVOLUTION +Se I-EVOLUTION +descartó I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +lesiones I-EVOLUTION +intracerebrales. I-EVOLUTION +Fue B-DERIVED_FROM/TO +referido I-DERIVED_FROM/TO +entonces I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Versilia, I-DERIVED_FROM/TO +Italia; I-DERIVED_FROM/TO +recibió B-TREATMENT +allí I-TREATMENT +un I-TREATMENT +segundo I-TREATMENT +y I-TREATMENT +tercer I-TREATMENT +ciclo I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +CHOP, I-TREATMENT +el I-TREATMENT +22.12.2011 I-TREATMENT +y I-TREATMENT +el I-TREATMENT +19.01.2012, I-TREATMENT +respectivamente, I-TREATMENT +presentando I-TREATMENT +aplasia I-TREATMENT +medular I-TREATMENT +secundaria I-TREATMENT +que I-TREATMENT +requirió I-TREATMENT +apoyo I-TREATMENT +con I-TREATMENT +estimulador I-TREATMENT +de I-TREATMENT +colonia I-TREATMENT +de I-TREATMENT +granulocitos I-TREATMENT +y I-TREATMENT +eritropoyetina. I-TREATMENT + I-TREATMENT +Viajó I-TREATMENT +desde I-TREATMENT +Italia I-TREATMENT +a I-TREATMENT +Chile, I-TREATMENT +ingresando I-TREATMENT +directamente I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +aeropuerto I-TREATMENT +de I-TREATMENT +Santiago I-TREATMENT +el I-TREATMENT +día I-TREATMENT +28.02.2012 I-TREATMENT +al I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Medicina I-TREATMENT +del I-TREATMENT +Hospital I-TREATMENT +Clínico I-TREATMENT +San I-TREATMENT +Borja I-TREATMENT +Arriarán, I-TREATMENT +para I-TREATMENT +coordinar I-TREATMENT +la I-TREATMENT +hemodiálisis I-TREATMENT +y I-TREATMENT +evaluación I-TREATMENT +por I-TREATMENT +el I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +hemato-oncología I-TREATMENT +para I-TREATMENT +eventual I-TREATMENT +quimioterapia I-TREATMENT +paliativa. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +procedimiento I-TREATMENT +de I-TREATMENT +hemodiálisis I-TREATMENT +el I-TREATMENT +día I-TREATMENT +01.03.2012 I-TREATMENT +presentando B-EVOLUTION +fiebre I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +hemocultivos I-EXPLORATION +con I-EXPLORATION +tiempo I-EXPLORATION +diferencial I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +una I-EXPLORATION +infección I-EXPLORATION +del I-EXPLORATION +tracto I-EXPLORATION +sanguíneo I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +catéter I-EXPLORATION +venoso I-EXPLORATION +central, I-EXPLORATION +y I-EXPLORATION +urocultivo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +6 I-EXPLORATION +de I-EXPLORATION +marzo I-EXPLORATION +de I-EXPLORATION +2012 I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +urocultivo I-EXPLORATION +una I-EXPLORATION +cepa I-EXPLORATION +de I-EXPLORATION +K. I-EXPLORATION +pneumoniae I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +ami-noglucósidos, I-EXPLORATION +quinolonas, I-EXPLORATION +β-lactámicos, I-EXPLORATION +cefalosporinas I-EXPLORATION +y I-EXPLORATION +carbapenémicos I-EXPLORATION +con I-EXPLORATION +halo I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm I-EXPLORATION +(de I-EXPLORATION +contacto) I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +retuvo I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +dado I-EXPLORATION +el I-EXPLORATION +perfil I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +no I-EXPLORATION +descrito I-EXPLORATION +antes I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +país. I-EXPLORATION +Además I-EXPLORATION +de I-EXPLORATION +lo I-EXPLORATION +anterior, I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +series I-EXPLORATION +de I-EXPLORATION +hemocultivos I-EXPLORATION +de I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +positividad I-EXPLORATION +diferencial I-EXPLORATION +un I-EXPLORATION +bacilo I-EXPLORATION +gramnegativo I-EXPLORATION +no I-EXPLORATION +fermen-tador I-EXPLORATION +que I-EXPLORATION +posteriormente I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Microbiología I-EXPLORATION +del I-EXPLORATION +Hospital I-EXPLORATION +Clínico I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Chile I-EXPLORATION +identificó I-EXPLORATION +como I-EXPLORATION +Achromobacter I-EXPLORATION +denitrificans I-EXPLORATION +realizándose I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +clínico I-EXPLORATION +de I-EXPLORATION +ITS/CVC I-EXPLORATION +e I-EXPLORATION +interpretándose I-EXPLORATION +el I-EXPLORATION +urocultivo I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +bacteriuria I-EXPLORATION +asintomática. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +8 I-EXPLORATION +de I-EXPLORATION +marzo I-EXPLORATION +de I-EXPLORATION +2012, I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Microbiología I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +de I-EXPLORATION +Control I-EXPLORATION +de I-EXPLORATION +Infecciones I-EXPLORATION +obtuvieron I-EXPLORATION +el I-EXPLORATION +antecedente I-EXPLORATION +epidemiológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +procedencia I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +(hospital I-EXPLORATION +en I-EXPLORATION +Italia). I-EXPLORATION +Frente I-EXPLORATION +a I-EXPLORATION +dicho I-EXPLORATION +antecedente I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +la I-EXPLORATION +posible I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +carbapenemasa I-EXPLORATION +KPC I-EXPLORATION +importada, I-EXPLORATION +indicándose I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +portación I-EXPLORATION +de I-EXPLORATION +KPC I-EXPLORATION +mediante I-EXPLORATION +hisopado I-EXPLORATION +rectal. I-EXPLORATION +Se I-EXPLORATION +repitió I-EXPLORATION +el I-EXPLORATION +urocultivo, I-EXPLORATION +se I-EXPLORATION +iniciaron I-EXPLORATION +las I-EXPLORATION +medidas I-EXPLORATION +de I-EXPLORATION +contención I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +transmisión I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +comunicación I-EXPLORATION +vía I-EXPLORATION +correo I-EXPLORATION +electrónico I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +médico I-EXPLORATION +tratante I-EXPLORATION +italiano I-EXPLORATION +para I-EXPLORATION +consultarle I-EXPLORATION +si I-EXPLORATION +la I-EXPLORATION +K. I-EXPLORATION +pneumoniae I-EXPLORATION +multi-resistente I-EXPLORATION +indicada I-EXPLORATION +en I-EXPLORATION +resumen I-EXPLORATION +de I-EXPLORATION +traslado I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +poseedora I-EXPLORATION +de I-EXPLORATION +BLEE I-EXPLORATION +o I-EXPLORATION +KPC. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +equipo I-EXPLORATION +de I-EXPLORATION +hemato-oncología I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +etapificación I-EXPLORATION +con I-EXPLORATION +imágenes I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +compromiso I-EXPLORATION +óseo I-EXPLORATION +difuso I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +extensa I-EXPLORATION +lesión I-EXPLORATION +lítica I-EXPLORATION +del I-EXPLORATION +ilíaco I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tejidos I-EXPLORATION +blandos. I-EXPLORATION +Desde B-TREATMENT +el I-TREATMENT +punto I-TREATMENT +de I-TREATMENT +vista I-TREATMENT +hemato-oncológico, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +sería I-TREATMENT +candidato I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +paliativo I-TREATMENT +dado I-TREATMENT +el I-TREATMENT +estadio I-TREATMENT +actual I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +de I-TREATMENT +base I-TREATMENT +y I-TREATMENT +sus I-TREATMENT +magras I-TREATMENT +condiciones I-TREATMENT +generales. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +11 I-EXPLORATION +de I-EXPLORATION +marzo I-EXPLORATION +se I-EXPLORATION +recibió I-EXPLORATION +confirmación I-EXPLORATION +desde I-EXPLORATION +Italia I-EXPLORATION +del I-EXPLORATION +antecedente I-EXPLORATION +de I-EXPLORATION +KPC. I-EXPLORATION +Se I-EXPLORATION +logró I-EXPLORATION +identificar I-EXPLORATION +nuevamente I-EXPLORATION +una I-EXPLORATION +K. I-EXPLORATION +pneumoniae I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +antimicrobianos I-EXPLORATION +excepto I-EXPLORATION +colistin I-EXPLORATION +y I-EXPLORATION +tigeciclina I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +urocultivo I-EXPLORATION +e I-EXPLORATION +hisopado I-EXPLORATION +rectal, I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +estudiados I-EXPLORATION +con I-EXPLORATION +batería I-EXPLORATION +bioquímica I-EXPLORATION +convencional I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +especie I-EXPLORATION +y I-EXPLORATION +antibio-grama I-EXPLORATION +por I-EXPLORATION +difusión I-EXPLORATION +con I-EXPLORATION +discos I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +a I-EXPLORATION +estándares I-EXPLORATION +CLSI6. I-EXPLORATION +Siguiendo I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +vigilancia I-EXPLORATION +acordado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Grupo I-EXPLORATION +Colaborativo I-EXPLORATION +de I-EXPLORATION +Resistencia I-EXPLORATION +de I-EXPLORATION +Chile I-EXPLORATION +(datos I-EXPLORATION +no I-EXPLORATION +publicados I-EXPLORATION +Reunión-Curso I-EXPLORATION +de I-EXPLORATION +Resistencia I-EXPLORATION +Santa I-EXPLORATION +Cruz I-EXPLORATION +2009), I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +fue I-EXPLORATION +derivada I-EXPLORATION +al I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Microbiología I-EXPLORATION +Molecular I-EXPLORATION +del I-EXPLORATION +Departamento I-EXPLORATION +de I-EXPLORATION +Laboratorios I-EXPLORATION +Clínicos I-EXPLORATION +Pontificia I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Chile I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +de I-EXPLORATION +genes I-EXPLORATION +de I-EXPLORATION +resistencia I-EXPLORATION +antimicrobiana. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +día I-EXPLORATION +12 I-EXPLORATION +de I-EXPLORATION +marzo I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +in I-EXPLORATION +vitro I-EXPLORATION +por I-EXPLORATION +CIM I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +de I-EXPLORATION +K. I-EXPLORATION +pneumoniae I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +test I-EXPLORATION +fenotípicos6 I-EXPLORATION +de I-EXPLORATION +Hodge I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +borónico, I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +a I-EXPLORATION +estándares I-EXPLORATION +CLSI. I-EXPLORATION +Se I-EXPLORATION +obtuvo I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +ambos I-EXPLORATION +test I-EXPLORATION +fenotípicos I-EXPLORATION +confirmándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +blaKPC I-EXPLORATION +(grupo I-EXPLORATION +KPC-2/ I-EXPLORATION +KPC-3), I-EXPLORATION +blaTEM I-EXPLORATION +y I-EXPLORATION +bla I-EXPLORATION +Se I-EXPLORATION +descartaron I-EXPLORATION +β-lactamasas I-EXPLORATION +tipo I-EXPLORATION +CTX-M, I-EXPLORATION +β-lactamasas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +familia I-EXPLORATION +AmpC, I-EXPLORATION +metalo-β-lactamasas I-EXPLORATION +(blaIMI I-EXPLORATION +blaVIM I-EXPLORATION +blaNDM-1), I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +car I-EXPLORATION +bapenemasas I-EXPLORATION +del I-EXPLORATION +grupo I-EXPLORATION +A I-EXPLORATION +(blaGES I-EXPLORATION +blaIMI I-EXPLORATION +blaSME). I-EXPLORATION + I-EXPLORATION +Finalmente, I-EXPLORATION +el I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública, I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +hallazgo I-EXPLORATION +de I-EXPLORATION +KPC I-EXPLORATION +(KPC-2/KPC-3) I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION +13 I-EXPLORATION +de I-EXPLORATION +marzo. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +corporal, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +parálisis I-PAST_MEDICAL_HISTORY +cerebral I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +asfixia I-PAST_MEDICAL_HISTORY +neonatal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +epilepsia, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +prolongado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +valproico I-PAST_MEDICAL_HISTORY +oral, I-PAST_MEDICAL_HISTORY +32 I-PAST_MEDICAL_HISTORY +mg/kg/día I-PAST_MEDICAL_HISTORY +administrados I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sonda I-PAST_MEDICAL_HISTORY +nasogástrica I-PAST_MEDICAL_HISTORY +(SNG). I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +UPC I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +neumonía I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +adenovirus, I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +grave I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +shock I-PRESENT_ILLNESS +séptico-hipovolémico I-PRESENT_ILLNESS +refractario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +catecolaminas, I-PRESENT_ILLNESS +recibiendo B-TREATMENT +hidrocortisona I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +estrés I-TREATMENT +y I-TREATMENT +asociándose I-TREATMENT +terapia I-TREATMENT +antimicrobiana I-TREATMENT +con I-TREATMENT +cefotaxima, I-TREATMENT +clindamicina I-TREATMENT +y I-TREATMENT +amikacina I-TREATMENT +iv. I-TREATMENT +El B-EVOLUTION +octavo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +se I-EVOLUTION +tomó I-EVOLUTION +un I-EVOLUTION +nivel I-EVOLUTION +plasmático I-EVOLUTION +de I-EVOLUTION +ácido I-EVOLUTION +valproico, I-EVOLUTION +el I-EVOLUTION +que I-EVOLUTION +resultó I-EVOLUTION +en I-EVOLUTION +90, I-EVOLUTION +1 I-EVOLUTION +μg/ml. I-EVOLUTION +El I-EVOLUTION +décimo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +deterioro I-EVOLUTION +hemodinámico I-EVOLUTION +y I-EVOLUTION +respiratorio, I-EVOLUTION +con I-EVOLUTION +cultivo I-EVOLUTION +de I-EVOLUTION +aspirado I-EVOLUTION +traqueal I-EVOLUTION +para I-EVOLUTION +Pseudomonas I-EVOLUTION +aeruginosa, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +esquema I-TREATMENT +antimicrobiano I-TREATMENT +a I-TREATMENT +vancomicina I-TREATMENT +y I-TREATMENT +meropenem I-TREATMENT +(120 I-TREATMENT +mg/kg/día), I-TREATMENT +manteniendo I-TREATMENT +amikacina. I-TREATMENT +Tras B-EXPLORATION +cinco I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +meropenem I-EXPLORATION +se I-EXPLORATION +monitorizó I-EXPLORATION +el I-EXPLORATION +ácido I-EXPLORATION +valproico, I-EXPLORATION +encontrándose I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +plasmático I-EXPLORATION +< I-EXPLORATION +3 I-EXPLORATION +μg/ I-EXPLORATION +ml. I-EXPLORATION +Por B-TREATMENT +estrategia I-TREATMENT +de I-TREATMENT +de-escalamiento I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +carbapenémico. I-TREATMENT +El B-EVOLUTION +ácido I-EVOLUTION +valproico I-EVOLUTION +se I-EVOLUTION +aumentó I-EVOLUTION +a I-EVOLUTION +45 I-EVOLUTION +mg/kg/día, I-EVOLUTION +controlándose I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +nivel I-EVOLUTION +plasmático I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +de I-EVOLUTION +meropenem, I-EVOLUTION +cuyo I-EVOLUTION +resultado I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +55 I-EVOLUTION +μg/ml. I-EVOLUTION +Catorce I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +de I-EVOLUTION +mero-penem I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +nuevo I-EVOLUTION +deterioro I-EVOLUTION +hemodinámico I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +sepsis I-EVOLUTION +por I-EVOLUTION +Enterobacter I-EVOLUTION +cloacae I-EVOLUTION +identificada I-EVOLUTION +en I-EVOLUTION +hemocultivos I-EVOLUTION +y I-EVOLUTION +secreción I-EVOLUTION +traqueal, I-EVOLUTION +reiniciándose B-TREATMENT +nuevamente I-TREATMENT +el I-TREATMENT +carbapenémico I-TREATMENT +a I-TREATMENT +igual I-TREATMENT +dosis I-TREATMENT +que I-TREATMENT +la I-TREATMENT +vez I-TREATMENT +anterior, I-TREATMENT +provocando B-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +caída I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +niveles I-EVOLUTION +plasmáticos I-EVOLUTION +de I-EVOLUTION +ácido I-EVOLUTION +valproico I-EVOLUTION +a I-EVOLUTION +< I-EVOLUTION +3 I-EVOLUTION +μg/ml, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +reiniciado. I-EVOLUTION +Se B-TREATMENT +mantuvo I-TREATMENT +con I-TREATMENT +igual I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +valproato. I-TREATMENT +Transcurridos B-EVOLUTION +20 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +terapia I-EVOLUTION +carbapenémica I-EVOLUTION +falleció I-EVOLUTION +por I-EVOLUTION +falla I-EVOLUTION +hipoxémica I-EVOLUTION +refractaria. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +crónico, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hemitórax I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cuanti-ficada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +sensible I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +músculo I-PRESENT_ILLNESS +pectoral I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +La B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +opacidad I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +mal I-EXPLORATION +definidos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +perihiliar I-EXPLORATION +izquierda. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +3 I-EXPLORATION +por I-EXPLORATION +5, I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +pulmonar I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +(flecha I-EXPLORATION +larga I-EXPLORATION +Figura I-EXPLORATION +1B) I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +extenso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +torácica I-EXPLORATION +anterior, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +invasión I-EXPLORATION +ni I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +estructuras I-EXPLORATION +bronquio-vasculares I-EXPLORATION +centrales, I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +neoplásica I-EXPLORATION +broncogénica I-EXPLORATION +periférica I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +adenopatías I-EXPLORATION +hiliares I-EXPLORATION +y I-EXPLORATION +mediastínicas I-EXPLORATION +ipsilaterales I-EXPLORATION +(flecha I-EXPLORATION +corta I-EXPLORATION +Figura I-EXPLORATION +1B). I-EXPLORATION +Con I-EXPLORATION +estos I-EXPLORATION +hallazgos, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +carina, I-EXPLORATION +língula I-EXPLORATION +y I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +intraluminales. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +tres I-EXPLORATION +muestras I-EXPLORATION +transbronquiales I-EXPLORATION +cuya I-EXPLORATION +biopsia I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +bronquitis I-EXPLORATION +crónica I-EXPLORATION +inespecífica I-EXPLORATION +con I-EXPLORATION +metaplasia I-EXPLORATION +escamosa I-EXPLORATION +incompleta. I-EXPLORATION +Fue B-EVOLUTION +internado I-EVOLUTION +para I-EVOLUTION +completar I-EVOLUTION +su I-EVOLUTION +estudio I-EVOLUTION +evolucionando I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +persistente I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +masa I-EVOLUTION +tumoral, I-EVOLUTION +sin I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +hemodinamia I-EVOLUTION +estable. I-EVOLUTION +Dentro B-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +(hemoglobina I-EXPLORATION +9, I-EXPLORATION +5 I-EXPLORATION +g/dl), I-EXPLORATION +trombocitosis I-EXPLORATION +(776.000 I-EXPLORATION +/mm3) I-EXPLORATION +y I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +izquierda I-EXPLORATION +(42.600/ I-EXPLORATION +mm3 I-EXPLORATION +con I-EXPLORATION +37% I-EXPLORATION +de I-EXPLORATION +baciliformes). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +mielograma I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +hiperplasia I-EXPLORATION +mieloide I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +médula I-EXPLORATION +reactiva I-EXPLORATION +sin I-EXPLORATION +constituir I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +hematológica. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +percutánea I-EXPLORATION +por I-EXPLORATION +radiología I-EXPLORATION +intervencional I-EXPLORATION +que I-EXPLORATION +dio I-EXPLORATION +salida I-EXPLORATION +a I-EXPLORATION +contenido I-EXPLORATION +purulento, I-EXPLORATION +cuyo I-EXPLORATION +cultivo I-EXPLORATION +bacteriano I-EXPLORATION +aeróbico I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Por B-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +costal I-TREATMENT +abscedado, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +quirúrgico I-TREATMENT +del I-TREATMENT +absceso, I-TREATMENT +aseo I-TREATMENT +y I-TREATMENT +desbridamiento I-TREATMENT +del I-TREATMENT +tejido I-TREATMENT +desvitalizado. I-TREATMENT +Se I-TREATMENT +tomó I-TREATMENT +una I-TREATMENT +muestra I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +torácica I-TREATMENT +para I-TREATMENT +biopsia I-TREATMENT +y I-TREATMENT +se I-TREATMENT +instaló I-TREATMENT +un I-TREATMENT +sistema I-TREATMENT +aspirativo I-TREATMENT +para I-TREATMENT +cierre I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +actinomicosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +torácica, I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +piel, I-EXPLORATION +tejido I-EXPLORATION +subcutáneo, I-EXPLORATION +músculo I-EXPLORATION +pectoral I-EXPLORATION +y I-EXPLORATION +porción I-EXPLORATION +perióstica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +costilla, I-EXPLORATION +sin I-EXPLORATION +elementos I-EXPLORATION +histológicos I-EXPLORATION +malignos. I-EXPLORATION +Fue B-TREATMENT +evaluado I-TREATMENT +por I-TREATMENT +el I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +infectología I-TREATMENT +decidiéndose I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +G I-TREATMENT +sódica I-TREATMENT +i.v. I-TREATMENT +durante I-TREATMENT +2 I-TREATMENT +semanas. I-TREATMENT +Evolucionó B-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +con I-EVOLUTION +regresión I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios I-EVOLUTION +y I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +débito I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +drenajes. I-EVOLUTION +A B-TREATMENT +las I-TREATMENT +tres I-TREATMENT +semanas I-TREATMENT +postoperatorias I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +el I-TREATMENT +último I-TREATMENT +aseo I-TREATMENT +quirúrgico I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +definitivo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +amoxicilina I-EVOLUTION +hasta I-EVOLUTION +completar I-EVOLUTION +tres I-EVOLUTION +meses. I-EVOLUTION +Se I-EVOLUTION +mantuvo I-EVOLUTION +en I-EVOLUTION +controles I-EVOLUTION +ambulatorios, I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +control I-EVOLUTION +radiológico I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +siete I-EVOLUTION +meses I-EVOLUTION +postoperatorios I-EVOLUTION +que I-EVOLUTION +mostró I-EVOLUTION +regresión I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión. I-EVOLUTION + I-EVOLUTION + +RNT B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +gestación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +semanas, I-PRESENT_ILLNESS +AEG, I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nacimiento I-PRESENT_ILLNESS +3.510 I-PRESENT_ILLNESS +gr I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +talla I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +cm. I-PRESENT_ILLNESS +Apgar B-PAST_MEDICAL_HISTORY +9-10, I-PAST_MEDICAL_HISTORY +segunda I-PAST_MEDICAL_HISTORY +hija I-PAST_MEDICAL_HISTORY +de B-FAMILY_HISTORY +padres I-FAMILY_HISTORY +sanos. I-FAMILY_HISTORY +Nació B-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +electiva I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +anterior. I-PAST_MEDICAL_HISTORY +La B-FAMILY_HISTORY +madre I-FAMILY_HISTORY +tenía I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +un I-FAMILY_HISTORY +embarazo I-FAMILY_HISTORY +fisiológico, I-FAMILY_HISTORY +una I-FAMILY_HISTORY +infección I-FAMILY_HISTORY +urinaria I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +primer I-FAMILY_HISTORY +trimestre I-FAMILY_HISTORY +de I-FAMILY_HISTORY +gestación I-FAMILY_HISTORY +y I-FAMILY_HISTORY +detección I-FAMILY_HISTORY +de I-FAMILY_HISTORY +portación I-FAMILY_HISTORY +recto-vaginal I-FAMILY_HISTORY +de I-FAMILY_HISTORY +Streptococcus I-FAMILY_HISTORY +agalactiae I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +tercer I-FAMILY_HISTORY +trimestre I-FAMILY_HISTORY +del I-FAMILY_HISTORY +embarazo. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Inició B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida, I-PRESENT_ILLNESS +movimientos I-PRESENT_ILLNESS +mioclónicos I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hemicuerpo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +estando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +vigilia; I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +notó I-PRESENT_ILLNESS +somnolienta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +demanda I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +alimentos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +llevada I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +(SU) I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +evaluación. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +estaba I-EXPLORATION +febril, I-EXPLORATION +en I-EXPLORATION +relativas I-EXPLORATION +buenas I-EXPLORATION +condiciones I-EXPLORATION +generales, I-EXPLORATION +sin I-EXPLORATION +movimientos I-EXPLORATION +anormales, I-EXPLORATION +fontanela I-EXPLORATION +con I-EXPLORATION +tensión I-EXPLORATION +normal, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +examen I-EXPLORATION +segmentario I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Signos I-EXPLORATION +vitales: I-EXPLORATION +FC I-EXPLORATION +177 I-EXPLORATION +por I-EXPLORATION +min, I-EXPLORATION +FR I-EXPLORATION +52 I-EXPLORATION +por I-EXPLORATION +min, I-EXPLORATION +T° I-EXPLORATION +38, I-EXPLORATION +3° I-EXPLORATION +C I-EXPLORATION +axilar, I-EXPLORATION +P. I-EXPLORATION +arterial I-EXPLORATION +91/55 I-EXPLORATION +mm/Hg, I-EXPLORATION +P. I-EXPLORATION +arterial I-EXPLORATION +media I-EXPLORATION +62 I-EXPLORATION +mm/Hg, I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +O2 I-EXPLORATION +97%. I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +iniciales: I-EXPLORATION +leucocitos I-EXPLORATION +6.800/mm3 I-EXPLORATION +(52% I-EXPLORATION +linfocitos), I-EXPLORATION +hematocrito I-EXPLORATION +40, I-EXPLORATION +7%, I-EXPLORATION +PCR: I-EXPLORATION +0 I-EXPLORATION +mg/L, I-EXPLORATION +perfil I-EXPLORATION +bioquímico I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +hiperbilirrubinemia I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +indirecto. I-EXPLORATION +Examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +normales. I-EXPLORATION +Durante B-EVOLUTION +la I-EVOLUTION +observación I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +SU I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +respiración I-EVOLUTION +irregular, I-EVOLUTION +piel I-EVOLUTION +reticulada I-EVOLUTION +y I-EVOLUTION +movimientos I-EVOLUTION +mioclónicos I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hemicuerpo I-EVOLUTION +derecho I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +cedían I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +contención. I-EVOLUTION +Por B-TREATMENT +su I-TREATMENT +condición I-TREATMENT +clínica I-TREATMENT +se I-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +apoyo I-TREATMENT +con I-TREATMENT +oxígeno, I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +isotónica I-TREATMENT +(NaCl I-TREATMENT +9%) I-TREATMENT +20 I-TREATMENT +ml/kg I-TREATMENT +en I-TREATMENT +bolo, I-TREATMENT +lorazepam I-TREATMENT +0. I-TREATMENT +1 I-TREATMENT +mg/kg I-TREATMENT +i.v., I-TREATMENT +iniciándose I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +ampicilina I-TREATMENT ++ I-TREATMENT +cefotaxima I-TREATMENT +i.v. I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +obtener I-TREATMENT +hemocultivos I-TREATMENT +y I-TREATMENT +las I-TREATMENT +muestras I-TREATMENT +de I-TREATMENT +LCR. I-TREATMENT +El B-EXPLORATION +análisis I-EXPLORATION +citoquímico I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +directa I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +bacterias I-EXPLORATION +(muestra I-EXPLORATION +1, I-EXPLORATION +Tabla I-EXPLORATION +1). I-EXPLORATION +Un I-EXPLORATION +ml I-EXPLORATION +adicional I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +se I-EXPLORATION +guardó I-EXPLORATION +a I-EXPLORATION +4°C I-EXPLORATION +para I-EXPLORATION +estudios I-EXPLORATION +posteriores I-EXPLORATION +de I-EXPLORATION +biología I-EXPLORATION +molecular. I-EXPLORATION + I-EXPLORATION +Se B-DERIVED_FROM/TO +trasladó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cuidados I-DERIVED_FROM/TO +Intensivos I-DERIVED_FROM/TO +Neonatales I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +monitorización. I-DERIVED_FROM/TO +A B-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +internación, I-EVOLUTION +nuevamente I-EVOLUTION +presentó I-EVOLUTION +fiebre, I-EVOLUTION +hiporreactividad, I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +fijación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mirada I-EVOLUTION +con I-EVOLUTION +repetición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +crisis I-EVOLUTION +convulsiva I-EVOLUTION +focal. I-EVOLUTION +Se B-EXPLORATION +plantearon I-EXPLORATION +como I-EXPLORATION +posibles I-EXPLORATION +diagnósticos I-EXPLORATION +una I-EXPLORATION +meningitis I-EXPLORATION +bacteriana I-EXPLORATION +aguda I-EXPLORATION +inicial I-EXPLORATION +o I-EXPLORATION +una I-EXPLORATION +encefalitis I-EXPLORATION +herpética I-EXPLORATION +por I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +repetir I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +y B-TREATMENT +adicionar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +antimicrobiana, I-TREATMENT +aciclovir I-TREATMENT +i.v. I-TREATMENT +60 I-TREATMENT +mg/kg/día I-TREATMENT +fraccionado I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +h. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +citoquímico I-EXPLORATION +del I-EXPLORATION +segundo I-EXPLORATION +LCR I-EXPLORATION +destacó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +190 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +con I-EXPLORATION +predominio I-EXPLORATION +mononuclear I-EXPLORATION +(79%), I-EXPLORATION +170 I-EXPLORATION +eritrocitos/mm3, I-EXPLORATION +glucorraquia I-EXPLORATION +y I-EXPLORATION +proteínorraquia I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +directa I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +bacterias I-EXPLORATION +(muestra I-EXPLORATION +2, I-EXPLORATION +Tabla I-EXPLORATION +1). I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +RPC I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +cualitativa I-EXPLORATION +para I-EXPLORATION +VHS I-EXPLORATION +tipos I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +2 I-EXPLORATION +(herpes I-EXPLORATION +simplex I-EXPLORATION +virus I-EXPLORATION +1/2 I-EXPLORATION +Real I-EXPLORATION +Time I-EXPLORATION +PCR I-EXPLORATION +kit, I-EXPLORATION +InsideGen® I-EXPLORATION +Bioscan, I-EXPLORATION +Chile) I-EXPLORATION +sin I-EXPLORATION +lograrse I-EXPLORATION +la I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +ADN I-EXPLORATION +viral. I-EXPLORATION +Pese B-TREATMENT +al I-TREATMENT +resultado I-TREATMENT +negativo I-TREATMENT +de I-TREATMENT +RPC-TR I-TREATMENT +a I-TREATMENT +las I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +de I-TREATMENT +iniciado I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +clínico, I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +aciclovir I-TREATMENT +1. I-TREATMENT +v. I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +permanecía I-TREATMENT +con I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +conciencia I-TREATMENT +y I-TREATMENT +crisis I-TREATMENT +focales. I-TREATMENT + I-TREATMENT +Una B-EXPLORATION +TAC I-EXPLORATION +cerebral, I-EXPLORATION +al I-EXPLORATION +segundo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización, I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +electroencefalograma I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +lentitud I-EXPLORATION +hipovoltada I-EXPLORATION +difusa I-EXPLORATION +y I-EXPLORATION +ocasionales I-EXPLORATION +paroxismos I-EXPLORATION +agudos I-EXPLORATION +multifocales. I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +administró I-TREATMENT +fenobarbital I-TREATMENT +15 I-TREATMENT +mg/ I-TREATMENT +kg I-TREATMENT +i.v. I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +5 I-TREATMENT +mg/kg/día I-TREATMENT +v.o. I-TREATMENT +como I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +mantención. I-TREATMENT +Los B-EXPLORATION +cultivos I-EXPLORATION +bacteriológicos I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +y I-EXPLORATION +segundo I-EXPLORATION +LCR I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +del I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +conciencia, I-EVOLUTION +posturas I-EVOLUTION +anormales I-EVOLUTION +en I-EVOLUTION +reposo, I-EVOLUTION +crisis I-EVOLUTION +clónicas I-EVOLUTION +multifocales I-EVOLUTION +múltiples I-EVOLUTION +y B-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +alta I-EXPLORATION +sospecha I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +encefalitis I-EXPLORATION +herpética, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +tercera I-EXPLORATION +RPC-TR I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +para I-EXPLORATION +VHS I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +2 I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +iniciado I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +clínico I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +24 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +comenzar I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +aciclovir, I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +VHS I-EXPLORATION +1 I-EXPLORATION +(muestra I-EXPLORATION +3, I-EXPLORATION +Tabla I-EXPLORATION +1). I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +funciones I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +renal I-EXPLORATION +fueron I-EXPLORATION +normales, I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +oftalmológica. I-EXPLORATION +Las B-EVOLUTION +manifestaciones I-EVOLUTION +convulsivas I-EVOLUTION +persistieron I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización. I-EVOLUTION +De I-EVOLUTION +allí I-EVOLUTION +en I-EVOLUTION +adelante, I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +apreció I-EVOLUTION +alerta, I-EVOLUTION +con I-EVOLUTION +succión I-EVOLUTION +vigorosa, I-EVOLUTION +sin I-EVOLUTION +nuevas I-EVOLUTION +crisis, I-EVOLUTION +destacando I-EVOLUTION +sólo I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +tembloroso I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +superior I-EVOLUTION +izquierda. I-EVOLUTION + I-EVOLUTION +Una B-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +efectuada I-EXPLORATION +al I-EXPLORATION +día I-EXPLORATION +10 I-EXPLORATION +de I-EXPLORATION +internación I-EXPLORATION +evidenció I-EXPLORATION +lesiones I-EXPLORATION +hiperintensas I-EXPLORATION +subcorticales I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +peri-rolándica I-EXPLORATION +bilateral, I-EXPLORATION +frontomedial I-EXPLORATION +e I-EXPLORATION +insular I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +impregnación I-EXPLORATION +leptomeníngea I-EXPLORATION +focal, I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +meningo-encefalitis. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +obtener I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +RPC-TR I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +VHS I-EXPLORATION +1, I-EXPLORATION +se I-EXPLORATION +reinterrogó I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +madre I-EXPLORATION +dirigidamente I-EXPLORATION +quien I-EXPLORATION +relató I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +padre I-EXPLORATION +habría I-EXPLORATION +presentado I-EXPLORATION +una I-EXPLORATION +erupción I-EXPLORATION +labial I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +herpes I-EXPLORATION +labial I-EXPLORATION +dos I-EXPLORATION +semanas I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +enfermar I-EXPLORATION +la I-EXPLORATION +niña I-EXPLORATION +y I-EXPLORATION +tenía I-EXPLORATION +recurrencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +20 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +antiviral I-EXPLORATION +se I-EXPLORATION +controló I-EXPLORATION +el I-EXPLORATION +LCR I-EXPLORATION +certificándose I-EXPLORATION +la I-EXPLORATION +negatividad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +RPC-TR I-EXPLORATION +para I-EXPLORATION +VHS I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +2 I-EXPLORATION +en I-EXPLORATION +LCR. I-EXPLORATION +Completó B-TREATMENT +21 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +aciclovir, I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT + I-TREATMENT +Desde B-EVOLUTION +su I-EVOLUTION +alta, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +controló I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +sistemática I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +Policlínicas I-EVOLUTION +de I-EVOLUTION +Infectología I-EVOLUTION +y I-EVOLUTION +Neurología I-EVOLUTION +infantil. I-EVOLUTION +En I-EVOLUTION +nuestra I-EVOLUTION +última I-EVOLUTION +evaluación, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +vida, I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +una I-EVOLUTION +lactante I-EVOLUTION +eutrófica I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +significativo I-EVOLUTION +retraso I-EVOLUTION +del I-EVOLUTION +desarrollo I-EVOLUTION +psicomotor. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sano, I-PAST_MEDICAL_HISTORY +originario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Concepción I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +radicado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +AAntofagasta I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año. I-PAST_MEDICAL_HISTORY +Fue B-PRESENT_ILLNESS +internado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +privado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +alta, I-PRESENT_ILLNESS +mialgias, I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +seca I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +alimentarios. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +viajado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Región I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Bío-Bío I-PAST_MEDICAL_HISTORY +(zona I-PAST_MEDICAL_HISTORY +urbana I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Concepción) I-PAST_MEDICAL_HISTORY +36 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +tenido I-PAST_MEDICAL_HISTORY +contacto I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +amigo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +cursando I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +diarreico. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +presentaba I-EXPLORATION +escasas I-EXPLORATION +crepitaciones I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +consolidación. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +28.400 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +y I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +(63% I-EXPLORATION +segmentados I-EXPLORATION +y I-EXPLORATION +17% I-EXPLORATION +baciliformes), I-EXPLORATION +35.000 I-EXPLORATION +plaquetas/mm3, I-EXPLORATION +PCR I-EXPLORATION +7, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +(N I-EXPLORATION += I-EXPLORATION +0-1), I-EXPLORATION +LDH I-EXPLORATION +y I-EXPLORATION +transaminasas I-EXPLORATION +elevadas. I-EXPLORATION +Al B-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +presentó I-EVOLUTION +disnea, I-EVOLUTION +polipnea I-EVOLUTION +e I-EVOLUTION +hipoxemia. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +opacidades I-EXPLORATION +pulmonares I-EXPLORATION +bilaterales. I-EXPLORATION +Se B-DERIVED_FROM/TO +trasladó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cuidados I-DERIVED_FROM/TO +Intensivos I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +conectó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +ventilación I-DERIVED_FROM/TO +mecánica. I-DERIVED_FROM/TO +Evolucionó B-EVOLUTION +rápidamente I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +SDRA I-EVOLUTION +y I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +disfunción I-EVOLUTION +multiorgánica. I-EVOLUTION +Se B-TREATMENT +manejó I-TREATMENT +con I-TREATMENT +corticoesteroides I-TREATMENT +i.v., I-TREATMENT +aminas I-TREATMENT +vasoactivas, I-TREATMENT +antimicrobianos I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro I-TREATMENT +y I-TREATMENT +oseltamivir I-TREATMENT +empíricos. I-TREATMENT +La B-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +y I-EXPLORATION +RPC I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +influenza I-EXPLORATION +A I-EXPLORATION +H1N1, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +hantavirus I-EXPLORATION +al I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública. I-EXPLORATION +Al B-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +falleció I-EVOLUTION +por I-EVOLUTION +hipotensión I-EVOLUTION +arterial I-EVOLUTION +refractaria, I-EVOLUTION +oligoanuria, I-EVOLUTION +hipoxemia I-EVOLUTION +y I-EVOLUTION +acidosis I-EVOLUTION +metabólica I-EVOLUTION +grave. I-EVOLUTION +Postmortem B-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +una I-EXPLORATION +serología I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +hantavirus I-EXPLORATION +(IgM I-EXPLORATION +e I-EXPLORATION +IgG) I-EXPLORATION +10. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +adquirida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +transmisión I-PAST_MEDICAL_HISTORY +vertical, I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +cutáneas I-PRESENT_ILLNESS +maculares I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +necrótico. I-PRESENT_ILLNESS +Posteriormente, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +agregó I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefaleas I-PRESENT_ILLNESS +intensas I-PRESENT_ILLNESS +asociadas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +internado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +probable I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +meningitis. I-PRESENT_ILLNESS +Dentro B-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +céfalo-raquídeo I-EXPLORATION +(LCR) I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +tinta I-EXPLORATION +china I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +positiva I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +hubo I-EXPLORATION +aislamiento I-EXPLORATION +de I-EXPLORATION +Cryptococcus I-EXPLORATION +neoformans. I-EXPLORATION +En I-EXPLORATION +ese I-EXPLORATION +momento, I-EXPLORATION +tenía I-EXPLORATION +linfocitos I-EXPLORATION +CD4 I-EXPLORATION +de I-EXPLORATION +158 I-EXPLORATION +céls/mm3 I-EXPLORATION +(9%). I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +deoxicolato I-TREATMENT +i.v I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +fluconazol I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +evolución. I-TREATMENT +Se I-TREATMENT +mantuvo I-TREATMENT +hospitalizado I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +antifúngico I-TREATMENT +durante I-TREATMENT +42 I-TREATMENT +días. I-TREATMENT +Tres I-TREATMENT +meses I-TREATMENT +después I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +monoterapia I-TREATMENT +con I-TREATMENT +zidovudina I-TREATMENT +(AZT), I-TREATMENT +que I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +meses I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +a I-TREATMENT +didanosina I-TREATMENT +(ddI). I-TREATMENT +Posteriormente, I-TREATMENT +recibió I-TREATMENT +biterapia I-TREATMENT +con I-TREATMENT +ddI I-TREATMENT +y I-TREATMENT +ritonavir. I-TREATMENT +Falleció B-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +edad. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +VIH I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +transmisión I-PRESENT_ILLNESS +vertical, I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mala I-PAST_MEDICAL_HISTORY +adherencia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +regímenes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +propuestos, I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +rechazado I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +TAR. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +internado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +enfermedades I-PAST_MEDICAL_HISTORY +intercurrentes I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +microorganismos I-PAST_MEDICAL_HISTORY +habituales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +oportunistas. I-PAST_MEDICAL_HISTORY +Fue B-PRESENT_ILLNESS +internado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +acompañados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5° I-PRESENT_ILLNESS +C I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +exantema I-PRESENT_ILLNESS +máculo-papular I-PRESENT_ILLNESS +generalizado. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +además I-EXPLORATION +del I-EXPLORATION +exantema, I-EXPLORATION +una I-EXPLORATION +desnutrición I-EXPLORATION +secundaria, I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +adenopatías I-EXPLORATION +cervicales, I-EXPLORATION +estertores I-EXPLORATION +húmedos I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +campos I-EXPLORATION +pulmonares, I-EXPLORATION +caries I-EXPLORATION +dentales I-EXPLORATION +y I-EXPLORATION +otorrea I-EXPLORATION +purulenta I-EXPLORATION +a I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +ese I-EXPLORATION +momento I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +(CV) I-EXPLORATION +de I-EXPLORATION +95.000 I-EXPLORATION +copias/ml I-EXPLORATION +y I-EXPLORATION +linfocitos I-EXPLORATION +CD4 I-EXPLORATION +de I-EXPLORATION +26 I-EXPLORATION +céls/mm3. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +antibioterapia, I-TREATMENT +sin B-EVOLUTION +embargo, I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +persistía I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +agregó I-EVOLUTION +cefalea I-EVOLUTION +intensa, I-EVOLUTION +vómitos, I-EVOLUTION +fotofobia I-EVOLUTION +y I-EVOLUTION +acusofobia. I-EVOLUTION + I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal; I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +citoquímico I-EXPLORATION +de I-EXPLORATION +LCR: I-EXPLORATION +glucosa I-EXPLORATION +0, I-EXPLORATION +43 I-EXPLORATION +g/l, I-EXPLORATION +proteínas I-EXPLORATION +1, I-EXPLORATION +15 I-EXPLORATION +gr/l, I-EXPLORATION +celularidad: I-EXPLORATION +5 I-EXPLORATION +leucocitos/mm3; I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +microbio-lógico I-EXPLORATION +directo I-EXPLORATION +(tinta I-EXPLORATION +china) I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +C. I-EXPLORATION +neoformans. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +deoxicolato I-TREATMENT +i.v. I-TREATMENT +durante I-TREATMENT +21 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +fluconazol I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +en I-TREATMENT +plan I-TREATMENT +de I-TREATMENT +mantención. I-TREATMENT +Hubo B-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +21 I-EXPLORATION +días I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +con I-EXPLORATION +cultivo I-EXPLORATION +negativo. I-EXPLORATION +Fue B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +33 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +ya I-EVOLUTION +evidenciaba I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +y I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general. I-EVOLUTION +El B-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +genotipificación I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +mutaciones I-EXPLORATION +asociadas I-EXPLORATION +a I-EXPLORATION +resistencia I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +AZT, I-TREATMENT +lamivudina I-TREATMENT +(3TC) I-TREATMENT +y I-TREATMENT +lopinavir/ritonavir. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cuantificada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +odinofagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +confirmándose I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +candidiasis I-PRESENT_ILLNESS +orofaríngea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +esofágica I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +endoscopia. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +recibió I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +específico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +procedió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +investigar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +posible I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +VIH, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +confirmó. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +enflaquecimiento I-EXPLORATION +marcado I-EXPLORATION +y I-EXPLORATION +lesiones I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +candidiasis I-EXPLORATION +orofaríngea. I-EXPLORATION +Se I-EXPLORATION +encontraba I-EXPLORATION +afebril, I-EXPLORATION +eupneico, I-EXPLORATION +con I-EXPLORATION +examen I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Inició B-TREATMENT +profilaxis I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +960 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +ácido I-TREATMENT +folínico I-TREATMENT +15 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +fluconazol I-TREATMENT +150 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +y I-TREATMENT +terapia I-TREATMENT +anti-retroviral I-TREATMENT +(TAR) I-TREATMENT +con I-TREATMENT +abacavir/lamivudina I-TREATMENT +y I-TREATMENT +efavirenz, I-TREATMENT +con I-TREATMENT +muy I-TREATMENT +buena I-TREATMENT +tolerancia I-TREATMENT +y I-TREATMENT +adherencia. I-TREATMENT +Dos B-EVOLUTION +semanas I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +consultó I-EVOLUTION +por I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +fiebre I-EVOLUTION +hasta I-EVOLUTION +39°C, I-EVOLUTION +cefalea I-EVOLUTION +y I-EVOLUTION +tos I-EVOLUTION +seca. I-EVOLUTION +Se I-EVOLUTION +decidió I-EVOLUTION +su I-EVOLUTION +internación I-EVOLUTION +por I-EVOLUTION +fiebre I-EVOLUTION +de I-EVOLUTION +39°C, I-EVOLUTION +taquicardia I-EVOLUTION +y I-EVOLUTION +saturación I-EVOLUTION +de I-EVOLUTION +oxígeno I-EVOLUTION +de I-EVOLUTION +93% I-EVOLUTION +con I-EVOLUTION +aire I-EVOLUTION +ambiental. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +candidiasis I-EXPLORATION +oral I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +pulmonar I-EXPLORATION +en I-EXPLORATION +esos I-EXPLORATION +momentos I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +algodonoso I-EXPLORATION +difuso I-EXPLORATION +bilateral. I-EXPLORATION +Los I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +expectoración, I-EXPLORATION +urocultivo, I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +baciloscopias I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +La I-EXPLORATION +RPC I-EXPLORATION +para I-EXPLORATION +Pneumocystis I-EXPLORATION +jiroveci I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +expectoración I-EXPLORATION +inducida I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +Se B-TREATMENT +ajustó I-TREATMENT +el I-TREATMENT +cotrimoxazol I-TREATMENT +de I-TREATMENT +dosis I-TREATMENT +profiláctica I-TREATMENT +a I-TREATMENT +terapéutica I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +iv, I-TREATMENT +se I-TREATMENT +agregó I-TREATMENT +prednisona I-TREATMENT +y I-TREATMENT +ceftriaxona I-TREATMENT +iv, I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +ácido I-TREATMENT +folínico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +TAR I-TREATMENT +iniciada I-TREATMENT +recientemente. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +saturación I-EVOLUTION +de I-EVOLUTION +oxígeno I-EVOLUTION +adecuada I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios. I-EVOLUTION +Se B-TREATMENT +dio I-TREATMENT +el I-TREATMENT +alta I-TREATMENT +hospitalaria I-TREATMENT +al I-TREATMENT +quinto I-TREATMENT +día I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +prednisona I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +control I-EVOLUTION +ambulatorio I-EVOLUTION +estaba I-EVOLUTION +completamente I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +radiografía I-EVOLUTION +mostró I-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +del I-EVOLUTION +infiltrado I-EVOLUTION +pulmonar. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +hospitalario I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +atropello I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tejido. I-PRESENT_ILLNESS +Previo B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +ingreso I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +atendido I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +salud I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realizó I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +curación I-DERIVED_FROM/TO +amplia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +herida I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +hemostasia, I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +cual I-DERIVED_FROM/TO +nos I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +resolución I-DERIVED_FROM/TO +quirúrgica. I-DERIVED_FROM/TO +Ingresó B-EXPLORATION +consciente I-EXPLORATION +(Glasgow I-EXPLORATION +15), I-EXPLORATION +afebril, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +PA I-EXPLORATION +de I-EXPLORATION +80/60 I-EXPLORATION +mm I-EXPLORATION +Hg, I-EXPLORATION +FC: I-EXPLORATION +115 I-EXPLORATION +por I-EXPLORATION +min, I-EXPLORATION +FR: I-EXPLORATION +21 I-EXPLORATION +por I-EXPLORATION +min, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +vía I-EXPLORATION +aérea I-EXPLORATION +permeable, I-EXPLORATION +inmovilización I-EXPLORATION +cervical I-EXPLORATION +y I-EXPLORATION +ventilación I-EXPLORATION +espontánea. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +izquierda I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +hemorragia I-EXPLORATION +activa I-EXPLORATION +del I-EXPLORATION +pie I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +piel, I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +y I-EXPLORATION +músculo I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +inframaleolar I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +punta I-EXPLORATION +del I-EXPLORATION +pie, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +falanges I-EXPLORATION +distales I-EXPLORATION +del I-EXPLORATION +primer, I-EXPLORATION +segundo, I-EXPLORATION +tercer I-EXPLORATION +y I-EXPLORATION +cuarto I-EXPLORATION +ortejos, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +clasificado I-EXPLORATION +como I-EXPLORATION +traumatismo I-EXPLORATION +grave I-EXPLORATION +Gustilo I-EXPLORATION +3 I-EXPLORATION +c. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +estabilización I-TREATMENT +hemodinámica I-TREATMENT +con I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +cristaloides I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +Dentro B-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +20.310/mm3, I-EXPLORATION +neutrófilos I-EXPLORATION +86%, I-EXPLORATION +baciliformes I-EXPLORATION +2%. I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +se I-EXPLORATION +constató, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +blando, I-EXPLORATION +una I-EXPLORATION +fractura I-EXPLORATION +del I-EXPLORATION +maléolo I-EXPLORATION +tibial I-EXPLORATION +interno I-EXPLORATION +discretamente I-EXPLORATION +diastasado. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +angiotomografía I-EXPLORATION +de I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +calibre I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +tibiales I-EXPLORATION +anteriores, I-EXPLORATION +con I-EXPLORATION +vasoespasmo I-EXPLORATION +y I-EXPLORATION +compresión I-EXPLORATION +por I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos I-EXPLORATION +adyacentes I-EXPLORATION +sin I-EXPLORATION +extravasación I-EXPLORATION +del I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +primera I-TREATMENT +exploración I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +deforramiento I-TREATMENT +total I-TREATMENT +del I-TREATMENT +pie I-TREATMENT +izquierdo I-TREATMENT +más I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +en I-TREATMENT +la I-TREATMENT +región I-TREATMENT +plantar I-TREATMENT +con I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +dispositivo I-TREATMENT +para I-TREATMENT +el I-TREATMENT +cierre I-TREATMENT +asistido I-TREATMENT +de I-TREATMENT +las I-TREATMENT +heridas I-TREATMENT +por I-TREATMENT +presión I-TREATMENT +negativa. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +ampicilina/sulbactam I-TREATMENT +iv. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +satisfactoria I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +48 I-EVOLUTION +h, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +registro I-EVOLUTION +único I-EVOLUTION +de I-EVOLUTION +temperatura I-EVOLUTION +bucal I-EVOLUTION +de I-EVOLUTION +37, I-EVOLUTION +5°C I-EVOLUTION +post-quirúrgico, I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +atribuido I-EVOLUTION +al I-EVOLUTION +proceso I-EVOLUTION +inflamatorio. I-EVOLUTION +Al B-TREATMENT +tercer I-TREATMENT +día I-TREATMENT +de I-TREATMENT +hospitalización I-TREATMENT +se I-TREATMENT +planificó I-TREATMENT +realizar I-TREATMENT +un I-TREATMENT +autoinjerto, I-TREATMENT +procedimiento I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +sustituido I-TREATMENT +por I-TREATMENT +un I-TREATMENT +aseo I-TREATMENT +quirúrgico I-TREATMENT +más I-TREATMENT +un I-TREATMENT +desbridamiento, I-TREATMENT +al I-TREATMENT +encontrarse I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +escaso I-TREATMENT +tejido I-TREATMENT +de I-TREATMENT +granulación I-TREATMENT +con I-TREATMENT +secreción I-TREATMENT +en I-TREATMENT +moderada I-TREATMENT +cantidad, I-TREATMENT +de I-TREATMENT +mal I-TREATMENT +olor. I-TREATMENT +Luego B-EXPLORATION +del I-EXPLORATION +procedimiento I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +secreción. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +células I-EXPLORATION +escasas, I-EXPLORATION +con I-EXPLORATION +moderada I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +polimorfonucleares I-EXPLORATION +(PMN) I-EXPLORATION +y I-EXPLORATION +bacilos I-EXPLORATION +gramnegativos. I-EXPLORATION +A I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +h, I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +evidenció I-EXPLORATION +el I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +bacilo I-EXPLORATION +gramnegativo, I-EXPLORATION +lactosa I-EXPLORATION +negativa. I-EXPLORATION +Desde B-EVOLUTION +el I-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +internación, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +hasta I-EVOLUTION +3 I-EVOLUTION +8°C I-EVOLUTION +bucal, I-EVOLUTION +con I-EVOLUTION +mala I-EVOLUTION +condición I-EVOLUTION +del I-EVOLUTION +tejido I-EVOLUTION +en I-EVOLUTION +cicatrización, I-EVOLUTION +incremento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +secreción I-EVOLUTION +y I-EVOLUTION +mal I-EVOLUTION +olor. I-EVOLUTION +Los B-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +12.800/mm3 I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +308 I-EXPLORATION +mg/L. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +realizar, I-TREATMENT +por I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +su I-TREATMENT +estado I-TREATMENT +clínico I-TREATMENT +y I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +infección I-TREATMENT +en I-TREATMENT +el I-TREATMENT +sitio I-TREATMENT +de I-TREATMENT +arrollamiento, I-TREATMENT +una I-TREATMENT +amputación I-TREATMENT +corta I-TREATMENT +bajo I-TREATMENT +la I-TREATMENT +articulación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +rodilla I-TREATMENT +del I-TREATMENT +miembro I-TREATMENT +inferior I-TREATMENT +izquierdo I-TREATMENT +con I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +Lisfranc. I-TREATMENT +Finalmente, B-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +secreción, I-EXPLORATION +al I-EXPLORATION +quinto I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización, I-EXPLORATION +analizado I-EXPLORATION +por I-EXPLORATION +métodos I-EXPLORATION +automatizados I-EXPLORATION +Bact/Alert® I-EXPLORATION +3d I-EXPLORATION +60 I-EXPLORATION +(Biomérieux, I-EXPLORATION +France) I-EXPLORATION +fue I-EXPLORATION +informado I-EXPLORATION +con I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +Cedecea I-EXPLORATION +lapagei I-EXPLORATION +susceptible I-EXPLORATION +a I-EXPLORATION +cefuroxima, I-EXPLORATION +amikacina, I-EXPLORATION +cotrimoxazol, I-EXPLORATION +ciprofloxacina, I-EXPLORATION +cefotaxima, I-EXPLORATION +carbapenémicos I-EXPLORATION +y I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +ampicilina I-EXPLORATION +y I-EXPLORATION +ampicilina/sulbactam. I-EXPLORATION +El I-EXPLORATION +aislado I-EXPLORATION +fue I-EXPLORATION +confirmado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Centro I-EXPLORATION +de I-EXPLORATION +Referencia I-EXPLORATION +(Centro I-EXPLORATION +de I-EXPLORATION +Microbiología, I-EXPLORATION +Hospital I-EXPLORATION +Vozandes, I-EXPLORATION +Quito). I-EXPLORATION +Tres B-EVOLUTION +días I-EVOLUTION +posteriores I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica I-EVOLUTION +y I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +intravenoso I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta; I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +infección I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +oficio I-PAST_MEDICAL_HISTORY +clasificador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +residuos. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +pareja I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +utilizaba I-PAST_MEDICAL_HISTORY +métodos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +barrera. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +emergencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +líquidas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +sangre, I-PRESENT_ILLNESS +mucus I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +pus; I-PRESENT_ILLNESS +acompañadas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Presentaba I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +vigil, I-EXPLORATION +afebril, I-EXPLORATION +normotenso I-EXPLORATION +(120/70), I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +FC I-EXPLORATION +de I-EXPLORATION +82 I-EXPLORATION +por I-EXPLORATION +min, I-EXPLORATION +pálido I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +presentó I-EVOLUTION +fiebre I-EVOLUTION +de I-EVOLUTION +hasta I-EVOLUTION +38, I-EVOLUTION +5° I-EVOLUTION +C I-EVOLUTION +axilar I-EVOLUTION +y I-EVOLUTION +heces I-EVOLUTION +líquidas I-EVOLUTION +con I-EVOLUTION +sangre I-EVOLUTION +y I-EVOLUTION +mucus I-EVOLUTION +en I-EVOLUTION +varias I-EVOLUTION +oportunidades. I-EVOLUTION +Fue I-EVOLUTION +internado I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +sala I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +paciente, I-EVOLUTION +con I-EVOLUTION +diagnóstico I-EVOLUTION +clínico I-EVOLUTION +de I-EVOLUTION +diarrea I-EVOLUTION +en I-EVOLUTION +paciente I-EVOLUTION +con I-EVOLUTION +probable I-EVOLUTION +infección I-EVOLUTION +por I-EVOLUTION +VIH. I-EVOLUTION + I-EVOLUTION +De B-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaban: I-EXPLORATION +hemoglobina I-EXPLORATION +9, I-EXPLORATION +8 I-EXPLORATION +g/dl; I-EXPLORATION +hematocrito: I-EXPLORATION +28, I-EXPLORATION +3%; I-EXPLORATION +VCM I-EXPLORATION +77, I-EXPLORATION +2 I-EXPLORATION +fl I-EXPLORATION +y I-EXPLORATION +HCM I-EXPLORATION +24, I-EXPLORATION +9 I-EXPLORATION +pg; I-EXPLORATION +leucocitos: I-EXPLORATION +5.500/mm3; I-EXPLORATION +linfocitos: I-EXPLORATION +750/ I-EXPLORATION +mm3 I-EXPLORATION +(17,1%); I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +CD4 I-EXPLORATION +150 I-EXPLORATION +céls/ I-EXPLORATION +mm3; I-EXPLORATION +VHS: I-EXPLORATION +69 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +1° I-EXPLORATION +hora. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +directo I-EXPLORATION +de I-EXPLORATION +deposiciones I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +abundantes I-EXPLORATION +PMN I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +coprocultivo I-EXPLORATION +se I-EXPLORATION +desarrolló I-EXPLORATION +Shigella I-EXPLORATION +sp. I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +hemocultivos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +fue I-EXPLORATION +reactiva I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Western I-EXPLORATION +blot I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Referencia I-EXPLORATION +Nacional. I-EXPLORATION + I-EXPLORATION +Estudios I-EXPLORATION +bacteriológicos I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +cepas I-EXPLORATION +se I-EXPLORATION +enviaron I-EXPLORATION +al I-EXPLORATION +Departamento I-EXPLORATION +de I-EXPLORATION +Bacteriología I-EXPLORATION +y I-EXPLORATION +Virología, I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Higiene, I-EXPLORATION +para I-EXPLORATION +completar I-EXPLORATION +su I-EXPLORATION +estudio. I-EXPLORATION +La I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +género I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +por I-EXPLORATION +métodos I-EXPLORATION +fenotípicos I-EXPLORATION +convencionales I-EXPLORATION +utilizando I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +medios I-EXPLORATION +de I-EXPLORATION +identificación: I-EXPLORATION +triple I-EXPLORATION +azúcar I-EXPLORATION +hierro I-EXPLORATION +(TSI), I-EXPLORATION +movilidad-indol-ornitina I-EXPLORATION +decarboxilasa I-EXPLORATION +(MIO), I-EXPLORATION +citrato I-EXPLORATION +de I-EXPLORATION +Simmons, I-EXPLORATION +fenilalanina I-EXPLORATION +deaminasa, I-EXPLORATION +agar I-EXPLORATION +hierro-lisina I-EXPLORATION +(LIA), I-EXPLORATION +arginina I-EXPLORATION +dehidrolasa, I-EXPLORATION +utilización I-EXPLORATION +de I-EXPLORATION +mucato, I-EXPLORATION +malonato I-EXPLORATION +y I-EXPLORATION +fermentación I-EXPLORATION +de I-EXPLORATION +carbohidratos I-EXPLORATION +en I-EXPLORATION +caldo I-EXPLORATION +con I-EXPLORATION +rojo-fenol10. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +serogrupo I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cepas I-EXPLORATION +de I-EXPLORATION +Shigella I-EXPLORATION +se I-EXPLORATION +determinó I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +aglutinación I-EXPLORATION +en I-EXPLORATION +lámina I-EXPLORATION +utilizando I-EXPLORATION +antisueros I-EXPLORATION +policlonales I-EXPLORATION +comerciales I-EXPLORATION +(BD, I-EXPLORATION +Difco I-EXPLORATION +TM) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +serotipo I-EXPLORATION +con I-EXPLORATION +antisueros I-EXPLORATION +absorbidos I-EXPLORATION +serotipo-específicos. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +susceptibilidad I-EXPLORATION +antimicrobiana I-EXPLORATION +se I-EXPLORATION +utilizó I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +difusión I-EXPLORATION +en I-EXPLORATION +disco I-EXPLORATION +en I-EXPLORATION +agar11. I-EXPLORATION +Los I-EXPLORATION +antibacterianos I-EXPLORATION +ensayados I-EXPLORATION +fueron: I-EXPLORATION +ampicilina, I-EXPLORATION +ampicilina/sulbactam, I-EXPLORATION +cefradina, I-EXPLORATION +cefoxitina, I-EXPLORATION +ceftriaxona, I-EXPLORATION +ácido I-EXPLORATION +nalidíxico, I-EXPLORATION +ciprofloxacina, I-EXPLORATION +tetraciclina I-EXPLORATION +y I-EXPLORATION +cotrimoxazol I-EXPLORATION +(Oxoid I-EXPLORATION +Ltd., I-EXPLORATION +Basingstoke, I-EXPLORATION +Hampshire, I-EXPLORATION +Inglaterra). I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +evaluación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sensibilidad I-EXPLORATION +a I-EXPLORATION +azitromicina I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +existen I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +interpretación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +por I-EXPLORATION +esta I-EXPLORATION +técnica I-EXPLORATION +para I-EXPLORATION +azitromicina I-EXPLORATION +en I-EXPLORATION +EUCAST I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +CLSI11. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +electroforesis I-EXPLORATION +en I-EXPLORATION +gel I-EXPLORATION +en I-EXPLORATION +campo I-EXPLORATION +pulsado I-EXPLORATION +(PFGE) I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuatro I-EXPLORATION +aislados I-EXPLORATION +de I-EXPLORATION +Shigella I-EXPLORATION +spp. I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +al I-EXPLORATION +procedimiento I-EXPLORATION +estándar I-EXPLORATION +del I-EXPLORATION +CDC12. I-EXPLORATION +La I-EXPLORATION +interpretación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +patrones I-EXPLORATION +de I-EXPLORATION +bandas I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +visualmente I-EXPLORATION +siguiendo I-EXPLORATION +los I-EXPLORATION +criterios I-EXPLORATION +de I-EXPLORATION +Tenover I-EXPLORATION +y I-EXPLORATION +cols13. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +cuatro I-EXPLORATION +cepas I-EXPLORATION +correspondieron I-EXPLORATION +a I-EXPLORATION +Shigella I-EXPLORATION +flexneri I-EXPLORATION +del I-EXPLORATION +serotipo I-EXPLORATION +6 I-EXPLORATION +y I-EXPLORATION +presentaron I-EXPLORATION +resistencia I-EXPLORATION +sólo I-EXPLORATION +a I-EXPLORATION +cotrimoxa-zol. I-EXPLORATION +Las I-EXPLORATION +dos I-EXPLORATION +cepas I-EXPLORATION +recuperadas I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +paciente I-EXPLORATION +(heces I-EXPLORATION +y I-EXPLORATION +sangre) I-EXPLORATION +mostraron I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +bandas I-EXPLORATION +idéntico I-EXPLORATION +entre I-EXPLORATION +sí I-EXPLORATION +y I-EXPLORATION +muy I-EXPLORATION +similar I-EXPLORATION +al I-EXPLORATION +patrón I-EXPLORATION +obtenido I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +cepas I-EXPLORATION +del I-EXPLORATION +otro I-EXPLORATION +paciente. I-EXPLORATION +Las I-EXPLORATION +cepas I-EXPLORATION +se I-EXPLORATION +definieron I-EXPLORATION +como I-EXPLORATION +muy I-EXPLORATION +relacionadas I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +vista I-EXPLORATION +genético. I-EXPLORATION + I-EXPLORATION +Tratamiento B-TREATMENT +antimicrobiano I-TREATMENT +y I-TREATMENT +evolución I-TREATMENT + I-TREATMENT +El I-TREATMENT +primer I-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +cotrimoxazol, I-TREATMENT +800/160 I-TREATMENT +mg, I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h, I-TREATMENT +por I-TREATMENT +48 I-TREATMENT +h. I-TREATMENT +Luego I-TREATMENT +de I-TREATMENT +conocer I-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +bacteriológico I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +a I-TREATMENT +ampicilina I-TREATMENT +1 I-TREATMENT +gr I-TREATMENT +iv, I-TREATMENT +4 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +durante I-TREATMENT +6 I-TREATMENT +días, I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +ciprofloxacina I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h, I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT + I-TREATMENT +El I-TREATMENT +segundo I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +sin I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +bacteriológico. I-TREATMENT +Recibió I-TREATMENT +ciprofloxacina I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +iv, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +por I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +ambos I-EVOLUTION +casos I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +con I-EVOLUTION +remisión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +digestiva I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +otras I-EVOLUTION +complicaciones, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +fueron I-EVOLUTION +dados I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +portador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +reflujo I-PAST_MEDICAL_HISTORY +vesicoureteral I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +5, I-PAST_MEDICAL_HISTORY +bilateral, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hidronefrosis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desnutrición I-PAST_MEDICAL_HISTORY +grave. I-PAST_MEDICAL_HISTORY +Recibía I-PAST_MEDICAL_HISTORY +profilaxis I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ITU I-PAST_MEDICAL_HISTORY +recurrentes I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cotrimoxazol I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +exposición I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +antibacterianos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +(cefuroximo, I-PAST_MEDICAL_HISTORY +ceftriaxona I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ciprofloxacina). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +UCI I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +pielonefritis I-PRESENT_ILLNESS +aguda I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +reagudizada. I-PRESENT_ILLNESS +El B-EXPLORATION +urocultivo I-EXPLORATION +realizado I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +a I-EXPLORATION +E.coli I-EXPLORATION +(cepa I-EXPLORATION +ITU1) I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +ampicilina, I-EXPLORATION +cefalotina, I-EXPLORATION +cefuroximo, I-EXPLORATION +ceftriaxona I-EXPLORATION +y I-EXPLORATION +gentamicina; I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +ciprofloxacina I-EXPLORATION +y I-EXPLORATION +cotrimoxazol. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cefuroximo I-TREATMENT +iv I-TREATMENT +150 I-TREATMENT +mg/kg/día. I-TREATMENT +Al B-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +sepsis I-EVOLUTION +de I-EVOLUTION +foco I-EVOLUTION +urinario. I-EVOLUTION +Se B-TREATMENT +cambió I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +ceftriaxona I-TREATMENT +iv I-TREATMENT +a I-TREATMENT +100 I-TREATMENT +mg/ I-TREATMENT +kg/día I-TREATMENT +previa I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +urocultivo. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +persistía I-EVOLUTION +febril. I-EVOLUTION +El B-EXPLORATION +urocultivo I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +con I-EXPLORATION +> I-EXPLORATION +105 I-EXPLORATION +UFC/ml I-EXPLORATION +de I-EXPLORATION +E. I-EXPLORATION +coli I-EXPLORATION +(cepa I-EXPLORATION +ITU2) I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +imipenem, I-EXPLORATION +meropenem, I-EXPLORATION +amikacina I-EXPLORATION +y I-EXPLORATION +gentamicina; I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +ampicilina, I-EXPLORATION +cefalotina, I-EXPLORATION +cefuroximo, I-EXPLORATION +ceftriaxona, I-EXPLORATION +ciprofloxacina I-EXPLORATION +y I-EXPLORATION +cotrimoxazol. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +meropenem I-TREATMENT +iv I-TREATMENT +60 I-TREATMENT +mg/kg/día, I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +urocultivo I-TREATMENT +de I-TREATMENT +control, I-TREATMENT +intra-tratamiento, I-TREATMENT +sin I-TREATMENT +desarrollo I-TREATMENT +bacteriano. I-TREATMENT + I-TREATMENT +Tipificación B-EXPLORATION +molecular I-EXPLORATION +y I-EXPLORATION +mecanismo I-EXPLORATION +de I-EXPLORATION +resistencia: I-EXPLORATION +Mediante I-EXPLORATION +EFCP I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +que I-EXPLORATION +ambas I-EXPLORATION +cepas I-EXPLORATION +eran I-EXPLORATION +genéticamente I-EXPLORATION +indistinguibles. I-EXPLORATION +La I-EXPLORATION +cepa I-EXPLORATION +ITU2 I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +BLEE I-EXPLORATION +SHV-5 I-EXPLORATION +codificada I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +plásmido I-EXPLORATION +conjugativo I-EXPLORATION +del I-EXPLORATION +grupo I-EXPLORATION +IncFIB, I-EXPLORATION +ausente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +ITU1. I-EXPLORATION + I-EXPLORATION + +Recién B-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +días, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +perinatales I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +destacar. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +internación I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +UCI I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +bronquiolitis I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +VRS I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +flebitis I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +brazo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +venosa I-PRESENT_ILLNESS +periférica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumefacción I-PRESENT_ILLNESS +dolorosa, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +rubor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +calor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +segunda I-PRESENT_ILLNESS +articulación I-PRESENT_ILLNESS +condrocostal I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Con B-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +osteoartritis I-TREATMENT +condrocostal I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibacteriano I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +meropenem I-TREATMENT +60 I-TREATMENT +mg/kg/día I-TREATMENT +y I-TREATMENT +vancomicina I-TREATMENT +40 I-TREATMENT +mg/kg/día I-TREATMENT +durante I-TREATMENT +72 I-TREATMENT +h. I-TREATMENT +Los B-EXPLORATION +hemocultivos I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +a I-EXPLORATION +Klebsiella I-EXPLORATION +pneumoniae I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +oxiiminocefaslosporinas, I-EXPLORATION +amikacina, I-EXPLORATION +gentamicina, I-EXPLORATION +meropenem I-EXPLORATION +e I-EXPLORATION +imipenem. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +vancomicina I-TREATMENT +y I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +meropenem I-TREATMENT +durante I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +con B-EXPLORATION +negativización I-EXPLORATION +del I-EXPLORATION +hemocultivo I-EXPLORATION +al I-EXPLORATION +7° I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +terapia. I-EXPLORATION +Mejoraron B-EVOLUTION +los I-EVOLUTION +signos I-EVOLUTION +locales I-EVOLUTION +pero I-EVOLUTION +continuó I-EVOLUTION +febril I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +agregó I-EVOLUTION +limitación I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +rotación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cadera I-EVOLUTION +derecha. I-EVOLUTION +Con B-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +probable I-TREATMENT +osteoartritis I-TREATMENT +coxofemoral I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +punción I-TREATMENT +articular I-TREATMENT +y I-TREATMENT +drenaje I-TREATMENT +quirúrgico I-TREATMENT +que I-TREATMENT +dio I-TREATMENT +salida I-TREATMENT +a I-TREATMENT +material I-TREATMENT +purulento. I-TREATMENT +En I-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +agregó I-TREATMENT +amikacina I-TREATMENT +15 I-TREATMENT +mg/kg/día I-TREATMENT +por I-TREATMENT +el I-TREATMENT +antecedente I-TREATMENT +de I-TREATMENT +K. I-TREATMENT +pneumoniae I-TREATMENT +aislada I-TREATMENT +del I-TREATMENT +hemocultivo. I-TREATMENT +Del B-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +articular I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +K. I-EXPLORATION +pneumoniae I-EXPLORATION +(cepa I-EXPLORATION +OA1) I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +perfil I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +aislada I-EXPLORATION +en I-EXPLORATION +sangre. I-EXPLORATION +Dado B-TREATMENT +que I-TREATMENT +persistió I-TREATMENT +febril, I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +aseos I-TREATMENT +quirúrgicos I-TREATMENT +sucesivos I-TREATMENT +aislándose, B-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +17 I-EXPLORATION +días I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +aislado I-EXPLORATION +(OA1), I-EXPLORATION +K. I-EXPLORATION +pneumoniae I-EXPLORATION +(cepa I-EXPLORATION +OA2) I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +oxiiminocefalosporinas, I-EXPLORATION +amikacina I-EXPLORATION +y I-EXPLORATION +gentamicina. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +realizados I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +evolución I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +manteniéndose I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +esquema I-EXPLORATION +antibacteriano. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +evaluación I-EXPLORATION +inmunológica I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION +Luego B-TREATMENT +de I-TREATMENT +múltiples I-TREATMENT +aseos I-TREATMENT +quirúrgicos, I-TREATMENT +35 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +fiebre I-TREATMENT +y I-TREATMENT +45 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antibacteriano I-TREATMENT +se B-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +posterior. I-EVOLUTION + I-EVOLUTION +Tipificación B-EXPLORATION +molecular I-EXPLORATION +y I-EXPLORATION +mecanismo I-EXPLORATION +de I-EXPLORATION +resistencia: I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +por I-EXPLORATION +EFCP I-EXPLORATION +mostró I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +cepas I-EXPLORATION +OA1 I-EXPLORATION +y I-EXPLORATION +OA2 I-EXPLORATION +no I-EXPLORATION +estaban I-EXPLORATION +genéticamente I-EXPLORATION +relacionadas. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +diferencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +OA1, I-EXPLORATION +OA2 I-EXPLORATION +presentó I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +BLEE I-EXPLORATION +CTX-M-9 I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +plásmido I-EXPLORATION +IncHI1-HI2 I-EXPLORATION +no I-EXPLORATION +conjugativo. I-EXPLORATION +Adicionalmente I-EXPLORATION +OA2 I-EXPLORATION +presentaba I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +aac I-EXPLORATION +(6') I-EXPLORATION +1b, I-EXPLORATION +que I-EXPLORATION +confiere I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +amikacina I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +integrón I-EXPLORATION +de I-EXPLORATION +clase I-EXPLORATION +1 I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +genes I-EXPLORATION +aadB-aadA2 I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +variable, I-EXPLORATION +responsables I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +gentamicina. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +77 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +jubilado, B-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +estudio. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +coartación I-PAST_MEDICAL_HISTORY +aórtica I-PAST_MEDICAL_HISTORY +operada, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +recambio I-PAST_MEDICAL_HISTORY +valvular I-PAST_MEDICAL_HISTORY +aórtico I-PAST_MEDICAL_HISTORY +hacían I-PAST_MEDICAL_HISTORY +ya I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +reemplazo I-PAST_MEDICAL_HISTORY +compuesto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +válvula I-PAST_MEDICAL_HISTORY +aórtica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aorta I-PAST_MEDICAL_HISTORY +ascendente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +reemplazo I-PAST_MEDICAL_HISTORY +valvular I-PAST_MEDICAL_HISTORY +mitral, I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +anticoagulante I-PAST_MEDICAL_HISTORY +oral. I-PAST_MEDICAL_HISTORY +Además I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardíaca I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +control. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +intermitente I-PRESENT_ILLNESS +cuantificada I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +°C I-PRESENT_ILLNESS +axilar, I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +moderado I-PRESENT_ILLNESS +difuso, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carácter I-PRESENT_ILLNESS +inespecífico, I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +nocturna I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +mes. I-PRESENT_ILLNESS +Sin I-PRESENT_ILLNESS +diarrea, I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +tos, I-PRESENT_ILLNESS +disuria, I-PRESENT_ILLNESS +artralgias I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +cutáneas. I-PRESENT_ILLNESS +Dentro B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +epidemiológicos, I-PAST_MEDICAL_HISTORY +residía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Santiago I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +viajes I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +extranjero. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +consciente, I-EXPLORATION +vigil, I-EXPLORATION +cooperador, I-EXPLORATION +con I-EXPLORATION +hemodinamia I-EXPLORATION +estable, I-EXPLORATION +yugulares I-EXPLORATION +planas I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +adenopatías I-EXPLORATION +palpables. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +pulmonar I-EXPLORATION +era I-EXPLORATION +normal, I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +cardíaco I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +soplo I-EXPLORATION +sistólico I-EXPLORATION +en I-EXPLORATION +foco I-EXPLORATION +aórtico I-EXPLORATION +3/6, I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +era I-EXPLORATION +blando, I-EXPLORATION +depresible, I-EXPLORATION +sensible I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +difusa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +ni I-EXPLORATION +visceromegalia. I-EXPLORATION +Las I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +no I-EXPLORATION +presentaban I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +lechos I-EXPLORATION +ungueales I-EXPLORATION +no I-EXPLORATION +tenían I-EXPLORATION +lesiones. I-EXPLORATION +El I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +destacando I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +completa I-EXPLORATION +y I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +normales, I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +normocítica I-EXPLORATION +normocrómica I-EXPLORATION +(hemoglobina I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +gr/dL I-EXPLORATION +y I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +31, I-EXPLORATION +7%), I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +otras I-EXPLORATION +series I-EXPLORATION +normales; I-EXPLORATION +VHS I-EXPLORATION +82 I-EXPLORATION +mm I-EXPLORATION +1° I-EXPLORATION +hora; I-EXPLORATION +PCR I-EXPLORATION +5, I-EXPLORATION +3 I-EXPLORATION +mg/dL I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +1 I-EXPLORATION +mg/dL) I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +INR I-EXPLORATION +2, I-EXPLORATION +5. I-EXPLORATION +Por I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +pruebas I-EXPLORATION +hepáticas: I-EXPLORATION +GOT I-EXPLORATION +45 I-EXPLORATION +UI/L, I-EXPLORATION +GGT I-EXPLORATION +81 I-EXPLORATION +UI/L, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +0, I-EXPLORATION +69 I-EXPLORATION +mg/dL, I-EXPLORATION +LDH I-EXPLORATION +360 I-EXPLORATION +U/L, I-EXPLORATION +GPT I-EXPLORATION +y I-EXPLORATION +fosfatasas I-EXPLORATION +alcalinas I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +hepatitis I-EXPLORATION +A, I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +y I-EXPLORATION +VIH I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +negativas, I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +Widal I-EXPLORATION +negativa, I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +Entre I-EXPLORATION +otros I-EXPLORATION +exámenes I-EXPLORATION +destacaba I-EXPLORATION +TSH I-EXPLORATION +0, I-EXPLORATION +84 I-EXPLORATION +U/ml I-EXPLORATION +(VN I-EXPLORATION +0, I-EXPLORATION +3-4, I-EXPLORATION +2 I-EXPLORATION +U/ml) I-EXPLORATION +y I-EXPLORATION +factor I-EXPLORATION +reumatoide I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +persistencia I-EXPLORATION +del I-EXPLORATION +cuadro, I-EXPLORATION +fue I-EXPLORATION +internado I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +continuó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +AP I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Por I-EXPLORATION +el I-EXPLORATION +antecedente I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +válvula I-EXPLORATION +protésica I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +transesofágico I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +filamentosa I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +x I-EXPLORATION +8 I-EXPLORATION +x I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +aórtica. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +para I-TREATMENT +una I-TREATMENT +EI I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +válvula I-TREATMENT +protésica I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +iv I-TREATMENT +1 I-TREATMENT +g, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +gentamicina I-TREATMENT +iv I-TREATMENT +80 I-TREATMENT +mg, I-TREATMENT +tres I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +y I-TREATMENT +rifampicina I-TREATMENT +600 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Los B-EXPLORATION +dos I-EXPLORATION +hemocultivos I-EXPLORATION +tomados I-EXPLORATION +previo I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +antibacteriano, I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +23 I-EXPLORATION +hrs. I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +bacilo I-EXPLORATION +grampositivo, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +identificado I-EXPLORATION +como I-EXPLORATION +L. I-EXPLORATION +monocytogenes. I-EXPLORATION +Se B-TREATMENT +ajustó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +ampicilina I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +iv, I-TREATMENT +seis I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +y I-TREATMENT +gentamicina I-TREATMENT +80 I-TREATMENT +mg, I-TREATMENT +tres I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día. I-TREATMENT + I-TREATMENT +Por B-EVOLUTION +presentar I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +y B-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +antibacteriano I-TREATMENT +intravenoso I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +ambulatoria. I-TREATMENT +Se B-EVOLUTION +controló I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +mensual I-EVOLUTION +durante I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +primeros I-EVOLUTION +meses, I-EVOLUTION +luego I-EVOLUTION +cada I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +hasta I-EVOLUTION +completar I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +posteriormente I-EVOLUTION +cada I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +durante I-EVOLUTION +el I-EVOLUTION +segundo I-EVOLUTION +año. I-EVOLUTION +Durante I-EVOLUTION +su I-EVOLUTION +seguimiento I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +un I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +ajustaron I-EVOLUTION +las I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +antibacterianos I-EVOLUTION +según I-EVOLUTION +su I-EVOLUTION +función I-EVOLUTION +renal. I-EVOLUTION +Completó B-TREATMENT +tres I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +gentamicina I-TREATMENT +80 I-TREATMENT +mg, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +suspendiéndose I-TREATMENT +por I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal; I-TREATMENT +ampicilina I-TREATMENT +2 I-TREATMENT +g, I-TREATMENT +cuatro I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +por I-TREATMENT +doce I-TREATMENT +semanas I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +mantención I-TREATMENT +con I-TREATMENT +amoxicilina I-TREATMENT +1 I-TREATMENT +g, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +y I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +terapia I-TREATMENT +supresora I-TREATMENT +con I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +dos I-TREATMENT +años, I-TREATMENT +para I-TREATMENT +garantizar I-TREATMENT +la I-TREATMENT +esterilidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +residual. I-TREATMENT +El B-EXPLORATION +último I-EXPLORATION +ecocardiograma I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +variaciones I-EXPLORATION +significativas I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +inicial. I-EXPLORATION +Actualmente, B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +residente B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +procedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ciudad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Iquitos, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Inició B-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +(día I-PRESENT_ILLNESS +1) I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +mialgias, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +óseo, I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +retro-ocular. I-PRESENT_ILLNESS +Ante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +persistencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estos I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +3, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +diagnosticó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +dengue I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alarma, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +rash, I-PRESENT_ILLNESS +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +paracetamol I-TREATMENT +(500 I-TREATMENT +mg I-TREATMENT +tres I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día) I-TREATMENT +e I-TREATMENT +hidratación I-TREATMENT +oral. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +del I-EXPLORATION +proyecto I-EXPLORATION +de I-EXPLORATION +investigación I-EXPLORATION +"Vigilancia I-EXPLORATION +y I-EXPLORATION +etiología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +febril I-EXPLORATION +aguda I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Perú", I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +venosa I-EXPLORATION +para I-EXPLORATION +ser I-EXPLORATION +enviada I-EXPLORATION +al I-EXPLORATION +laboratorio I-EXPLORATION +del I-EXPLORATION +Naval I-EXPLORATION +Medical I-EXPLORATION +Research I-EXPLORATION +Unit I-EXPLORATION +Six I-EXPLORATION +(NAMRU-6) I-EXPLORATION +para I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC) I-EXPLORATION +para I-EXPLORATION +dengue I-EXPLORATION +y I-EXPLORATION +leptospirosis, I-EXPLORATION +IgM I-EXPLORATION +por I-EXPLORATION +método I-EXPLORATION +de I-EXPLORATION +ELISA I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +viral I-EXPLORATION +para I-EXPLORATION +otras I-EXPLORATION +arbovirosis. I-EXPLORATION +Al B-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +se I-EVOLUTION +agregó I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +moderado I-EVOLUTION +a I-EVOLUTION +intenso, I-EVOLUTION +tipo I-EVOLUTION +cólico, I-EVOLUTION +localizado I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +epigastrio I-EVOLUTION +e I-EVOLUTION +hipocondrio I-EVOLUTION +derecho, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +náuseas I-EVOLUTION +y I-EVOLUTION +vómitos. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +6 I-EVOLUTION +y I-EVOLUTION +7 I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +aumentaron I-EVOLUTION +en I-EVOLUTION +intensidad I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +consultó I-EVOLUTION +nuevamente. I-EVOLUTION +Recibió B-TREATMENT +hidratación I-TREATMENT +y I-TREATMENT +analgesia I-TREATMENT +intravenosa; I-TREATMENT +sin I-TREATMENT +embargo, I-TREATMENT +al I-TREATMENT +no I-TREATMENT +presentar I-TREATMENT +mejoría I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +su I-TREATMENT +internación. I-TREATMENT +Ingresó B-EVOLUTION +en I-EVOLUTION +mal I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +quejumbrosa, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +temperatura I-EVOLUTION +de I-EVOLUTION +37, I-EVOLUTION +6°C I-EVOLUTION +axilar, I-EVOLUTION +presión I-EVOLUTION +arterial I-EVOLUTION +90/60 I-EVOLUTION +mmHg, I-EVOLUTION +frecuencia I-EVOLUTION +respiratoria I-EVOLUTION +26 I-EVOLUTION +por I-EVOLUTION +min, I-EVOLUTION +y I-EVOLUTION +frecuencia I-EVOLUTION +cardíaca I-EVOLUTION +98 I-EVOLUTION +latidos/ I-EVOLUTION +min. I-EVOLUTION +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +deshidratación I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +rash I-EXPLORATION +eritematoso I-EXPLORATION +generalizado, I-EXPLORATION +sin I-EXPLORATION +linfadenopatías. I-EXPLORATION +Presentaba I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Murphy I-EXPLORATION +positivo. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +cardiopulmonar I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +neurológico I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +prueba I-EXPLORATION +del I-EXPLORATION +lazo I-EXPLORATION +o I-EXPLORATION +torniquete I-EXPLORATION +resultó I-EXPLORATION +negativa. I-EXPLORATION +Entre I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +ALT I-EXPLORATION +(alanino I-EXPLORATION +aminotransferasa) I-EXPLORATION +180 I-EXPLORATION +U/L, I-EXPLORATION +AST I-EXPLORATION +(aspartato I-EXPLORATION +aminotransferasa) I-EXPLORATION +365 I-EXPLORATION +U/L, I-EXPLORATION +albúmina I-EXPLORATION +sérica I-EXPLORATION +2, I-EXPLORATION +39 I-EXPLORATION +g/dl, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +0, I-EXPLORATION +18 I-EXPLORATION +mg/dl, I-EXPLORATION +bilirrubina I-EXPLORATION +indirecta I-EXPLORATION +0, I-EXPLORATION +09 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +43%, I-EXPLORATION +recuento I-EXPLORATION +plaquetario I-EXPLORATION +100.000/mm3. I-EXPLORATION +La I-EXPLORATION +glicemia, I-EXPLORATION +urea I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +sérica I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +amilasa I-EXPLORATION +sérica I-EXPLORATION +inicial I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +41 I-EXPLORATION +U/L. I-EXPLORATION +Se B-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +hidratación I-TREATMENT +y I-TREATMENT +medicación I-TREATMENT +sintomática I-TREATMENT +intravenosa I-TREATMENT +(hioscina, I-TREATMENT +metamizol I-TREATMENT +y I-TREATMENT +dimenhidrinato). I-TREATMENT +El B-EVOLUTION +día I-EVOLUTION +8 I-EVOLUTION +ya I-EVOLUTION +no I-EVOLUTION +presentaba I-EVOLUTION +fiebre, I-EVOLUTION +pero I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +vómitos I-EVOLUTION +se I-EVOLUTION +hicieron I-EVOLUTION +aún I-EVOLUTION +más I-EVOLUTION +intensos. I-EVOLUTION +Se B-EXPLORATION +controló I-EXPLORATION +la I-EXPLORATION +amilasa I-EXPLORATION +sérica I-EXPLORATION +213 I-EXPLORATION +U/L I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +fosfatasas I-EXPLORATION +alcalinas I-EXPLORATION +75, I-EXPLORATION +5 I-EXPLORATION +U/L I-EXPLORATION +(VN I-EXPLORATION +hasta I-EXPLORATION +270 I-EXPLORATION +U/L). I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ultrasonografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +escasa I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +ascítico, I-EXPLORATION +efusión I-EXPLORATION +pleural, I-EXPLORATION +edema I-EXPLORATION +peri-vesicular I-EXPLORATION +y I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +vesicular I-EXPLORATION +(8, I-EXPLORATION +5 I-EXPLORATION +mm), I-EXPLORATION +sin I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +litiasis I-EXPLORATION +o I-EXPLORATION +visceromegalia. I-EXPLORATION +El I-EXPLORATION +día I-EXPLORATION +10 I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +abdominal I-EXPLORATION +cuya I-EXPLORATION +mala I-EXPLORATION +calidad I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +mayores I-EXPLORATION +detalles I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +pero I-EXPLORATION +permitió I-EXPLORATION +descartar I-EXPLORATION +el I-EXPLORATION +compromiso I-EXPLORATION +pancreático. I-EXPLORATION +La I-EXPLORATION +prueba I-EXPLORATION +del I-EXPLORATION +lazo, I-EXPLORATION +realizada I-EXPLORATION +ese I-EXPLORATION +mismo I-EXPLORATION +día, I-EXPLORATION +resultó I-EXPLORATION +positiva. I-EXPLORATION +Se B-TREATMENT +continuó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +soporte I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +día I-TREATMENT +12, I-TREATMENT +cuando B-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +su I-EVOLUTION +alta I-EVOLUTION +médica I-EVOLUTION +por I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +parcial I-EVOLUTION +(disminución I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +náuseas I-EVOLUTION +y I-EVOLUTION +vómitos) I-EVOLUTION +con I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +dengue I-EVOLUTION +y I-EVOLUTION +colecistitis I-EVOLUTION +alitiásica. I-EVOLUTION +La I-EVOLUTION +sintomatología I-EVOLUTION +disminuyó I-EVOLUTION +progresivamente I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +25 I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +un I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +transaminasas I-EVOLUTION +ALT I-EVOLUTION +y I-EVOLUTION +AST I-EVOLUTION +que I-EVOLUTION +fueron I-EVOLUTION +de I-EVOLUTION +18 I-EVOLUTION +y I-EVOLUTION +25 I-EVOLUTION +U/L, I-EVOLUTION +respectivamente. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +otras I-EXPLORATION +infecciones I-EXPLORATION +resultaron I-EXPLORATION +negativas: I-EXPLORATION +leptospirosis I-EXPLORATION +(RPC), I-EXPLORATION +rickettsiosis I-EXPLORATION +(IgG), I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +(HBsAg) I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +arbovirosis I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +encefalitis I-EXPLORATION +equina I-EXPLORATION +venezolana, I-EXPLORATION +mayaro, I-EXPLORATION +oropuche, I-EXPLORATION +fiebre I-EXPLORATION +amarilla I-EXPLORATION +y I-EXPLORATION +virus I-EXPLORATION +del I-EXPLORATION +grupo I-EXPLORATION +C I-EXPLORATION +(serología I-EXPLORATION +IgM I-EXPLORATION +y I-EXPLORATION +aislamiento I-EXPLORATION +viral). I-EXPLORATION +La I-EXPLORATION +gota I-EXPLORATION +gruesa I-EXPLORATION +para I-EXPLORATION +malaria I-EXPLORATION +también I-EXPLORATION +resultó I-EXPLORATION +negativa. I-EXPLORATION +La I-EXPLORATION +RPC I-EXPLORATION +para I-EXPLORATION +dengue I-EXPLORATION +resultó I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +virus I-EXPLORATION +dengue I-EXPLORATION +serotipo I-EXPLORATION +4. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +TEC I-PAST_MEDICAL_HISTORY +simple I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +secuelas I-PAST_MEDICAL_HISTORY +y B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rinorrea I-PRESENT_ILLNESS +acuosa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +cefalea. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +otorrinolaringología I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +diagnosticó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +probable I-PRESENT_ILLNESS +rinitis I-PRESENT_ILLNESS +vasomotora. I-PRESENT_ILLNESS +Se B-TREATMENT +prescribió I-TREATMENT +corticoides I-TREATMENT +intranasales I-TREATMENT +y I-TREATMENT +sistémicos I-TREATMENT +(prednisona I-TREATMENT +10 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día) I-TREATMENT +y I-TREATMENT +azitromicina I-TREATMENT +por I-TREATMENT +siete I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Luego B-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +transitoria I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +cefalea I-EVOLUTION +holocránea I-EVOLUTION +de I-EVOLUTION +inicio I-EVOLUTION +súbito, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +dolor I-EVOLUTION +cervical, I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +conciencia I-EVOLUTION +sin I-EVOLUTION +focalidad I-EVOLUTION +neurológica I-EVOLUTION +evidente I-EVOLUTION +y I-EVOLUTION +calofríos, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +consultó I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencia I-EVOLUTION +de I-EVOLUTION +nuestro I-EVOLUTION +hospital. I-EVOLUTION +Al B-EXPLORATION +ingreso I-EXPLORATION +destacaban I-EXPLORATION +cifras I-EXPLORATION +tensionales I-EXPLORATION +límites I-EXPLORATION +(presión I-EXPLORATION +arterial I-EXPLORATION +108/70 I-EXPLORATION +mm I-EXPLORATION +Hg) I-EXPLORATION +que I-EXPLORATION +respondieron I-EXPLORATION +a I-EXPLORATION +volumen, I-EXPLORATION +fiebre I-EXPLORATION +(T° I-EXPLORATION +38, I-EXPLORATION +5°C), I-EXPLORATION +desorientación I-EXPLORATION +temporo-espacial, I-EXPLORATION +agitación I-EXPLORATION +psicomotora I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +meníngeos. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +que I-EXPLORATION +dio I-EXPLORATION +salida I-EXPLORATION +a I-EXPLORATION +LCR I-EXPLORATION +turbio, I-EXPLORATION +citoquímico: I-EXPLORATION +8.480 I-EXPLORATION +céls/mm3, I-EXPLORATION +100% I-EXPLORATION +polimorfonucleares, I-EXPLORATION +proteínas I-EXPLORATION +370 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +glucosa I-EXPLORATION +2 I-EXPLORATION +mg/dl. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +una I-TREATMENT +MBA I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +2 I-TREATMENT +g, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día I-TREATMENT +y I-TREATMENT +dexametasona I-TREATMENT +i.v. I-TREATMENT +10 I-TREATMENT +mg, I-TREATMENT +4 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +esta I-TREATMENT +última I-TREATMENT +por I-TREATMENT +4 I-TREATMENT +días. I-TREATMENT +La B-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION +Fue B-EVOLUTION +admitida I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Pacientes I-EVOLUTION +Críticos, I-EVOLUTION +donde I-EVOLUTION +evolucionó I-EVOLUTION +sin I-EVOLUTION +requerimiento I-EVOLUTION +de I-EVOLUTION +fármacos I-EVOLUTION +vasoactivos, I-EVOLUTION +con I-EVOLUTION +caída I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +curva I-EVOLUTION +febril I-EVOLUTION +y I-EVOLUTION +recuperación I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +condición I-EVOLUTION +neurológica I-EVOLUTION +en I-EVOLUTION +menos I-EVOLUTION +de I-EVOLUTION +24 I-EVOLUTION +h. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +bacterias I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +naranja I-EXPLORATION +de I-EXPLORATION +acridina I-EXPLORATION +mostró I-EXPLORATION +formas I-EXPLORATION +cocoides. I-EXPLORATION +Tanto I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +LCR I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +hubo I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +agalactiae I-EXPLORATION +susceptible I-EXPLORATION +a I-EXPLORATION +penicilina, I-EXPLORATION +eritromicina I-EXPLORATION +y I-EXPLORATION +clindamicina. I-EXPLORATION +El I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +(Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública I-EXPLORATION +de I-EXPLORATION +Chile) I-EXPLORATION +confirmó I-EXPLORATION +posteriormente I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cultivos, I-EXPLORATION +informando I-EXPLORATION +además I-EXPLORATION +que I-EXPLORATION +correspondía I-EXPLORATION +al I-EXPLORATION +serotipo I-EXPLORATION +Ib. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +fue I-EXPLORATION +evaluada I-EXPLORATION +por I-EXPLORATION +ginecología I-EXPLORATION +encontrándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +vulvovaginitis I-EXPLORATION +y I-EXPLORATION +miomas I-EXPLORATION +uterinos, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +microbiológico. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +otorrino-laringológico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +rinorrea I-EXPLORATION +acuosa I-EXPLORATION +abundante I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +izquierda I-EXPLORATION +evidenciada I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +maniobra I-EXPLORATION +de I-EXPLORATION +Valsalva. I-EXPLORATION +Por I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +fístula I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +paranasales I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +resolución I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +continuidad I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lámina I-EXPLORATION +cribosa I-EXPLORATION +del I-EXPLORATION +etmoides I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +adelgazamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +postero-lateral I-EXPLORATION +del I-EXPLORATION +hemiseno I-EXPLORATION +esfenoidal I-EXPLORATION +izquierdo I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +aspecto I-EXPLORATION +más I-EXPLORATION +craneal I-EXPLORATION +con I-EXPLORATION +engrasamiento I-EXPLORATION +mucoso. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +β2-transferrina I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +nasal, I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +positivo. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +además I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +importancia. I-EXPLORATION + I-EXPLORATION +Su B-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios, I-EVOLUTION +completando I-EVOLUTION +14 I-EVOLUTION +días I-EVOLUTION +con I-EVOLUTION +ceftriaxona. I-EVOLUTION +Se I-EVOLUTION +decidió I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +programación I-EVOLUTION +diferida I-EVOLUTION +de I-EVOLUTION +resolución I-EVOLUTION +quirúrgica I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fístula I-EVOLUTION +de I-EVOLUTION +LCR. I-EVOLUTION +Se B-TREATMENT +recomendó I-TREATMENT +la I-TREATMENT +vacunación I-TREATMENT +antineumocócica I-TREATMENT +polisacárida I-TREATMENT +y I-TREATMENT +antimeningocócica I-TREATMENT +cuadrivalente I-TREATMENT +conjugada. I-TREATMENT + I-TREATMENT +En B-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +dirigida I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refirió I-PAST_MEDICAL_HISTORY +golpes I-PAST_MEDICAL_HISTORY +menores I-PAST_MEDICAL_HISTORY +recurrentes I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cabeza I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +previas I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +muro I-PAST_MEDICAL_HISTORY +debajo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +escalera I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +permitía I-PAST_MEDICAL_HISTORY +acceder I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +patio I-PAST_MEDICAL_HISTORY +común I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +tender I-PAST_MEDICAL_HISTORY +ropa. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +reconoció I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +ocupado I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +papel I-PAST_MEDICAL_HISTORY +higiénico I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +limpiarse I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +genital I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +nasal I-PAST_MEDICAL_HISTORY +unos I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +escasez I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +éste I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +baño, I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +visita I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +unos I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +atendiendo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +intensa I-PAST_MEDICAL_HISTORY +rinorrea. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tras B-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +salida I-EVOLUTION +de I-EVOLUTION +LCR I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +nariz. I-EVOLUTION +A B-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +esto, I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +una I-TREATMENT +fístula I-TREATMENT +de I-TREATMENT +probable I-TREATMENT +origen I-TREATMENT +espontáneo I-TREATMENT +y I-TREATMENT +que I-TREATMENT +ya I-TREATMENT +había I-TREATMENT +tenido I-TREATMENT +un I-TREATMENT +episodio I-TREATMENT +de I-TREATMENT +MBA, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +aconsejó I-TREATMENT +someterse I-TREATMENT +a I-TREATMENT +una I-TREATMENT +cirugía I-TREATMENT +endoscópica I-TREATMENT +nasal I-TREATMENT +para I-TREATMENT +reparar I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +dehiscente I-TREATMENT +en I-TREATMENT +la I-TREATMENT +base I-TREATMENT +del I-TREATMENT +cráneo I-TREATMENT +anterior. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +cutánea I-PRESENT_ILLNESS +dolorosa I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +pápula, I-PRESENT_ILLNESS +pardo-negruzca, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bordes I-PRESENT_ILLNESS +eritematosos, I-PRESENT_ILLNESS +ubicada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +pulpejo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +ortejo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +múltiples I-EXPLORATION +huevecillos I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +blanco, I-EXPLORATION +de I-EXPLORATION +menos I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +regresado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +viaje I-PAST_MEDICAL_HISTORY +turístico I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Paraguay I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY +Se B-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +extracción I-TREATMENT +quirúrgica I-TREATMENT +de I-TREATMENT +los I-TREATMENT +parásitos. I-TREATMENT +Además I-TREATMENT +se I-TREATMENT +indicaron I-TREATMENT +antibacterianos I-TREATMENT +tópicos I-TREATMENT +y I-TREATMENT +profilaxis I-TREATMENT +antitetánica, I-TREATMENT +con B-EVOLUTION +resolución I-EVOLUTION +total I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +punzante, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +productiva. I-PRESENT_ILLNESS +Además I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +lógica, I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +(siete I-PRESENT_ILLNESS +kg) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +nocturna. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-EXPLORATION +tomó I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +hemoglobina I-EXPLORATION +6, I-EXPLORATION +2 I-EXPLORATION +g/dl, I-EXPLORATION +leucocitos I-EXPLORATION +9.830/mm3, I-EXPLORATION +plaquetas I-EXPLORATION +77.200/mm3, I-EXPLORATION +PCR I-EXPLORATION +216 I-EXPLORATION +mg/l I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +consolidación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Se B-EVOLUTION +hospitalizó I-EVOLUTION +para I-EVOLUTION +estudio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +bicitopenia, I-EVOLUTION +disfagia I-EVOLUTION +y I-EVOLUTION +síndrome I-EVOLUTION +consuntivo. I-EVOLUTION +Se I-EVOLUTION +diagnosticó B-TREATMENT +una I-TREATMENT +neumonía I-TREATMENT +bacteriana I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +recibió I-TREATMENT +ceftriaxona I-TREATMENT +por I-TREATMENT +10 I-TREATMENT +días, I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica. I-EVOLUTION + I-EVOLUTION +Dentro B-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +disfagia I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +endoscopía I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +(EDA) I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +tres I-EXPLORATION +úlceras I-EXPLORATION +esofágicas I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +etiología I-EXPLORATION +viral I-EXPLORATION +(citomegalovirus) I-EXPLORATION +(CMV). I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ganciclovir I-TREATMENT +por I-TREATMENT +10 I-TREATMENT +días, I-TREATMENT +con B-EVOLUTION +escasa I-EVOLUTION +respuesta I-EVOLUTION +clínica. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +erosión I-EXPLORATION +mucosa I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +citopáticos I-EXPLORATION +de I-EXPLORATION +CMV. I-EXPLORATION +La I-EXPLORATION +RPC I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +para I-EXPLORATION +CMV I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +bicitopenia I-EXPLORATION +fue I-EXPLORATION +confirmada I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +neutropenia I-EXPLORATION +de I-EXPLORATION +200 I-EXPLORATION +neutrófilos/mm3; I-EXPLORATION +88% I-EXPLORATION +de I-EXPLORATION +blastos I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +mielograma I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +una I-EXPLORATION +leucemia I-EXPLORATION +mieloide I-EXPLORATION +aguda I-EXPLORATION +(LMA). I-EXPLORATION +Una B-TREATMENT +vez I-TREATMENT +finalizados I-TREATMENT +los I-TREATMENT +tratamientos I-TREATMENT +antimicrobianos I-TREATMENT +inició I-TREATMENT +quimioterapia. I-TREATMENT + I-TREATMENT +Tres B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +quimioterapia I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +neutropenia I-EVOLUTION +febril I-EVOLUTION +(NF) I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +RAN I-EVOLUTION +de I-EVOLUTION +20 I-EVOLUTION +neutrófilos/mm3. I-EVOLUTION +Una B-EXPLORATION +nueva I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +cambios I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +anterior. I-EXPLORATION +Inició B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +imipenem I-TREATMENT +y I-TREATMENT +vancomicina I-TREATMENT +i.v. I-TREATMENT +Por B-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fiebre I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +neutropenia, I-EXPLORATION +al I-EXPLORATION +cuarto I-EXPLORATION +día I-EXPLORATION +se I-EXPLORATION +repitieron I-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +pulmonar, I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +pelvis. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +pulmonar I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +"signo I-EXPLORATION +del I-EXPLORATION +halo". I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +voriconazol I-TREATMENT +sospechando I-TREATMENT +una I-TREATMENT +aspergilosis I-TREATMENT +pulmonar. I-TREATMENT +Los B-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +galactomananos I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +disfagia, I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +EDA I-EXPLORATION +mostró I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +úlceras I-EXPLORATION +esofágicas. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +evidenció I-EXPLORATION +hifas I-EXPLORATION +septadas, I-EXPLORATION +ramificadas I-EXPLORATION +en I-EXPLORATION +45°, I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +Aspergillus I-EXPLORATION +spp. I-EXPLORATION + I-EXPLORATION +Luego B-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antifúngico I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +sin I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +disfagia. I-EVOLUTION +Se B-TREATMENT +completaron I-TREATMENT +18 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antibacteriano I-TREATMENT +y I-TREATMENT +21 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +voriconazol. I-TREATMENT + I-TREATMENT + +Un B-PRESENT_ILLNESS +adulto I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +Departamento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Neurología I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Ataque I-PAST_MEDICAL_HISTORY +Isquémico I-PAST_MEDICAL_HISTORY +Transitorio I-PAST_MEDICAL_HISTORY +(AIT). I-PAST_MEDICAL_HISTORY +Sin B-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +ya I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +casa, I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +egreso I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +nuevamente I-PRESENT_ILLNESS +hospitalizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +AIT. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +esta I-PRESENT_ILLNESS +ocasión I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dado I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +curso I-PRESENT_ILLNESS +febril, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +evaluado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Departamento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Infectología. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +comunes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +desarrollar I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +EI, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +sometido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +AC I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +raíz I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +torácico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +causa I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +precisada. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Hallazgos B-EXPLORATION +destacables I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +eran: I-EXPLORATION +fiebre I-EXPLORATION +de I-EXPLORATION +39, I-EXPLORATION +7°C I-EXPLORATION +acompañada I-EXPLORATION +de I-EXPLORATION +calofríos I-EXPLORATION +solemnes, I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +motricidad I-EXPLORATION +en I-EXPLORATION +grado I-EXPLORATION +3/5 I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +superior I-EXPLORATION +e I-EXPLORATION +inferior I-EXPLORATION +derechas, I-EXPLORATION +borde I-EXPLORATION +hepático I-EXPLORATION +palpable I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +bajo I-EXPLORATION +el I-EXPLORATION +reborde I-EXPLORATION +costal I-EXPLORATION +derecho, I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +soplo I-EXPLORATION +sistólico I-EXPLORATION +de I-EXPLORATION +eyección, I-EXPLORATION +3/6, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +borde I-EXPLORATION +esternal I-EXPLORATION +izquierdo. I-EXPLORATION +No I-EXPLORATION +había I-EXPLORATION +estigmas I-EXPLORATION +periféricos I-EXPLORATION +de I-EXPLORATION +EI. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraban: I-EXPLORATION +recuento I-EXPLORATION +leucocitario I-EXPLORATION +de I-EXPLORATION +19.870/mm3, I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +10, I-EXPLORATION +9 I-EXPLORATION +g/dL, I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +31 I-EXPLORATION +mg/dL, I-EXPLORATION +creatininemia I-EXPLORATION +1, I-EXPLORATION +3 I-EXPLORATION +mg/dL. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +químicos I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +Habiendo B-TREATMENT +obtenido I-TREATMENT +hemocultivos, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +una I-TREATMENT +antibioterapia I-TREATMENT +combinada I-TREATMENT +de I-TREATMENT +cefepime I-TREATMENT +y I-TREATMENT +amikacina, I-TREATMENT +considerando I-TREATMENT +el I-TREATMENT +antecedente I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hospitalización I-TREATMENT +en I-TREATMENT +el I-TREATMENT +mes I-TREATMENT +previo. I-TREATMENT +Una B-EXPLORATION +ETT I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +vegetación I-EXPLORATION +libremente I-EXPLORATION +móvil I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +mm I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +mitral, I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +cierto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +insuficiencia I-EXPLORATION +mitral. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +incubación, I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +P. I-EXPLORATION +aeruginosa I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +hemocultivos. I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +que I-EXPLORATION +esta I-EXPLORATION +cepa I-EXPLORATION +tenía I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +antibiograma I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +1. I-EXPLORATION +La B-TREATMENT +antibioterapia I-TREATMENT +en I-TREATMENT +curso I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +y, B-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +control I-EXPLORATION +ecocadiográfico, I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +reducción I-EXPLORATION +del I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vegetación. I-EXPLORATION +No B-EVOLUTION +obstante, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +24 I-EVOLUTION +de I-EVOLUTION +antibioterapia, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +falla I-EVOLUTION +cardiaca I-EVOLUTION +aguda. I-EVOLUTION +Fue B-DERIVED_FROM/TO +trasladado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cuidados I-DERIVED_FROM/TO +intensivos I-DERIVED_FROM/TO +(UCI) I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +apoyado I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +ventilación I-DERIVED_FROM/TO +mecánica. I-DERIVED_FROM/TO +Se B-TREATMENT +le I-TREATMENT +sometió I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +cardiaca I-TREATMENT +con I-TREATMENT +reemplazo I-TREATMENT +mitral I-TREATMENT +por I-TREATMENT +una I-TREATMENT +válvula I-TREATMENT +protésica. I-TREATMENT +Diez B-EVOLUTION +días I-EVOLUTION +tras I-EVOLUTION +ser I-EVOLUTION +operado, I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +tamponamiento I-EVOLUTION +cardiaco, I-EVOLUTION +drenándose B-TREATMENT +quirúrgicamente I-TREATMENT +abundante I-TREATMENT +fluido. I-TREATMENT +La B-EVOLUTION +condición I-EVOLUTION +clínica I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +mejoró, I-EVOLUTION +pero I-EVOLUTION +16 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +cirugía, I-EVOLUTION +reapareció I-EVOLUTION +la I-EVOLUTION +fiebre, I-EVOLUTION +acompañada I-EVOLUTION +de I-EVOLUTION +leucocitosis, I-EVOLUTION +secreción I-EVOLUTION +respiratoria I-EVOLUTION +purulenta, I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +efusión I-EVOLUTION +pleural I-EVOLUTION +masiva. I-EVOLUTION +Se B-TREATMENT +cambió I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +a I-TREATMENT +meropenem I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +efectuó I-TREATMENT +una I-TREATMENT +toracostomia I-TREATMENT +a I-TREATMENT +izquierda. I-TREATMENT +Se B-EVOLUTION +comprobó I-EVOLUTION +la I-EVOLUTION +existencia I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +neumonía I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +ventilación I-EVOLUTION +mecánica, I-EVOLUTION +por I-EVOLUTION +Acinetobacter I-EVOLUTION +baumannii.: I-EVOLUTION +La I-EVOLUTION +condición I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +hemodinámica I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +empeoró I-EVOLUTION +y I-EVOLUTION +finalmente I-EVOLUTION +falleció. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +peruana, B-PAST_MEDICAL_HISTORY +procedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Lima, I-PAST_MEDICAL_HISTORY +consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +pruriginosas, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Posteriormente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +asoció I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +extremidad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +evaluación. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedente, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +visitado I-PAST_MEDICAL_HISTORY +Tulum I-PAST_MEDICAL_HISTORY +(Riviera I-PAST_MEDICAL_HISTORY +Maya, I-PAST_MEDICAL_HISTORY +México) I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +días, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +caminó I-PAST_MEDICAL_HISTORY +descalza I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +arena I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +practicó I-PAST_MEDICAL_HISTORY +buceo, I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sufrido I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +picaduras I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +mosquitos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +extremidades I-PAST_MEDICAL_HISTORY +inferiores. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +retornado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Lima I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consultar. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +serpiginosas, I-EXPLORATION +solevantadas, I-EXPLORATION +eritematosas, I-EXPLORATION +confluentes, I-EXPLORATION +de I-EXPLORATION +uno I-EXPLORATION +a I-EXPLORATION +tres I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +uno I-EXPLORATION +a I-EXPLORATION +dos I-EXPLORATION +milímetros I-EXPLORATION +de I-EXPLORATION +espesor, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +y I-EXPLORATION +2°, I-EXPLORATION +3° I-EXPLORATION +y I-EXPLORATION +4° I-EXPLORATION +ortejos I-EXPLORATION +del I-EXPLORATION +pie I-EXPLORATION +derecho. I-EXPLORATION +Además, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +dedos I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +pequeñas I-EXPLORATION +vesículas I-EXPLORATION +pruriginosas. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +clínico I-TREATMENT +de I-TREATMENT +larva I-TREATMENT +migrans I-TREATMENT +cutánea I-TREATMENT +y I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ivermectina I-TREATMENT +6 I-TREATMENT +mg/ml, I-TREATMENT +solución I-TREATMENT +oral I-TREATMENT +en I-TREATMENT +gotas, I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +200 I-TREATMENT +μg/kg I-TREATMENT +de I-TREATMENT +peso, I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +y I-TREATMENT +reposo. I-TREATMENT +Presentó B-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +fiebre, I-EVOLUTION +de I-EVOLUTION +38°C I-EVOLUTION +axilar. I-EVOLUTION +Las I-EVOLUTION +lesiones I-EVOLUTION +empezaron I-EVOLUTION +a I-EVOLUTION +remitir I-EVOLUTION +a I-EVOLUTION +partir I-EVOLUTION +del I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +poliquística I-PAST_MEDICAL_HISTORY +hepatorenal, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Crohn I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fenotipo I-PAST_MEDICAL_HISTORY +inflamatorio I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +yeyuno I-PAST_MEDICAL_HISTORY +(demostrado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +tomografía I-PAST_MEDICAL_HISTORY +computada I-PAST_MEDICAL_HISTORY +[TC] I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +abdomen I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pelvis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cápsula I-PAST_MEDICAL_HISTORY +endoscópica) I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +íleon I-PAST_MEDICAL_HISTORY +terminal I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +infliximab I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +azatioprina. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +sometido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +resección I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +íleon I-PAST_MEDICAL_HISTORY +terminal I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ileoascendo I-PAST_MEDICAL_HISTORY +anastomosis, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemorragia I-PAST_MEDICAL_HISTORY +digestiva I-PAST_MEDICAL_HISTORY +baja I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +base I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diverticulitis I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +motivaron I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +suspensión I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +biológica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +desarrolló I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bacteriemia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Escherichia I-PAST_MEDICAL_HISTORY +coli, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +quinolonas I-PAST_MEDICAL_HISTORY +(ciprofloxacina) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cefalosporinas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3era I-PAST_MEDICAL_HISTORY +generación I-PAST_MEDICAL_HISTORY +(ceftriaxona). I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +extenso I-EXPLORATION +estudio I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +otro I-EXPLORATION +foco I-EXPLORATION +primario, I-EXPLORATION +incluyendo I-EXPLORATION +ecocardiograma I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +por I-EXPLORATION +emisión I-EXPLORATION +de I-EXPLORATION +positrones I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TEP-TC), I-EXPLORATION +entre I-EXPLORATION +otros. I-EXPLORATION +Un B-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +segundo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +bacteriemia I-EVOLUTION +por I-EVOLUTION +E. I-EVOLUTION +coli I-EVOLUTION +se I-EVOLUTION +hospitalizó I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +febril I-EVOLUTION +y I-EVOLUTION +diarrea I-EVOLUTION +por I-EVOLUTION +CD I-EVOLUTION +(toxina I-EVOLUTION +A I-EVOLUTION +positiva) I-EVOLUTION +y I-EVOLUTION +colonoscopia I-EVOLUTION +completa I-EVOLUTION +con I-EVOLUTION +ileoscopia I-EVOLUTION +compatible I-EVOLUTION +con I-EVOLUTION +colitis I-EVOLUTION +pseudomebranosa I-EVOLUTION +siendo B-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +por I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +Aproximadamente B-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +después, I-EVOLUTION +presentó I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +febril. I-EVOLUTION +La B-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +perforación I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +yeyuno I-EXPLORATION +atribuido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn I-EXPLORATION +activa. I-EXPLORATION +Por B-TREATMENT +hemocultivos I-TREATMENT +positivos I-TREATMENT +a I-TREATMENT +E. I-TREATMENT +coli I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +y I-TREATMENT +metronidazol. I-TREATMENT +Posteriormente B-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +diarrea I-EVOLUTION +por I-EVOLUTION +CD, I-EVOLUTION +con I-EVOLUTION +toxina I-EVOLUTION +A I-EVOLUTION +y I-EVOLUTION +B I-EVOLUTION +positiva, I-EVOLUTION +siendo B-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +vancomicina, I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +por I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT + I-TREATMENT +Un B-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +cuarto I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +bacteriemia I-EVOLUTION +por I-EVOLUTION +E. I-EVOLUTION +coli, I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +diarrea I-EVOLUTION +por I-EVOLUTION +CD, I-EVOLUTION +con I-EVOLUTION +toxina I-EVOLUTION +A I-EVOLUTION +y I-EVOLUTION +B I-EVOLUTION +positiva, I-EVOLUTION +siendo B-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +vancomicina, I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +por I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +respuesta, I-EVOLUTION +sin I-EVOLUTION +embargo, I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +recaída I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +completado I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +motivo B-TREATMENT +por I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +trató I-TREATMENT +nuevamente I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +en I-TREATMENT +disminución I-TREATMENT +progresiva I-TREATMENT +y I-TREATMENT +probióticos I-TREATMENT +(Sacharomyces I-TREATMENT +boulardi), I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT + I-TREATMENT +Un B-EVOLUTION +año I-EVOLUTION +después, I-EVOLUTION +estando I-EVOLUTION +con I-EVOLUTION +profilaxis I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +diverticulitis I-EVOLUTION +con I-EVOLUTION +rifaximina I-EVOLUTION +y I-EVOLUTION +mesalazina, I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +diarrea I-EVOLUTION +por I-EVOLUTION +CD, I-EVOLUTION +con I-EVOLUTION +RPC I-EVOLUTION +positiva I-EVOLUTION +en I-EVOLUTION +deposiciones. I-EVOLUTION +Fue B-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +vancomicina, I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +por I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +recaída I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +cuatro I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +terminado I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION +Fue B-TREATMENT +tratado I-TREATMENT +nuevamente I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +en I-TREATMENT +disminución I-TREATMENT +progresiva I-TREATMENT +y I-TREATMENT +probióticos. I-TREATMENT +Evolucionó B-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +tórpida I-EVOLUTION +con I-EVOLUTION +fiebre, I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +diarrea, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +internado I-TREATMENT +y I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +metronidazol I-TREATMENT +intravenoso I-TREATMENT +(IV). I-TREATMENT +Al I-TREATMENT +no I-TREATMENT +presentar I-TREATMENT +mejoría I-TREATMENT +al I-TREATMENT +3° I-TREATMENT +día I-TREATMENT +recibió I-TREATMENT +inmunoglobulina I-TREATMENT +IV I-TREATMENT +400 I-TREATMENT +mg/kg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +en I-TREATMENT +cinco I-TREATMENT +dosis, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +respuesta I-TREATMENT +clínica I-TREATMENT +parcial. I-TREATMENT + I-TREATMENT +Dada I-TREATMENT +la I-TREATMENT +mala I-TREATMENT +evolución I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +todas I-TREATMENT +las I-TREATMENT +terapias I-TREATMENT +probadas I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +un I-TREATMENT +TMF I-TREATMENT +vía I-TREATMENT +colonoscopia I-TREATMENT +con I-TREATMENT +deposiciones I-TREATMENT +de I-TREATMENT +un I-TREATMENT +donante I-TREATMENT +familiar I-TREATMENT +directo I-TREATMENT +sin I-TREATMENT +antecedentes I-TREATMENT +de I-TREATMENT +patologías I-TREATMENT +y I-TREATMENT +con I-TREATMENT +estudio I-TREATMENT +pre-trasplante I-TREATMENT +en I-TREATMENT +sangre I-TREATMENT +y I-TREATMENT +deposiciones I-TREATMENT +(3) I-TREATMENT +negativo. I-TREATMENT +Se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +azatioprina I-TREATMENT +y I-TREATMENT +antimicrobianos, I-TREATMENT +cinco I-TREATMENT +días I-TREATMENT +y I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +antes I-TREATMENT +del I-TREATMENT +TMF, I-TREATMENT +respectivamente. I-TREATMENT + I-TREATMENT +Descripción I-TREATMENT +del I-TREATMENT +procedimiento: I-TREATMENT +se I-TREATMENT +utilizaron I-TREATMENT +69 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +deposiciones I-TREATMENT +sólidas I-TREATMENT +diluidas I-TREATMENT +en I-TREATMENT +300 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +suero I-TREATMENT +fisiológico I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +filtradas. I-TREATMENT +La I-TREATMENT +solución I-TREATMENT +fue I-TREATMENT +instilada I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +íleon I-TREATMENT +terminal I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +sigmoides I-TREATMENT +incluyendo I-TREATMENT +el I-TREATMENT +área I-TREATMENT +con I-TREATMENT +divertículos. I-TREATMENT + I-TREATMENT +A I-TREATMENT +las I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +del I-TREATMENT +TMF I-TREATMENT +presentó I-TREATMENT +un I-TREATMENT +cuadro I-TREATMENT +febril I-TREATMENT +(T° I-TREATMENT +axilar I-TREATMENT +39°C) I-TREATMENT +con I-TREATMENT +hemocultivos I-TREATMENT +positivos I-TREATMENT +a I-TREATMENT +E. I-TREATMENT +coli. I-TREATMENT +Fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +aztreonam I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +de I-TREATMENT +laboratorio. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +realizado I-EVOLUTION +el I-EVOLUTION +TMF, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +bacteriemia I-EVOLUTION +por I-EVOLUTION +E. I-EVOLUTION +coli I-EVOLUTION +siendo B-TREATMENT +nuevamente I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +aztreonam. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +completar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibacteriano I-TREATMENT +evolucionó I-TREATMENT +con I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +cuadro I-TREATMENT +de I-TREATMENT +diarrea I-TREATMENT +por I-TREATMENT +CD I-TREATMENT +con I-TREATMENT +RPC I-TREATMENT +positiva I-TREATMENT +para I-TREATMENT +CD. I-TREATMENT +Fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +vancomicina, I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +por I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +Un B-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +cuatro I-EVOLUTION +meses I-EVOLUTION +posterior I-EVOLUTION +al I-EVOLUTION +TMF I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +diarrea I-EVOLUTION +por I-EVOLUTION +CD I-EVOLUTION +(con I-EVOLUTION +RPC I-EVOLUTION +positiva) I-EVOLUTION +que B-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +vancomicina, I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +en I-TREATMENT +disminución I-TREATMENT +progresiva, I-TREATMENT +probióticos I-TREATMENT +e I-TREATMENT +inmunoglobulina I-TREATMENT +IV I-TREATMENT +400 I-TREATMENT +mg/kg I-TREATMENT +día I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +Actualmente B-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +en I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +azatioprina I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +enfermedad I-EVOLUTION +de I-EVOLUTION +Crohn. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +42 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +ocho I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +inmunológicos I-PAST_MEDICAL_HISTORY +periódicos, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +criterios I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antirretroviral. I-PAST_MEDICAL_HISTORY +Tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +leishmaniasis I-PAST_MEDICAL_HISTORY +cutánea I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antebrazo I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás, I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +residía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Madre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Dios I-PAST_MEDICAL_HISTORY +(Amazonía I-PAST_MEDICAL_HISTORY +oriental I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Perú). I-PAST_MEDICAL_HISTORY +Refirió I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +incompleto, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +pudo I-PAST_MEDICAL_HISTORY +especificar. I-PAST_MEDICAL_HISTORY +Además I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +colesteatoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +oído I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +parálisis I-PAST_MEDICAL_HISTORY +facial I-PAST_MEDICAL_HISTORY +periférica I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +secuela. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +enfermedades. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tenía I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +clínicos I-PAST_MEDICAL_HISTORY +anuales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carga I-PAST_MEDICAL_HISTORY +viral I-PAST_MEDICAL_HISTORY +(CV) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +niveles I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +linfocitos I-PAST_MEDICAL_HISTORY +T I-PAST_MEDICAL_HISTORY +CD4, I-PAST_MEDICAL_HISTORY +manteniéndose I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +valores I-PAST_MEDICAL_HISTORY +estables I-PAST_MEDICAL_HISTORY +(CV I-PAST_MEDICAL_HISTORY +< I-PAST_MEDICAL_HISTORY +20.000 I-PAST_MEDICAL_HISTORY +copias/ml I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +CD4 I-PAST_MEDICAL_HISTORY +> I-PAST_MEDICAL_HISTORY +700 I-PAST_MEDICAL_HISTORY +cél/mm3), I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +evidenció I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +leve I-PAST_MEDICAL_HISTORY +disminución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +CD4 I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +643 I-PAST_MEDICAL_HISTORY +(28%) I-PAST_MEDICAL_HISTORY +cél/mm3 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +importante I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +CV I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +47.466 I-PAST_MEDICAL_HISTORY +copias/ml. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +período I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +intercurrentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diarrea I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +coriza I-PAST_MEDICAL_HISTORY +autolimitados. I-PAST_MEDICAL_HISTORY +Tenía I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +marcadores I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +positivos: I-PAST_MEDICAL_HISTORY +HBsAg I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anticore I-PAST_MEDICAL_HISTORY +total, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +alteración I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +pruebas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +función I-PAST_MEDICAL_HISTORY +hepática. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Infectología I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +parietal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +congestión I-PRESENT_ILLNESS +nasal I-PRESENT_ILLNESS +persistente, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +examen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nasofaringe. I-PRESENT_ILLNESS +Un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +epistaxis, I-PRESENT_ILLNESS +secreción I-PRESENT_ILLNESS +nasal I-PRESENT_ILLNESS +mucopurulenta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +observó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +nasal I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +(ala I-PRESENT_ILLNESS +nasal). I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +lesiones I-EXPLORATION +pápulo-ulcerativas I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +vestibular I-EXPLORATION +y I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +derecha, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +secreción I-EXPLORATION +mucopurulenta I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +exofítica. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +nasal I-EXPLORATION +para I-EXPLORATION +estudio. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +además I-EXPLORATION +una I-EXPLORATION +cicatriz I-EXPLORATION +deprimida, I-EXPLORATION +delgada, I-EXPLORATION +lisa, I-EXPLORATION +hipopigmentada, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +irregulares I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +antebrazo I-EXPLORATION +derecho, I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +antigua I-EXPLORATION +de I-EXPLORATION +leishmaniasis I-EXPLORATION +cutánea. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antirretroviral I-TREATMENT +de I-TREATMENT +gran I-TREATMENT +actividad I-TREATMENT +(TARGA) I-TREATMENT +con I-TREATMENT +zidovudina, I-TREATMENT +lamivudina, I-TREATMENT +lopinavir I-TREATMENT +y I-TREATMENT +ritonavir, I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +síntomas I-TREATMENT +y I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +neoplasia I-TREATMENT +relacionada I-TREATMENT +al I-TREATMENT +VIH. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +mostró I-EXPLORATION +estructuras I-EXPLORATION +ovaladas, I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +a I-EXPLORATION +4 I-EXPLORATION +μm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +uniforme, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +cinetoplasto I-EXPLORATION +periférico, I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +citoplasma I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +histiocitos, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +amastigotes I-EXPLORATION +de I-EXPLORATION +Leishmania I-EXPLORATION +spp. I-EXPLORATION +La I-EXPLORATION +inmunofluorescencia I-EXPLORATION +indirecta I-EXPLORATION +(IFI) I-EXPLORATION +(con I-EXPLORATION +antígeno I-EXPLORATION +total I-EXPLORATION +para I-EXPLORATION +L. I-EXPLORATION +boliviana I-EXPLORATION +y I-EXPLORATION +L. I-EXPLORATION +brasiliensis) I-EXPLORATION +detectó I-EXPLORATION +anticuerpos I-EXPLORATION +anti-Leishmania I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +dilución I-EXPLORATION +de I-EXPLORATION +1/80, I-EXPLORATION +confirmándose I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +leishmaniasis. I-EXPLORATION +Al B-TREATMENT +mes I-TREATMENT +siguiente I-TREATMENT +de I-TREATMENT +iniciado I-TREATMENT +el I-TREATMENT +TARGA I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +estibogluconato I-TREATMENT +sódico, I-TREATMENT +20 I-TREATMENT +mg/kg/día I-TREATMENT +por I-TREATMENT +30 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Luego B-EVOLUTION +de I-EVOLUTION +completar I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +estibogluconato I-EVOLUTION +sódico, I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +mejoró I-EVOLUTION +entre I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +y I-EVOLUTION +cuatro I-EVOLUTION +semanas, I-EVOLUTION +hasta I-EVOLUTION +su I-EVOLUTION +cicatrización I-EVOLUTION +completa. I-EVOLUTION +Tres I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +de I-EVOLUTION +CD4 I-EVOLUTION +se I-EVOLUTION +elevaron I-EVOLUTION +hasta I-EVOLUTION +843 I-EVOLUTION +cél/ml I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +carga I-EVOLUTION +viral I-EVOLUTION +disminuyó I-EVOLUTION +a I-EVOLUTION +< I-EVOLUTION +40 I-EVOLUTION +copias/ml. I-EVOLUTION +Actualmente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático, I-EVOLUTION +con I-EVOLUTION +TARGA, I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +recaída I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +ni I-EVOLUTION +lesiones I-EVOLUTION +similares. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Down, I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +congénita I-PAST_MEDICAL_HISTORY +operada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +(canal I-PAST_MEDICAL_HISTORY +aurículo-ventricular I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ductus I-PAST_MEDICAL_HISTORY +arterioso I-PAST_MEDICAL_HISTORY +persistente). I-PAST_MEDICAL_HISTORY +Tenía B-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +vacunas I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Programa I-PRESENT_ILLNESS +Nacional I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Inmunizaciones I-PRESENT_ILLNESS +(PNI) I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +vacunas I-PRESENT_ILLNESS +extra-PNI. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +veces I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia I-PRESENT_ILLNESS +Infantil I-PRESENT_ILLNESS +(SUI) I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +eritrodermia. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +eritema I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +hemi-cara I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +extendió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +contra-lateral. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +40° I-PRESENT_ILLNESS +C, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +eritema I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +progresión I-PRESENT_ILLNESS +descendente, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +comprometió I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuello, I-PRESENT_ILLNESS +tronco I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +superiores. I-PRESENT_ILLNESS +Además I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acompañó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +flictenas I-PRESENT_ILLNESS +eritematosas, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +pruriginosas, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +mentoniana I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +preauricular I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +desaparecieron I-PRESENT_ILLNESS +espontáneamente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +transcurso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +día. I-PRESENT_ILLNESS +Se B-EXPLORATION +evaluó I-EXPLORATION +con I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +destacando I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +normales I-EXPLORATION +(10.470/mm3) I-EXPLORATION +con I-EXPLORATION +predominio I-EXPLORATION +polimorfonuclear I-EXPLORATION +(92,3%), I-EXPLORATION +sin I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +serie I-EXPLORATION +roja I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +1 I-EXPLORATION +mg/dl). I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +hizo I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +una I-TREATMENT +dermatitis I-TREATMENT +alérgica I-TREATMENT +y I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +clorfenamina I-TREATMENT +y I-TREATMENT +glucocorticoides I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +durante I-TREATMENT +tres I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Por B-DERIVED_FROM/TO +persistencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +sintomatología, I-DERIVED_FROM/TO +consultó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +pediatra I-DERIVED_FROM/TO +tratante I-DERIVED_FROM/TO +quien I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +nuevamente I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +SUI. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EVOLUTION +ese I-EVOLUTION +momento, I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +8° I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +7° I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +fiebre, I-EVOLUTION +se I-EVOLUTION +apreciaba I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales. I-EVOLUTION +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +describía I-EXPLORATION +una I-EXPLORATION +"lesión I-EXPLORATION +eritro-descamativa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +que I-EXPLORATION +respetaba I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +peribucal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +placa I-EXPLORATION +eritematosa I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +superiores I-EXPLORATION +que I-EXPLORATION +respetaba I-EXPLORATION +las I-EXPLORATION +muñecas, I-EXPLORATION +manos I-EXPLORATION +y I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +codo. I-EXPLORATION +También I-EXPLORATION +afectaba I-EXPLORATION +el I-EXPLORATION +cuero I-EXPLORATION +cabelludo, I-EXPLORATION +cuello I-EXPLORATION +y I-EXPLORATION +mitad I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +tronco, I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +delimitados, I-EXPLORATION +sin I-EXPLORATION +adenopatías I-EXPLORATION +palpables. I-EXPLORATION +Presentaba I-EXPLORATION +una I-EXPLORATION +inyección I-EXPLORATION +conjuntival I-EXPLORATION +sin I-EXPLORATION +secreción I-EXPLORATION +y I-EXPLORATION +lengua I-EXPLORATION +aframbuesada. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +cardíaco I-EXPLORATION +era I-EXPLORATION +normal, I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +descamación I-EXPLORATION +periungueal". I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +destacando I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +leucopenia I-EXPLORATION +de I-EXPLORATION +4.880/mm3, I-EXPLORATION +con I-EXPLORATION +predominio I-EXPLORATION +polimorfonuclear I-EXPLORATION +(90%), I-EXPLORATION +plaquetas I-EXPLORATION +198.000/mm3, I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +20, I-EXPLORATION +2 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +anti-estreptolisina I-EXPLORATION +O I-EXPLORATION +759 I-EXPLORATION +U/ I-EXPLORATION +ml I-EXPLORATION +(VN: I-EXPLORATION +< I-EXPLORATION +200). I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +faríngeo I-EXPLORATION +y I-EXPLORATION +dos I-EXPLORATION +hemocultivos I-EXPLORATION +periféricos. I-EXPLORATION + I-EXPLORATION +Ingresó B-EVOLUTION +al I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Pediatría I-EVOLUTION +al I-EVOLUTION +8° I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +con I-EVOLUTION +estabilidad I-EVOLUTION +hemodinámica I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +conciencia. I-EVOLUTION +Se B-TREATMENT +planteó I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +escarlatina I-TREATMENT +e I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +amoxicilina, I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT +Además B-EXPLORATION +se I-EXPLORATION +planteó I-EXPLORATION +la I-EXPLORATION +necesidad I-EXPLORATION +de I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Kawasaki I-EXPLORATION +atípica I-EXPLORATION +o I-EXPLORATION +una I-EXPLORATION +endocarditis I-EXPLORATION +infecciosa. I-EXPLORATION +Se B-EVOLUTION +controlaron I-EVOLUTION +exámenes I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso. I-EVOLUTION +Tenía I-EVOLUTION +una I-EVOLUTION +PCR I-EVOLUTION +de I-EVOLUTION +23, I-EVOLUTION +9 I-EVOLUTION +mg/dl I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +perfil I-EVOLUTION +bioquímico I-EVOLUTION +normal. I-EVOLUTION +Evaluada B-TREATMENT +por I-TREATMENT +infectología, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +cambiar I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +a I-TREATMENT +penicilina I-TREATMENT +sódica I-TREATMENT +i.v. I-TREATMENT + I-TREATMENT +Evolucionó B-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +antimicrobiano, I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +incubación I-EVOLUTION +se I-EVOLUTION +informaron I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +hemocultivos I-EVOLUTION +positivos I-EVOLUTION +para I-EVOLUTION +Streptococcus I-EVOLUTION +ß- I-EVOLUTION +hemolítico I-EVOLUTION +del I-EVOLUTION +grupo I-EVOLUTION +G, I-EVOLUTION +con I-EVOLUTION +susceptibilidad I-EVOLUTION +in I-EVOLUTION +vitro I-EVOLUTION +a I-EVOLUTION +penicilina, I-EVOLUTION +clindamicina, I-EVOLUTION +cloxacilina, I-EVOLUTION +eritromicina I-EVOLUTION +y I-EVOLUTION +levofloxacino, I-EVOLUTION +y I-EVOLUTION +resistencia I-EVOLUTION +a I-EVOLUTION +cotrimoxazol. I-EVOLUTION +El I-EVOLUTION +ecocardiograma I-EVOLUTION +realizado I-EVOLUTION +fue I-EVOLUTION +normal I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +hubo I-EVOLUTION +detección I-EVOLUTION +de I-EVOLUTION +otros I-EVOLUTION +focos I-EVOLUTION +clínicos I-EVOLUTION +secundarios. I-EVOLUTION + I-EVOLUTION +Evolucionó I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +franca I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +eritema I-EVOLUTION +facial I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +tronco. I-EVOLUTION +Al I-EVOLUTION +5° I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antimicrobiano, I-EVOLUTION +se I-EVOLUTION +informó I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +especie I-EVOLUTION +identificada, I-EVOLUTION +por I-EVOLUTION +método I-EVOLUTION +de I-EVOLUTION +Vitek®, I-EVOLUTION +correspondía I-EVOLUTION +a I-EVOLUTION +Streptococcus I-EVOLUTION +dysgalactiae I-EVOLUTION +subespecie I-EVOLUTION +equisimilis. I-EVOLUTION + I-EVOLUTION +La B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +i.v. I-TREATMENT +más I-TREATMENT +cuatro I-TREATMENT +días I-TREATMENT +de I-TREATMENT +amoxicilina/ácido I-TREATMENT +clavulánico, I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +completando I-TREATMENT +en I-TREATMENT +la I-TREATMENT +fase I-TREATMENT +ambulatoria I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT +El B-EVOLUTION +control I-EVOLUTION +posterior I-EVOLUTION +demostró I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +satisfactoria. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +básico I-EXPLORATION +de I-EXPLORATION +inmunodeficiencia I-EXPLORATION +descartándose I-EXPLORATION +una I-EXPLORATION +hipogamaglobulinemia, I-EXPLORATION +hipocomplementemia I-EXPLORATION +o I-EXPLORATION +leucopenia I-EXPLORATION +secundaria I-EXPLORATION +al I-EXPLORATION +Síndrome I-EXPLORATION +de I-EXPLORATION +Down. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +cepa I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +al I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Biología I-EXPLORATION +Molecular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +Católica I-EXPLORATION +para I-EXPLORATION +genotipificación. I-EXPLORATION +Por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +RPC I-EXPLORATION +universal I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +Streptococcus I-EXPLORATION +dysgalactiae I-EXPLORATION +subespecie I-EXPLORATION +equisimilis, I-EXPLORATION +genotipo I-EXPLORATION +stg653.0. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +84 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +nacionalidad B-PAST_MEDICAL_HISTORY +chilena, I-PAST_MEDICAL_HISTORY +dueña I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +casa. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +policlínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Dermatología I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nódulos I-PRESENT_ILLNESS +cutáneos I-PRESENT_ILLNESS +eritematosos I-PRESENT_ILLNESS +ulcerados, I-PRESENT_ILLNESS +asintomáticos, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +palmar I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dedo I-PRESENT_ILLNESS +meñique I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +ventral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +antebrazo I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +siguiendo I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +patrón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disposición I-PRESENT_ILLNESS +lineal I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +largo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +trayecto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vasos I-PRESENT_ILLNESS +linfáticos I-PRESENT_ILLNESS +; I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +acompañantes. I-PRESENT_ILLNESS +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +esencial, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardíaca I-PAST_MEDICAL_HISTORY +congestiva, I-PAST_MEDICAL_HISTORY +hipotiroidis-mo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +hemolítica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +crioaglutininas. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tuberculosis, I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +corticoides, I-PAST_MEDICAL_HISTORY +inmunosupresión I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +trauma I-PAST_MEDICAL_HISTORY +reciente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +zonas I-PAST_MEDICAL_HISTORY +afectadas. I-PAST_MEDICAL_HISTORY +No B-FAMILY_HISTORY +existían I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +relevancia I-FAMILY_HISTORY +ni I-FAMILY_HISTORY +viajes I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +último I-FAMILY_HISTORY +tiempo. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Se B-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +de I-EXPLORATION +micosis I-EXPLORATION +subcutánea, I-EXPLORATION +micobacteriosis I-EXPLORATION +tuberculosa I-EXPLORATION +y I-EXPLORATION +micobacteriosis I-EXPLORATION +atípica, I-EXPLORATION +realizándose I-EXPLORATION +biopsia I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +cutáneas. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +histopatológico I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +paniculitis I-EXPLORATION +granulomatosa I-EXPLORATION +supurativa I-EXPLORATION +sin I-EXPLORATION +caseificación. I-EXPLORATION +Las I-EXPLORATION +tinciones I-EXPLORATION +de I-EXPLORATION +PAS, I-EXPLORATION +Grocott, I-EXPLORATION +Ziehl-Neelsen I-EXPLORATION +y I-EXPLORATION +Gram I-EXPLORATION +no I-EXPLORATION +revelaron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +microorganismos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +muestra. I-EXPLORATION +Sin I-EXPLORATION +embargo, I-EXPLORATION +la I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +M. I-EXPLORATION +tuberculosis. I-EXPLORATION +Dentro I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +hemograma, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación, I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VIH, I-EXPLORATION +perfil I-EXPLORATION +bioquímico, I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +orina, I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +todos I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +Quantiferon I-EXPLORATION +TB I-EXPLORATION +gold® I-EXPLORATION +resultó I-EXPLORATION +positivo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +PPD. I-EXPLORATION + I-EXPLORATION +Basado I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +resultados, I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +tuberculosis I-EXPLORATION +cutánea I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +primario I-TREATMENT +de I-TREATMENT +cuatro I-TREATMENT +fármacos: I-TREATMENT +isoniacida, I-TREATMENT +pirazinamida, I-TREATMENT +rifampicina I-TREATMENT +y I-TREATMENT +etambutol. I-TREATMENT +Durante I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +seguimiento I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +terapia I-TREATMENT +antituberculosa I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +a I-TREATMENT +los I-TREATMENT +protocolos I-TREATMENT +establecidos, I-TREATMENT +demostrando B-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +clínicamente I-EVOLUTION +significativa I-EVOLUTION +con I-EVOLUTION +regresión I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +ulcerativas I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +efectos I-EVOLUTION +secundarios I-EVOLUTION +reportados. I-EVOLUTION + I-EVOLUTION + +Comunicamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Iquitos, I-PAST_MEDICAL_HISTORY +selva I-PAST_MEDICAL_HISTORY +peruana, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia. I-PAST_MEDICAL_HISTORY +Tenía B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +febril, I-PRESENT_ILLNESS +calofríos, I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +epigastralgia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +gingivorragia. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +5°C, I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +110/80 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +y I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +de I-EXPLORATION +22 I-EXPLORATION +respiraciones I-EXPLORATION +por I-EXPLORATION +min. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +alteraciones. I-EXPLORATION +Al B-EVOLUTION +día I-EVOLUTION +siguiente, I-EVOLUTION +se I-EVOLUTION +agregó I-EVOLUTION +distensión I-EVOLUTION +abdominal, I-EVOLUTION +disnea I-EVOLUTION +a I-EVOLUTION +mediano I-EVOLUTION +esfuerzo I-EVOLUTION +y I-EVOLUTION +deposiciones I-EVOLUTION +con I-EVOLUTION +contenido I-EVOLUTION +rojizo I-EVOLUTION +oscuro, I-EVOLUTION +cuyo I-EVOLUTION +cultivo I-EVOLUTION +fue I-EVOLUTION +negativo; I-EVOLUTION +al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +pulmonar I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +murmullo I-EXPLORATION +vesicular I-EXPLORATION +disminuido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +inferior, I-EXPLORATION +sin I-EXPLORATION +ruidos I-EXPLORATION +agregados. I-EXPLORATION +Dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +48% I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +en I-EXPLORATION +51.000/mm3. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +dengue I-EXPLORATION +y I-EXPLORATION +leptospira, I-EXPLORATION +resultando I-EXPLORATION +la I-EXPLORATION +IgM I-EXPLORATION +para I-EXPLORATION +dengue I-EXPLORATION +positiva. I-EXPLORATION +Se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +dengue I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +IgM. I-EXPLORATION +Por I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +disnea I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecocardiografía I-EXPLORATION +y I-EXPLORATION +troponina I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +positiva I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +configuró I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +miocarditis. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +cardiomegalia I-EXPLORATION +con I-EXPLORATION +derrame I-EXPLORATION +pleural. I-EXPLORATION +Se B-EVOLUTION +ingresó I-EVOLUTION +a I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cuidados I-EVOLUTION +Intensivos I-EVOLUTION +por I-EVOLUTION +mala I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fiebre. I-EVOLUTION +Por B-TREATMENT +insuficiencia I-TREATMENT +respiratoria I-TREATMENT +y I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +conciencia I-TREATMENT +(Glasgow I-TREATMENT +10) I-TREATMENT +se I-TREATMENT +conectó I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasora. I-TREATMENT +Dentro B-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +auxiliares I-EXPLORATION +destacaban I-EXPLORATION +gases I-EXPLORATION +arteriales: I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +52; I-EXPLORATION +pCO2 I-EXPLORATION +58 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +PO2 I-EXPLORATION +(A-a) I-EXPLORATION +368 I-EXPLORATION +mmHg, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +157.000/mm3, I-EXPLORATION +hematocrito I-EXPLORATION +43%, I-EXPLORATION +glucosa I-EXPLORATION +167 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +1, I-EXPLORATION +08 I-EXPLORATION +mg/dl. I-EXPLORATION +Se B-EVOLUTION +diagnosticó I-EVOLUTION +dengue I-EVOLUTION +grave I-EVOLUTION +con I-EVOLUTION +injuria I-EVOLUTION +renal I-EVOLUTION +aguda, I-EVOLUTION +insuficiencia I-EVOLUTION +cardíaca, I-EVOLUTION +respiratoria I-EVOLUTION +y I-EVOLUTION +sepsis I-EVOLUTION +grave. I-EVOLUTION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ciprofloxacina, I-TREATMENT +ceftazidima I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +empírica, I-TREATMENT +vitamina I-TREATMENT +K I-TREATMENT +y I-TREATMENT +furosemida I-TREATMENT +i.v. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +días, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +mejoría, I-EVOLUTION +con I-EVOLUTION +ventilación I-EVOLUTION +espontánea I-EVOLUTION +y I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +edema. I-EVOLUTION +Dentro B-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +el I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +troponina I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecocardiografia I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +semana I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +dedicado B-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +construcción, I-PAST_MEDICAL_HISTORY +originario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Guanajuato, I-PAST_MEDICAL_HISTORY +Gto., I-PAST_MEDICAL_HISTORY +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +o B-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +importantes. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +verrugosa I-PRESENT_ILLNESS +nodular I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +nariz I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +gradual I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +Un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +abscesos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +brazo I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +cuales I-PRESENT_ILLNESS +fueron I-PRESENT_ILLNESS +drenados, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +notó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +tercer I-PRESENT_ILLNESS +absceso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +brazo. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +periorbitaria I-EXPLORATION +y I-EXPLORATION +antecubital I-EXPLORATION +derecho I-EXPLORATION +placas I-EXPLORATION +nodulares I-EXPLORATION +verrugosas, I-EXPLORATION +edematosas I-EXPLORATION +y I-EXPLORATION +cubiertas I-EXPLORATION +por I-EXPLORATION +costras I-EXPLORATION +hemáticas. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +directo I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Coccidioides I-EXPLORATION +spp. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +coccidioidomicosis I-TREATMENT +cutánea I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +itraconazol I-TREATMENT +oral I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +chofer, B-PAST_MEDICAL_HISTORY +originario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Jiquilpan, I-PAST_MEDICAL_HISTORY +Mich I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +residente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Tijuana, I-PAST_MEDICAL_HISTORY +B.C. I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nueve I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipoglicemiantes I-PAST_MEDICAL_HISTORY +orales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +osteoartrosis I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +meloxicam I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +corticoesteroides I-PAST_MEDICAL_HISTORY +intralesionales I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +ocasiones. I-PAST_MEDICAL_HISTORY +Además I-PAST_MEDICAL_HISTORY +mencionó I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +neumonía I-PAST_MEDICAL_HISTORY +aparentemente I-PAST_MEDICAL_HISTORY +bacteriana I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antibacterianos. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +localizadas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +glabelar, I-PRESENT_ILLNESS +nariz I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +paranasal I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Las B-EXPLORATION +lesiones I-EXPLORATION +eran I-EXPLORATION +placas I-EXPLORATION +nodulares I-EXPLORATION +poco I-EXPLORATION +elevadas, I-EXPLORATION +ulceradas, I-EXPLORATION +con I-EXPLORATION +fondo I-EXPLORATION +granulomatoso I-EXPLORATION +y I-EXPLORATION +costras I-EXPLORATION +sanguíneas, I-EXPLORATION +de I-EXPLORATION +1-2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +con I-EXPLORATION +examen I-EXPLORATION +directo I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Coccidioides I-EXPLORATION +spp. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +intradermorreacción I-EXPLORATION +positiva. I-EXPLORATION + I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +itraconazol I-TREATMENT +oral I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +por I-TREATMENT +cuatro I-TREATMENT +meses I-TREATMENT +y I-TREATMENT +por I-TREATMENT +intolerancia I-TREATMENT +gástrica I-TREATMENT +tuvo I-TREATMENT +que I-TREATMENT +ser I-TREATMENT +sustituido I-TREATMENT +por I-TREATMENT +terbinafina I-TREATMENT +oral I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +durante I-TREATMENT +cinco I-TREATMENT +meses. I-TREATMENT +Al B-EVOLUTION +suspender I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +acudió I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +flogosis I-EVOLUTION +de I-EVOLUTION +ambas I-EVOLUTION +rodillas I-EVOLUTION +y I-EVOLUTION +salida I-EVOLUTION +de I-EVOLUTION +material I-EVOLUTION +purulento I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +fístulas. I-EVOLUTION +Se B-TREATMENT +aisló I-TREATMENT +C. I-TREATMENT +posadasii I-TREATMENT +y I-TREATMENT +se I-TREATMENT +internó I-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +originario B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Puebla I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +residente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Tijuana, I-PAST_MEDICAL_HISTORY +B.C., I-PAST_MEDICAL_HISTORY +agricultor, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +amlodipino. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ala I-PRESENT_ILLNESS +nasal I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +caracterizada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen, I-PRESENT_ILLNESS +eritema, I-PRESENT_ILLNESS +exulceraciones I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +exudado I-PRESENT_ILLNESS +seroso, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +El B-EXPLORATION +diagnóstico I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +esférulas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +directo I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +positivo I-EXPLORATION +a I-EXPLORATION +Coccidioides I-EXPLORATION +spp. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +itraconazol I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día. I-TREATMENT + I-TREATMENT + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +género I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hospitalizaciones I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +patología I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +Un B-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +previo I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hospitalización I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +recibido I-PRESENT_ILLNESS +flucloxacilina I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +impétigo. I-PRESENT_ILLNESS +Su B-FAMILY_HISTORY +madre I-FAMILY_HISTORY +era I-FAMILY_HISTORY +portadora I-FAMILY_HISTORY +de I-FAMILY_HISTORY +un I-FAMILY_HISTORY +lupus I-FAMILY_HISTORY +eritematoso I-FAMILY_HISTORY +sistémico, I-FAMILY_HISTORY +dueña I-FAMILY_HISTORY +de I-FAMILY_HISTORY +casa I-FAMILY_HISTORY +y I-FAMILY_HISTORY +su I-FAMILY_HISTORY +padre, I-FAMILY_HISTORY +trabajador I-FAMILY_HISTORY +en I-FAMILY_HISTORY +servicios I-FAMILY_HISTORY +de I-FAMILY_HISTORY +correo I-FAMILY_HISTORY +internacional. I-FAMILY_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Emergencia I-PRESENT_ILLNESS +(UE) I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +rodilla I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +diagnosticó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +contusión I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +manejó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +ambulatoria I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +inmovilización I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +analgesia. I-PRESENT_ILLNESS +Dada I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +persistencia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +vuelve I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consultar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +después. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +dolor I-EXPLORATION +espontáneo I-EXPLORATION +intenso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +derecha, I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +metáfisis I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tibia I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +local, I-EXPLORATION +sin I-EXPLORATION +fiebre, I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +hemodinámico, I-EXPLORATION +ni I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +leucocitosis I-EXPLORATION +y I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +(24% I-EXPLORATION +baciliformes), I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +270 I-EXPLORATION +mg/L I-EXPLORATION +y I-EXPLORATION +VHS I-EXPLORATION +101 I-EXPLORATION +mm/h. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +discreto I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +derecha, I-EXPLORATION +sin I-EXPLORATION +lesión I-EXPLORATION +ósea I-EXPLORATION +asociada. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +aseo I-EXPLORATION +quirúrgico I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +tratamiento I-EXPLORATION +antimicrobiano I-EXPLORATION +con I-EXPLORATION +cloxacilina I-EXPLORATION +iv I-EXPLORATION +(185 I-EXPLORATION +mg/kg/día) I-EXPLORATION +cada I-EXPLORATION +6 I-EXPLORATION +h. I-EXPLORATION +Al I-EXPLORATION +tercer I-EXPLORATION +día I-EXPLORATION +post-operatorio, I-EXPLORATION +persistió I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +intenso I-EXPLORATION +y I-EXPLORATION +comenzó I-EXPLORATION +con I-EXPLORATION +fiebre I-EXPLORATION +y I-EXPLORATION +compromiso I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +Los I-EXPLORATION +dos I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +óseo I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +SARM, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +vancomicina, I-TREATMENT +aislamiento I-TREATMENT +de I-TREATMENT +contacto I-TREATMENT +según I-TREATMENT +la I-TREATMENT +norma I-TREATMENT +institucional I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +aseo I-TREATMENT +quirúrgico. I-TREATMENT +Dada B-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fiebre I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +cintigrama I-EXPLORATION +óseo I-EXPLORATION +trifásico, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +actividad I-EXPLORATION +osteoblástica I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +metáfisis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tibia I-EXPLORATION +proximal I-EXPLORATION +derecha. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +tórpida, I-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fiebre I-EVOLUTION +hasta I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +iniciado I-EVOLUTION +vancomicina, I-EVOLUTION +requiriendo I-EVOLUTION +múltiples I-EVOLUTION +aseos I-EVOLUTION +quirúrgicos I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +encontraron I-EVOLUTION +colecciones I-EVOLUTION +y I-EVOLUTION +daño I-EVOLUTION +articular. I-EVOLUTION +Los I-EVOLUTION +cultivos I-EVOLUTION +intraoperatorios I-EVOLUTION +persistieron I-EVOLUTION +positivos I-EVOLUTION +hasta I-EVOLUTION +12 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +iniciado I-EVOLUTION +vancomicina. I-EVOLUTION +Por I-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fiebre I-EVOLUTION +se I-EVOLUTION +descartaron I-EVOLUTION +focos I-EVOLUTION +secundarios I-EVOLUTION +u I-EVOLUTION +otra I-EVOLUTION +infección. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +inmunológico I-EXPLORATION +básico I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION +El B-TREATMENT +día I-TREATMENT +18 I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +presentó I-TREATMENT +un I-TREATMENT +exantema I-TREATMENT +máculo-papular I-TREATMENT +morbiliforme, I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +considerada I-TREATMENT +como I-TREATMENT +una I-TREATMENT +reacción I-TREATMENT +adversa I-TREATMENT +a I-TREATMENT +fármacos, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +a I-TREATMENT +clindamicina I-TREATMENT +iv. I-TREATMENT +Evolucionó B-EVOLUTION +afebril I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +dolor I-EVOLUTION +local, I-EVOLUTION +completando I-EVOLUTION +en I-EVOLUTION +total I-EVOLUTION +56 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antibacteriano: I-EVOLUTION +17 B-TREATMENT +días I-TREATMENT +de I-TREATMENT +vancomicina I-TREATMENT +y I-TREATMENT +39 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +clindamicina. I-TREATMENT +Fue B-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios I-EVOLUTION +en I-EVOLUTION +descenso I-EVOLUTION +(VHS I-EVOLUTION +28 I-EVOLUTION +mm/h I-EVOLUTION +y I-EVOLUTION +PCR I-EVOLUTION +19, I-EVOLUTION +2 I-EVOLUTION +mg/L), I-EVOLUTION +y I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +linezolid I-EVOLUTION +vía I-EVOLUTION +oral I-EVOLUTION +(300 I-EVOLUTION +mg, I-EVOLUTION +dos I-EVOLUTION +veces I-EVOLUTION +al I-EVOLUTION +día), I-EVOLUTION +por I-EVOLUTION +20 I-EVOLUTION +días. I-EVOLUTION +El B-EXPLORATION +ISP I-EXPLORATION +confirmó I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +fue I-EXPLORATION +SARM, I-EXPLORATION +PVL I-EXPLORATION +negativa. I-EXPLORATION +Además, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +portación I-EXPLORATION +nasal I-EXPLORATION +familiar I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +madre I-EXPLORATION +resultó I-EXPLORATION +ser I-EXPLORATION +positiva I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +decolonización I-EXPLORATION +con I-EXPLORATION +mupirocina I-EXPLORATION +tópica. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +genético I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +caracterización I-EXPLORATION +molecular I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +cepas I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +del I-EXPLORATION +marcador I-EXPLORATION +PV-L I-EXPLORATION +y I-EXPLORATION +determinaron I-EXPLORATION +un I-EXPLORATION +mismo I-EXPLORATION +subtipo I-EXPLORATION +genético I-EXPLORATION +por I-EXPLORATION +PFGE I-EXPLORATION +(CL-SAU-COM-SMA-017) I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +MLST I-EXPLORATION +al I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +secuencia I-EXPLORATION +ST8. I-EXPLORATION + I-EXPLORATION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +género I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +patologías I-PAST_MEDICAL_HISTORY +crónicas, I-PAST_MEDICAL_HISTORY +hospitalizaciones, I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antibacterianos I-PAST_MEDICAL_HISTORY +recientes. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +adinamia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lumbalgia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +trauma I-PRESENT_ILLNESS +dorso-lumbar I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39° I-PRESENT_ILLNESS +C. I-PRESENT_ILLNESS +Se B-EVOLUTION +internó I-EVOLUTION +para I-EVOLUTION +estudio I-EVOLUTION +evolucionando I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +PCR I-EVOLUTION +hasta I-EVOLUTION +150 I-EVOLUTION +mg/L. I-EVOLUTION +A B-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +h, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +renal I-EXPLORATION +izquierda, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +inició I-TREATMENT +cefotaxima I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +empírica. I-TREATMENT +Al I-TREATMENT +día I-TREATMENT +siguiente I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +a I-TREATMENT +cloxacilina I-TREATMENT +(170 I-TREATMENT +mg/kg/día) I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +h. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +angio-TAC I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +absceso I-EXPLORATION +renal I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +Al B-TREATMENT +cuarto I-TREATMENT +día I-TREATMENT +de I-TREATMENT +tratamiento, I-TREATMENT +dada I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fiebre I-TREATMENT +e I-TREATMENT +incremento I-TREATMENT +de I-TREATMENT +PCR I-TREATMENT +hasta I-TREATMENT +270 I-TREATMENT +mg/L, I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +esquema I-TREATMENT +a I-TREATMENT +vancomicina I-TREATMENT +(40 I-TREATMENT +mg/kg/día) I-TREATMENT +y I-TREATMENT +meropenem I-TREATMENT +(60 I-TREATMENT +mg/kg/ I-TREATMENT +día). I-TREATMENT +Luego B-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +seis I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vancomicina I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +desfavorable, I-DERIVED_FROM/TO +aumento I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +parámetros I-DERIVED_FROM/TO +inflamatorios I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +tamaño I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +lesión I-DERIVED_FROM/TO +renal I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +trasladó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +otra I-DERIVED_FROM/TO +institución I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +instalación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +catéter I-DERIVED_FROM/TO +ureteral I-DERIVED_FROM/TO +(pig-tail) I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +drenaje I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +colección I-DERIVED_FROM/TO +renal, I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +tomó I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +muestra I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +cultivo. I-DERIVED_FROM/TO +Al B-EVOLUTION +5o I-EVOLUTION +día I-EVOLUTION +post-operatorio I-EVOLUTION +bajó I-EVOLUTION +la I-EVOLUTION +fiebre, I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios. I-EVOLUTION +El B-EXPLORATION +resultado I-EXPLORATION +del I-EXPLORATION +cultivo I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +SARM. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +informe I-TREATMENT +microbiológico I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +meropenem I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +vancomicina I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +definitivamente I-EVOLUTION +afebril I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +12 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +drenaje I-EVOLUTION +quirúrgico, I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +PCR, I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +siempre I-EVOLUTION +conservada I-EVOLUTION +e I-EVOLUTION +imagen I-EVOLUTION +ecográfica I-EVOLUTION +con I-EVOLUTION +absceso I-EVOLUTION +en I-EVOLUTION +regresión. I-EVOLUTION +Completó B-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +36 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +vancomicina. I-TREATMENT +Se B-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +cepa I-EXPLORATION +como I-EXPLORATION +SARM, I-EXPLORATION +PV-L I-EXPLORATION +positivo. I-EXPLORATION +La I-EXPLORATION +caracterización I-EXPLORATION +molecular I-EXPLORATION +correspondió I-EXPLORATION +al I-EXPLORATION +subtipo I-EXPLORATION +CL-SAU-COM-SMA-002 I-EXPLORATION +(PFGE) I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +ST731 I-EXPLORATION +perteneciente I-EXPLORATION +al I-EXPLORATION +CC I-EXPLORATION +30 I-EXPLORATION +por I-EXPLORATION +MLST. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +portación I-EXPLORATION +nasal I-EXPLORATION +a I-EXPLORATION +ambos I-EXPLORATION +padres, I-EXPLORATION +hermanos I-EXPLORATION +y I-EXPLORATION +abuelos, I-EXPLORATION +todos I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION + +Preescolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +vacunas I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +PNI I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +asistencia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +jardín I-PAST_MEDICAL_HISTORY +infantil. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +menos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +40°C I-PRESENT_ILLNESS +axilar, I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +alimentarios, I-PRESENT_ILLNESS +coriza I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +frontal. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +alucinaciones I-PRESENT_ILLNESS +visuales I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Urgencia I-EXPLORATION +(SU) I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +febril, I-EXPLORATION +decaída, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +segmentario I-EXPLORATION +y I-EXPLORATION +neurológico I-EXPLORATION +normal. I-EXPLORATION +Dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaban I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +36.100 I-EXPLORATION +céls/mm3 I-EXPLORATION +(25% I-EXPLORATION +segmentados), I-EXPLORATION +PCR I-EXPLORATION +205 I-EXPLORATION +mg/L I-EXPLORATION +(valor I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +10), I-EXPLORATION +orina I-EXPLORATION +completa I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +con I-EXPLORATION +escaso I-EXPLORATION +infiltrado I-EXPLORATION +intersticial. I-EXPLORATION +Se I-EXPLORATION +hospitalizó I-EXPLORATION +con I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +febril I-EXPLORATION +sin I-EXPLORATION +foco. I-EXPLORATION +Evolucionó I-EXPLORATION +con I-EXPLORATION +fiebre I-EXPLORATION +persistente, I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +sin I-EXPLORATION +foco I-EXPLORATION +evidente I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +parámetros I-EXPLORATION +inflamatorios I-EXPLORATION +elevados. I-EXPLORATION +Se I-EXPLORATION +planteó I-EXPLORATION +una I-EXPLORATION +probable I-EXPLORATION +neumonía I-EXPLORATION +neumocóccica; I-EXPLORATION +sin I-EXPLORATION +embargo, I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +evidenciaba I-EXPLORATION +consolidación I-EXPLORATION +pulmonar. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +ampicilina I-TREATMENT +i.v. I-TREATMENT +100 I-TREATMENT +mg/kg/día I-TREATMENT +fraccionado I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +h, I-TREATMENT +previa I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +hemocultivos. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +complementó I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +panel I-EXPLORATION +viral I-EXPLORATION +(por I-EXPLORATION +inmunofluorescencia) I-EXPLORATION +de I-EXPLORATION +aspirado I-EXPLORATION +nasofaríngeo, I-EXPLORATION +urocultivo, I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +y I-EXPLORATION +hemocultivos I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Por I-EXPLORATION +persistir I-EXPLORATION +febril, I-EXPLORATION +luego I-EXPLORATION +de I-EXPLORATION +48 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +terapia I-EXPLORATION +antimicrobiana, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +asimetría I-EXPLORATION +renal, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +más I-EXPLORATION +grande, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +más I-EXPLORATION +globuloso I-EXPLORATION +y I-EXPLORATION +mayor I-EXPLORATION +ecogenicidad. I-EXPLORATION +Se B-TREATMENT +ajustó I-TREATMENT +terapia I-TREATMENT +antimicrobiana I-TREATMENT +a I-TREATMENT +ceftriaxona I-TREATMENT +50 I-TREATMENT +mg/kg/día I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +por I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +un I-TREATMENT +foco I-TREATMENT +urinario I-TREATMENT +y I-TREATMENT +se I-TREATMENT +solicitó I-TREATMENT +un I-TREATMENT +cintigrama I-TREATMENT +renal I-TREATMENT +con I-TREATMENT +DMSA I-TREATMENT +(dimercaptosuccinic I-TREATMENT +acid), I-TREATMENT +que I-TREATMENT +se I-TREATMENT +informó I-TREATMENT +como I-TREATMENT +sugerente I-TREATMENT +de I-TREATMENT +un I-TREATMENT +proceso I-TREATMENT +inflamatorio I-TREATMENT +agudo I-TREATMENT +renal I-TREATMENT +izquierdo. I-TREATMENT +La B-EVOLUTION +fiebre I-EVOLUTION +cedió I-EVOLUTION +al I-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +ceftriaxona, I-EVOLUTION +junto I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios. I-EVOLUTION +Se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +séptimo I-EVOLUTION +día, I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +clínicas, I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +nefronia I-EVOLUTION +izquierda. I-EVOLUTION +Recibió B-TREATMENT +cefadroxilo I-TREATMENT +30 I-TREATMENT +mg/kg/día I-TREATMENT +por I-TREATMENT +siete I-TREATMENT +días, I-TREATMENT +completando I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +en I-TREATMENT +total. I-TREATMENT +Se I-TREATMENT +mantuvo B-EVOLUTION +en I-EVOLUTION +seguimiento I-EVOLUTION +en I-EVOLUTION +policlínico I-EVOLUTION +de I-EVOLUTION +infectología I-EVOLUTION +y I-EVOLUTION +nefrología, I-EVOLUTION +con I-EVOLUTION +evolución I-EVOLUTION +favorable. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +oriundo B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +provincia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Buenos I-PAST_MEDICAL_HISTORY +Aires, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +adquirida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +transmisión I-PAST_MEDICAL_HISTORY +vertical, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +abandono I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +tratamientos I-PAST_MEDICAL_HISTORY +antirretrovirales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gran I-PAST_MEDICAL_HISTORY +actividad I-PAST_MEDICAL_HISTORY +(TARGA). I-PAST_MEDICAL_HISTORY +Se B-PRESENT_ILLNESS +internó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kg. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +febril, I-EXPLORATION +en I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +palidez I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas. I-EXPLORATION +Se I-EXPLORATION +palpaba I-EXPLORATION +una I-EXPLORATION +hepato-esplenomegalia I-EXPLORATION +indolora I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +pulmonar I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +generalizada I-EXPLORATION +del I-EXPLORATION +murmullo I-EXPLORATION +pulmonar I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +campos I-EXPLORATION +pulmonares. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +opacidad I-EXPLORATION +parahiliar I-EXPLORATION +y I-EXPLORATION +basal I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +neumónico. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +fueron: I-EXPLORATION +entro-sedimentación I-EXPLORATION +> I-EXPLORATION +140 I-EXPLORATION +mm I-EXPLORATION +1° I-EXPLORATION +hora, I-EXPLORATION +hematocrito I-EXPLORATION +21%, I-EXPLORATION +hemoglobina I-EXPLORATION +6, I-EXPLORATION +6 I-EXPLORATION +g/L, I-EXPLORATION +leucocitos I-EXPLORATION +4.400 I-EXPLORATION +cél/mm3, I-EXPLORATION +plaquetas I-EXPLORATION +40.000 I-EXPLORATION +cél/mm3, I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +68%, I-EXPLORATION +urea I-EXPLORATION +16 I-EXPLORATION +mg/dL, I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +9 I-EXPLORATION +mg/dL, I-EXPLORATION +transaminasas I-EXPLORATION +GOT I-EXPLORATION +61 I-EXPLORATION +UI/L, I-EXPLORATION +GPT I-EXPLORATION +20 I-EXPLORATION +UI/L, I-EXPLORATION +fosfatasas I-EXPLORATION +alcalinas: I-EXPLORATION +185 I-EXPLORATION +U/L I-EXPLORATION +y I-EXPLORATION +láctico I-EXPLORATION +deshidrogenasa: I-EXPLORATION +400 I-EXPLORATION +U/l. I-EXPLORATION +El I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +CD4 I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +21 I-EXPLORATION +cél/mm3 I-EXPLORATION +(8%). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +expectoración I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +bacterias I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +corriente, I-EXPLORATION +micobacterias I-EXPLORATION +y I-EXPLORATION +hongos. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +directo I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Zielh-Neelsen, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +10 I-EXPLORATION +bacilos I-EXPLORATION +ácido-alcohol I-EXPLORATION +resistentes I-EXPLORATION +(BAAR) I-EXPLORATION +por I-EXPLORATION +cada I-EXPLORATION +10 I-EXPLORATION +campos. I-EXPLORATION +La I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +hepato-esplenomegalia I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +adenopatías I-EXPLORATION +hipoecogénicas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +retroperitoneo, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +ligamento I-EXPLORATION +hepato-duodenal. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +imágenes I-EXPLORATION +hipoecogénicas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +bazo, I-EXPLORATION +mesenterio I-EXPLORATION +y I-EXPLORATION +retroperitoneo. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +una I-TREATMENT +probable I-TREATMENT +tuberculosis I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +isoniacida, I-TREATMENT +rifampicina, I-TREATMENT +pirazinamida I-TREATMENT +y I-TREATMENT +etambutol I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +diaria I-TREATMENT +y I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +habituales. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +iniciada I-EVOLUTION +la I-EVOLUTION +terapia I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +comenzó I-EVOLUTION +a I-EVOLUTION +referir I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +articulación I-EVOLUTION +coxo-femoral I-EVOLUTION +izquierda I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +irradiaba I-EVOLUTION +hacia I-EVOLUTION +el I-EVOLUTION +muslo, I-EVOLUTION +produciendo I-EVOLUTION +impotencia I-EVOLUTION +funcional I-EVOLUTION +y I-EVOLUTION +posición I-EVOLUTION +antiálgica I-EVOLUTION +en I-EVOLUTION +semiflexión. I-EVOLUTION +Presentaba I-EVOLUTION +dolor I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +palpación I-EVOLUTION +de I-EVOLUTION +dicha I-EVOLUTION +articulación I-EVOLUTION +coxo-femoral I-EVOLUTION +con I-EVOLUTION +imposibilidad I-EVOLUTION +de I-EVOLUTION +extensión I-EVOLUTION +activa I-EVOLUTION +y I-EVOLUTION +pasiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +inferior I-EVOLUTION +izquierda. I-EVOLUTION +La I-EVOLUTION +ecotomografía I-EVOLUTION +mostró I-EVOLUTION +una I-EVOLUTION +moderada I-EVOLUTION +cantidad I-EVOLUTION +de I-EVOLUTION +líquido I-EVOLUTION +articular I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +tomografía I-EVOLUTION +axial I-EVOLUTION +computarizada I-EVOLUTION +(TAC) I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +una I-EVOLUTION +imagen I-EVOLUTION +radiolúcida, I-EVOLUTION +redondeada, I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cabeza I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +cuello I-EVOLUTION +femoral, I-EVOLUTION +con I-EVOLUTION +solución I-EVOLUTION +de I-EVOLUTION +continuidad I-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +cortical I-EVOLUTION +ósea. I-EVOLUTION +La I-EVOLUTION +cavidad I-EVOLUTION +acetabular I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +cabeza I-EVOLUTION +femoral I-EVOLUTION +estaban I-EVOLUTION +respetadas I-EVOLUTION +igual I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +sínfisis I-EVOLUTION +pubiana I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +ramas I-EVOLUTION +isquio I-EVOLUTION +e I-EVOLUTION +ilio-pubianas. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +cavidad I-EVOLUTION +articular I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +un I-EVOLUTION +moderado I-EVOLUTION +volumen I-EVOLUTION +de I-EVOLUTION +líquido. I-EVOLUTION + I-EVOLUTION +Se I-EVOLUTION +realizó I-EVOLUTION +una I-EVOLUTION +artrocentesis I-EVOLUTION +obteniéndose I-EVOLUTION +un I-EVOLUTION +material I-EVOLUTION +sero-hemático. I-EVOLUTION +Se I-EVOLUTION +enviaron I-EVOLUTION +muestras I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +identificación I-EVOLUTION +de I-EVOLUTION +bacterias I-EVOLUTION +de I-EVOLUTION +crecimiento I-EVOLUTION +común, I-EVOLUTION +micobacterias I-EVOLUTION +y I-EVOLUTION +hongos. I-EVOLUTION +El I-EVOLUTION +examen I-EVOLUTION +directo I-EVOLUTION +mediante I-EVOLUTION +la I-EVOLUTION +técnica I-EVOLUTION +de I-EVOLUTION +Zielh-Neelsen, I-EVOLUTION +mostró I-EVOLUTION +cinco I-EVOLUTION +a I-EVOLUTION +nueve I-EVOLUTION +BAAR I-EVOLUTION +por I-EVOLUTION +cada I-EVOLUTION +100 I-EVOLUTION +campos I-EVOLUTION +de I-EVOLUTION +observación. I-EVOLUTION + I-EVOLUTION +Además B-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +antituberculoso I-TREATMENT +se I-TREATMENT +agregaron I-TREATMENT +analgésicos I-TREATMENT +y I-TREATMENT +corticoesteroides. I-TREATMENT +Siete B-EVOLUTION +días I-EVOLUTION +después, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +paulatina I-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +movilidad I-EVOLUTION +del I-EVOLUTION +miembro I-EVOLUTION +inferior I-EVOLUTION +izquierdo, I-EVOLUTION +apoyada I-EVOLUTION +con I-EVOLUTION +soporte I-EVOLUTION +kinésico. I-EVOLUTION + I-EVOLUTION +Los B-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +tanto I-EXPLORATION +de I-EXPLORATION +esputo I-EXPLORATION +como I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +articular, I-EXPLORATION +permitieron I-EXPLORATION +identificar I-EXPLORATION +Mycobacterium I-EXPLORATION +tuberculosis I-EXPLORATION +con I-EXPLORATION +susceptibilidad I-EXPLORATION +conservada I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +fármacos I-EXPLORATION +proscriptos. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +30 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +se I-EVOLUTION +comprobó I-EVOLUTION +una I-EVOLUTION +marcada I-EVOLUTION +mejoría I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +pulmonares I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +examen I-EVOLUTION +directo I-EVOLUTION +de I-EVOLUTION +expectoración I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +fue I-EVOLUTION +negativo I-EVOLUTION +para I-EVOLUTION +BAAR. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Huaral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +procedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Lima I-PAST_MEDICAL_HISTORY +Metropolitana, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ocupación I-PAST_MEDICAL_HISTORY +dueña I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +casa, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pesadez I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +post-prandial I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +todo I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +comida. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +estos I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +asociaron I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +epigastralgia I-PRESENT_ILLNESS +urente I-PRESENT_ILLNESS +leve. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +epigastrio, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +peritoneales. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +demostraron I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +11.700/mm3 I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +eosinofilia I-EXPLORATION +de I-EXPLORATION +6.300/mm3, I-EXPLORATION +las I-EXPLORATION +fosfatasas I-EXPLORATION +alcalinas, I-EXPLORATION +GGT, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +y I-EXPLORATION +alfa-fetoproteínas I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +dos I-EXPLORATION +imágenes I-EXPLORATION +quísticas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hígado, I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +VII I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +otra I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +II. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +hipodensa I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +irregulares, I-EXPLORATION +de I-EXPLORATION +35 I-EXPLORATION +por I-EXPLORATION +15 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +hepático I-EXPLORATION +II. I-EXPLORATION +Se I-EXPLORATION +internó I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +hepático I-EXPLORATION +para I-EXPLORATION +realizarse I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +percutánea I-EXPLORATION +guiada I-EXPLORATION +por I-EXPLORATION +ecografía. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +histopatológicos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +fueron: I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +linfocitos, I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +y I-EXPLORATION +eosinófilos, I-EXPLORATION +estos I-EXPLORATION +últimos I-EXPLORATION +en I-EXPLORATION +gran I-EXPLORATION +cantidad. I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +además I-EXPLORATION +hepatocitos I-EXPLORATION +reactivos, I-EXPLORATION +regenerativos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parén-quima I-EXPLORATION +hepático. I-EXPLORATION +Por I-EXPLORATION +este I-EXPLORATION +motivo, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +Fas2-Elisa I-EXPLORATION +para I-EXPLORATION +F. I-EXPLORATION +hepatica, I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +tuvo I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +37 I-EXPLORATION +(valor I-EXPLORATION +normal: I-EXPLORATION +< I-EXPLORATION +0, I-EXPLORATION +2), I-EXPLORATION +muy I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +infección. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +triclabendazol I-TREATMENT +10 I-TREATMENT +mg/kg, I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +única. I-TREATMENT +Evolucionó B-EVOLUTION +favorablemente; I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +desapareció I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +eosinofilia. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +TAC I-EVOLUTION +abdominal I-EVOLUTION +realizada I-EVOLUTION +al I-EVOLUTION +sexto I-EVOLUTION +mes I-EVOLUTION +post-tratamiento, I-EVOLUTION +se I-EVOLUTION +evidenció I-EVOLUTION +regresión I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +hepática. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +medicamentos I-PAST_MEDICAL_HISTORY +recientes. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +seca I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +odinofagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +pruriginosas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +muslos. I-PRESENT_ILLNESS +Se B-TREATMENT +diagnosticó I-TREATMENT +una I-TREATMENT +faringoamigdalitis I-TREATMENT +aguda I-TREATMENT +con I-TREATMENT +una I-TREATMENT +escarlatina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +lincomicina I-TREATMENT +oral, I-TREATMENT +sin I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sintomatología I-TREATMENT +ni I-TREATMENT +remisión I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +cutáneas. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h, I-EVOLUTION +se I-EVOLUTION +agregó I-EVOLUTION +fiebre I-EVOLUTION +hasta I-EVOLUTION +38, I-EVOLUTION +5°C I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +se I-EVOLUTION +diseminaron I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +centrípeta, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +consultó I-EVOLUTION +nuevamente. I-EVOLUTION +La B-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +en I-EXPLORATION +regulares I-EXPLORATION +condiciones I-EXPLORATION +generales, I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +eritema I-EXPLORATION +faríngeo I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +pulmonar I-EXPLORATION +normal. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +pesquisaron I-EXPLORATION +adenopatías. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +cutáneo, I-EXPLORATION +destacaban I-EXPLORATION +máculas I-EXPLORATION +y I-EXPLORATION +pápulas I-EXPLORATION +eritematosas I-EXPLORATION +palmoplantares I-EXPLORATION +y I-EXPLORATION +pústulas I-EXPLORATION +no I-EXPLORATION +foliculares, I-EXPLORATION +de I-EXPLORATION +base I-EXPLORATION +eritematosa, I-EXPLORATION +confluentes I-EXPLORATION +en I-EXPLORATION +placas, I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +cuello, I-EXPLORATION +dorso, I-EXPLORATION +región I-EXPLORATION +lumbar I-EXPLORATION +y I-EXPLORATION +muslos. I-EXPLORATION +El I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Nikolsky I-EXPLORATION +era I-EXPLORATION +negativo. I-EXPLORATION +No I-EXPLORATION +tenía I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +oral, I-EXPLORATION +ocular I-EXPLORATION +ni I-EXPLORATION +genital. I-EXPLORATION +Sin B-TREATMENT +embargo, I-TREATMENT +dado I-TREATMENT +el I-TREATMENT +compromiso I-TREATMENT +cutáneo I-TREATMENT +extenso, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +su I-TREATMENT +internación. I-TREATMENT + I-TREATMENT +Los B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +(15.500 I-EXPLORATION +neutrófilos/mm3, I-EXPLORATION +sin I-EXPLORATION +eosinofilia), I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +de I-EXPLORATION +14, I-EXPLORATION +7 I-EXPLORATION +mg/dL I-EXPLORATION +(valor I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +1 I-EXPLORATION +mg/dL) I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +levemente I-EXPLORATION +alteradas: I-EXPLORATION +GOT: I-EXPLORATION +23 I-EXPLORATION +UI/L I-EXPLORATION +(VN I-EXPLORATION +9-25), I-EXPLORATION +GPT: I-EXPLORATION +48 I-EXPLORATION +UI/L I-EXPLORATION +(VN I-EXPLORATION +7-30), I-EXPLORATION +fosfatasas I-EXPLORATION +alcalinas: I-EXPLORATION +199 I-EXPLORATION +UI/L I-EXPLORATION +(VN I-EXPLORATION +30-100), I-EXPLORATION +GGT: I-EXPLORATION +110 I-EXPLORATION +UI/L I-EXPLORATION +(VN I-EXPLORATION +4-50). I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +escaso I-EXPLORATION +infiltrado I-EXPLORATION +intersticial, I-EXPLORATION +sin I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +consolidación. I-EXPLORATION +El I-EXPLORATION +panel I-EXPLORATION +viral I-EXPLORATION +respiratorio I-EXPLORATION +molecular, I-EXPLORATION +por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC), I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +La I-EXPLORATION +IgM I-EXPLORATION +para I-EXPLORATION +M. I-EXPLORATION +pneumoniae I-EXPLORATION +(técnica I-EXPLORATION +cualitativa I-EXPLORATION +por I-EXPLORATION +ELISA) I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +al I-EXPLORATION +segundo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización I-EXPLORATION +(correspondiente I-EXPLORATION +al I-EXPLORATION +noveno I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +evolución). I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +VIH, I-EXPLORATION +virus I-EXPLORATION +hepatitis I-EXPLORATION +B, I-EXPLORATION +C, I-EXPLORATION +y I-EXPLORATION +sífilis I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +corriente I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pústulas I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +mostró I-EXPLORATION +acantosis, I-EXPLORATION +espongiosis, I-EXPLORATION +exocitosis I-EXPLORATION +de I-EXPLORATION +neutrófilos I-EXPLORATION +y I-EXPLORATION +pústulas I-EXPLORATION +intracórneas, I-EXPLORATION +intraepidérmicas I-EXPLORATION +e I-EXPLORATION +intrafoliculares. I-EXPLORATION +La I-EXPLORATION +dermis I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +perivascular I-EXPLORATION +difuso I-EXPLORATION +con I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +neutrófilos. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +PAS I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +microorganismos. I-EXPLORATION +Dado I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +clínicos I-EXPLORATION +e I-EXPLORATION +histopatológicos, I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +una I-EXPLORATION +PEGA, I-EXPLORATION +probablemente I-EXPLORATION +causada I-EXPLORATION +por I-EXPLORATION +M. I-EXPLORATION +pneumoniae. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +hidrocortisona I-TREATMENT +i.v., I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +50 I-TREATMENT +mg I-TREATMENT +fraccionada I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +h, I-TREATMENT +y I-TREATMENT +levofloxacina I-TREATMENT +oral I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +con B-EVOLUTION +excelente I-EVOLUTION +evolución I-EVOLUTION +marcada I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +cutáneas, I-EVOLUTION +dándose I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +con B-TREATMENT +prednisona I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +decrecientes I-TREATMENT +y I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +antimicrobiano, I-TREATMENT +ambos I-TREATMENT +por I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +más. I-TREATMENT +Al B-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas, I-EVOLUTION +ya I-EVOLUTION +no I-EVOLUTION +presentaba I-EVOLUTION +lesiones I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +piel. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +insulino-requiriente, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +dislipide-mia, I-PAST_MEDICAL_HISTORY +gota, I-PAST_MEDICAL_HISTORY +glaucoma I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +meningo-encefalitis I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +hospital. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +brusco I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pocas I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +calofríos, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +conductuales I-PRESENT_ILLNESS +(agresividad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +familiares) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +rápido I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia. I-PRESENT_ILLNESS +Una B-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +glicemia I-EXPLORATION +capilar I-EXPLORATION +en I-EXPLORATION +domicilio I-EXPLORATION +descartó I-EXPLORATION +una I-EXPLORATION +hipoglicemia. I-EXPLORATION +Ingresó I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +centro I-EXPLORATION +asistencial I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +puntaje I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +Glasgow I-EXPLORATION +de I-EXPLORATION +coma I-EXPLORATION +(GCS) I-EXPLORATION +de I-EXPLORATION +14 I-EXPLORATION +puntos, I-EXPLORATION +confuso, I-EXPLORATION +desorientado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +agitación I-EXPLORATION +psicomotora I-EXPLORATION +(que I-EXPLORATION +se I-EXPLORATION +contuvo I-EXPLORATION +farmacológicamente I-EXPLORATION +con I-EXPLORATION +propofol, I-EXPLORATION +ketamina I-EXPLORATION +y I-EXPLORATION +lorazepam) I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +meníngeos I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +y I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +de I-EXPLORATION +encéfalo I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +informadas I-EXPLORATION +como I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +líquido I-EXPLORATION +incoloro, I-EXPLORATION +glucorraquia I-EXPLORATION +de I-EXPLORATION +132 I-EXPLORATION +mg/dL I-EXPLORATION +(glicemia I-EXPLORATION +de I-EXPLORATION +199 I-EXPLORATION +mg/dL), I-EXPLORATION +proteínas I-EXPLORATION +249 I-EXPLORATION +mg/dL, I-EXPLORATION +pleocitosis I-EXPLORATION +de I-EXPLORATION +940 I-EXPLORATION +céls/mm3 I-EXPLORATION +con I-EXPLORATION +36% I-EXPLORATION +polimorfonucleares I-EXPLORATION +y I-EXPLORATION +64% I-EXPLORATION +mononucleares, I-EXPLORATION +hematíes I-EXPLORATION +100 I-EXPLORATION +céls/mm3, I-EXPLORATION +100% I-EXPLORATION +frescos I-EXPLORATION +y I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +sin I-EXPLORATION +bacterias I-EXPLORATION +visibles. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +con I-EXPLORATION +cultivo I-EXPLORATION +y I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC) I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +varicela I-EXPLORATION +zoster, I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simplex I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +y I-EXPLORATION +6, I-EXPLORATION +citomegalovirus, I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +látex I-EXPLORATION +para I-EXPLORATION +N. I-EXPLORATION +meningitidis, I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +urocultivo, I-EXPLORATION +fueron I-EXPLORATION +todos I-EXPLORATION +negativos. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +generales I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +14.850 I-EXPLORATION +céls/mm3, I-EXPLORATION +neutrofilia I-EXPLORATION +(82%), I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +eritrosedimentación I-EXPLORATION +(VHS) I-EXPLORATION +discretamente I-EXPLORATION +elevada I-EXPLORATION +(21 I-EXPLORATION +mm/h), I-EXPLORATION +pruebas I-EXPLORATION +bioquímicas I-EXPLORATION +y I-EXPLORATION +hepáticas I-EXPLORATION +normales, I-EXPLORATION +salvo I-EXPLORATION +una I-EXPLORATION +hiperglicemia I-EXPLORATION +y I-EXPLORATION +alza I-EXPLORATION +leve I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +creatinina I-EXPLORATION +plasmática I-EXPLORATION +(1, I-EXPLORATION +3 I-EXPLORATION +mg/dL). I-EXPLORATION +Los I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +(5, I-EXPLORATION +5 I-EXPLORATION +mg/L) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +procalcitonina I-EXPLORATION +bajos I-EXPLORATION +(< I-EXPLORATION +0, I-EXPLORATION +05 I-EXPLORATION +ng/mL). I-EXPLORATION +Evolucionó B-TREATMENT +con I-TREATMENT +una I-TREATMENT +hipotensión I-TREATMENT +arterial I-TREATMENT +(96/56 I-TREATMENT +mm I-TREATMENT +Hg) I-TREATMENT +que I-TREATMENT +respondió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +volumen, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +conciencia I-TREATMENT +fluctuante I-TREATMENT +(Glasgow I-TREATMENT +bajó I-TREATMENT +a I-TREATMENT +11). I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +antimicrobiana I-TREATMENT +empírica I-TREATMENT +con I-TREATMENT +ceftriaxona, I-TREATMENT +ampicilina I-TREATMENT +y I-TREATMENT +aciclovir I-TREATMENT +i.v. I-TREATMENT +y I-TREATMENT +glucocorticoides I-TREATMENT +(dexametasona I-TREATMENT +8 I-TREATMENT +mg). I-TREATMENT +Se B-DERIVED_FROM/TO +trasladó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +ingresó I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +Glasgow I-DERIVED_FROM/TO +fluctuante I-DERIVED_FROM/TO +(entre I-DERIVED_FROM/TO +10 I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +13 I-DERIVED_FROM/TO +puntos), I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +hemodinamia I-DERIVED_FROM/TO +estable, I-DERIVED_FROM/TO +febril I-DERIVED_FROM/TO +(38, I-DERIVED_FROM/TO +5 I-DERIVED_FROM/TO +oC), I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +reflejos I-DERIVED_FROM/TO +osteotendíneos I-DERIVED_FROM/TO +exacerbados, I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +focalidad I-DERIVED_FROM/TO +neurológica, I-DERIVED_FROM/TO +signos I-DERIVED_FROM/TO +meníngeos I-DERIVED_FROM/TO +o I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +embólicas I-DERIVED_FROM/TO +sistémicas I-DERIVED_FROM/TO +o I-DERIVED_FROM/TO +cutáneas. I-DERIVED_FROM/TO +Se B-EXPLORATION +repitió I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +LCR, I-EXPLORATION +en I-EXPLORATION +cuyo I-EXPLORATION +citoquímico I-EXPLORATION +las I-EXPLORATION +proteínas I-EXPLORATION +disminuyeron I-EXPLORATION +a I-EXPLORATION +81 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +pleocitosis I-EXPLORATION +a I-EXPLORATION +40 I-EXPLORATION +céls/mm3. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +para I-EXPLORATION +tuberculosis I-EXPLORATION +(adenosina I-EXPLORATION +deaminasa, I-EXPLORATION +baciloscopia I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +Koch), I-EXPLORATION +enterovirus I-EXPLORATION +(RPC) I-EXPLORATION +y I-EXPLORATION +hongos I-EXPLORATION +(tinta I-EXPLORATION +china I-EXPLORATION +y I-EXPLORATION +cultivo) I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +y/o I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +también I-EXPLORATION +una I-EXPLORATION +neumonía I-EXPLORATION +por I-EXPLORATION +imágenes I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +se B-TREATMENT +logró I-TREATMENT +desconectar I-TREATMENT +del I-TREATMENT +ventilador I-TREATMENT +mecánico I-TREATMENT +a I-TREATMENT +las I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +de I-TREATMENT +su I-TREATMENT +ingreso, I-TREATMENT +sin B-EVOLUTION +demostrar I-EVOLUTION +focalización I-EVOLUTION +neurológica I-EVOLUTION +alguna I-EVOLUTION +y I-EVOLUTION +recuperando I-EVOLUTION +totalmente I-EVOLUTION +sus I-EVOLUTION +funciones I-EVOLUTION +cerebrales I-EVOLUTION +superiores. I-EVOLUTION +Los B-TREATMENT +antimicrobianos I-TREATMENT +fueron I-TREATMENT +suspendidos I-TREATMENT +a I-TREATMENT +las I-TREATMENT +72 I-TREATMENT +h. I-TREATMENT +Al B-EXPLORATION +interrogatorio I-EXPLORATION +dirigido, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +refirió I-EXPLORATION +ningún I-EXPLORATION +síntoma I-EXPLORATION +respiratorio I-EXPLORATION +alto I-EXPLORATION +o I-EXPLORATION +bajo I-EXPLORATION +(rinorrea, I-EXPLORATION +tos, I-EXPLORATION +odinofagia I-EXPLORATION +o I-EXPLORATION +disfonía) I-EXPLORATION +que I-EXPLORATION +justificara I-EXPLORATION +la I-EXPLORATION +búsqueda I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +respiratorios. I-EXPLORATION +Fue B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso. I-EVOLUTION + I-EVOLUTION +Se B-PAST_MEDICAL_HISTORY +obtuvieron I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +meningoencefalitis I-PAST_MEDICAL_HISTORY +ocurrida I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +atrás, I-PAST_MEDICAL_HISTORY +según I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +epicrisis. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +internado I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +días, I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ellos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ventilación I-PAST_MEDICAL_HISTORY +mecánica. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +indicó I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +bacterias I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram, I-EXPLORATION +pleocitosis I-EXPLORATION +de I-EXPLORATION +70 I-EXPLORATION +céls/mm3 I-EXPLORATION +(60% I-EXPLORATION +mononuclear), I-EXPLORATION +proteínas I-EXPLORATION +de I-EXPLORATION +68 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +glucosa I-EXPLORATION +de I-EXPLORATION +135 I-EXPLORATION +mg/dL. I-EXPLORATION +El B-TREATMENT +cuadro I-TREATMENT +se I-TREATMENT +interpretó I-TREATMENT +como I-TREATMENT +viral, I-TREATMENT +tratándose I-TREATMENT +con I-TREATMENT +aciclovir I-TREATMENT +i.v. I-TREATMENT +por I-TREATMENT +10 I-TREATMENT +días, I-TREATMENT +sin I-TREATMENT +realizarse I-TREATMENT +estudio I-TREATMENT +viral I-TREATMENT +del I-TREATMENT +LCR. I-TREATMENT + I-TREATMENT +En B-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +dirigida I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +rescató I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vacunación I-PAST_MEDICAL_HISTORY +anual I-PAST_MEDICAL_HISTORY +contra I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +influenza I-PAST_MEDICAL_HISTORY +(vacuna I-PAST_MEDICAL_HISTORY +trivalente) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +consecutivos I-PAST_MEDICAL_HISTORY +(2011 I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +2015). I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2014, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +vacuna I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +administrada I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +meningoencefalitis I-PAST_MEDICAL_HISTORY +(Vaxigrip®, I-PAST_MEDICAL_HISTORY +Sanofi, I-PAST_MEDICAL_HISTORY +lote I-PAST_MEDICAL_HISTORY +K7375-2) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +episodio, I-PAST_MEDICAL_HISTORY +producido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2015, I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +(Influval®, I-PAST_MEDICAL_HISTORY +Abbott, I-PAST_MEDICAL_HISTORY +lote I-PAST_MEDICAL_HISTORY +HY01N). I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +análisis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +causalidad, I-PAST_MEDICAL_HISTORY +según I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +puntuación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Naranjo I-PAST_MEDICAL_HISTORY +dio I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +puntos18. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +clínicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +°C I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +escalofríos, I-PRESENT_ILLNESS +palidez I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +piel, I-PRESENT_ILLNESS +adenopatías I-PRESENT_ILLNESS +cervicales I-PRESENT_ILLNESS +bilaterales, I-PRESENT_ILLNESS +decaimiento I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inapetencia. I-PRESENT_ILLNESS +Había I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +tratado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +azitromicina I-PRESENT_ILLNESS +500 I-PRESENT_ILLNESS +mg I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +días. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +soplo I-EXPLORATION +sistólico I-EXPLORATION +grado I-EXPLORATION +II/III I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +foco I-EXPLORATION +auscultatorio I-EXPLORATION +correspondiente I-EXPLORATION +al I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo. I-EXPLORATION +El I-EXPLORATION +electroencefalograma I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +no I-EXPLORATION +evidenciaron I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +inflamatorios: I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +10.500 I-EXPLORATION +céls/ml, I-EXPLORATION +una I-EXPLORATION +neutrofilia I-EXPLORATION +de I-EXPLORATION +70% I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +PCR I-EXPLORATION +elevada I-EXPLORATION +(119 I-EXPLORATION +mg/L). I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cefotaxima I-TREATMENT +i.v. I-TREATMENT +200 I-TREATMENT +mg/kg/día I-TREATMENT +previa I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +hemocultivos I-TREATMENT +seriados I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +consecutivos. I-TREATMENT +A B-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +incubación, I-EXPLORATION +ambos I-EXPLORATION +hemocultivos I-EXPLORATION +fueron I-EXPLORATION +positivos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +bacilos I-EXPLORATION +grampositivos I-EXPLORATION +pleomórficos I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +"V". I-EXPLORATION +La I-EXPLORATION +identificación I-EXPLORATION +directa I-EXPLORATION +del I-EXPLORATION +microorganismo I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +positivos I-EXPLORATION +mediante I-EXPLORATION +espectrometría I-EXPLORATION +de I-EXPLORATION +masas I-EXPLORATION +MALDI-TOF I-EXPLORATION +fue I-EXPLORATION +C. I-EXPLORATION +pseudodiphtheriticum. I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +contexto, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecocardiografía I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +vegetativa I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +mm I-EXPLORATION +del I-EXPLORATION +lado I-EXPLORATION +ventricular I-EXPLORATION +izquierdo, I-EXPLORATION +provocando I-EXPLORATION +insuficiencia I-EXPLORATION +moderada, I-EXPLORATION +sin I-EXPLORATION +repercusión I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +hemodinamia I-EXPLORATION +y I-EXPLORATION +función I-EXPLORATION +cardíaca. I-EXPLORATION +Asimismo, I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +valvulopatía I-EXPLORATION +aórtica I-EXPLORATION +bicúspide. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +una I-TREATMENT +endocarditis I-TREATMENT +infecciosa I-TREATMENT +se I-TREATMENT +agregó I-TREATMENT +gentamicina I-TREATMENT +(6 I-TREATMENT +mg/kg/día) I-TREATMENT +a I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +a I-TREATMENT +la I-TREATMENT +espera I-TREATMENT +de I-TREATMENT +la I-TREATMENT +identificación I-TREATMENT +definitiva I-TREATMENT +del I-TREATMENT +microorganismo I-TREATMENT +y I-TREATMENT +su I-TREATMENT +perfil I-TREATMENT +de I-TREATMENT +susceptibilidad I-TREATMENT +antimicrobiana. I-TREATMENT +A B-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +incubación I-EXPLORATION +en I-EXPLORATION +medios I-EXPLORATION +de I-EXPLORATION +cultivo I-EXPLORATION +sólidos I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +el I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +colonias I-EXPLORATION +grises I-EXPLORATION +en I-EXPLORATION +placas I-EXPLORATION +de I-EXPLORATION +agar I-EXPLORATION +sangre, I-EXPLORATION +catalasa I-EXPLORATION +positivas. I-EXPLORATION +La I-EXPLORATION +identificación I-EXPLORATION +mediante I-EXPLORATION +secuenciación I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +ARN I-EXPLORATION +16S I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +aislamiento I-EXPLORATION +de I-EXPLORATION +C. I-EXPLORATION +pseudodiphtheriticum. I-EXPLORATION +El I-EXPLORATION +antibiograma I-EXPLORATION +con I-EXPLORATION +epsilometría I-EXPLORATION +(E-test) I-EXPLORATION +mostró I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +azitromicina I-EXPLORATION +(CIM I-EXPLORATION +> I-EXPLORATION +256 I-EXPLORATION +μg/ml) I-EXPLORATION +y I-EXPLORATION +sensibilidad I-EXPLORATION +(CIM) I-EXPLORATION +a I-EXPLORATION +amoxicilina/ác. I-EXPLORATION +clavulánico I-EXPLORATION +(0, I-EXPLORATION +016 I-EXPLORATION +μg/ml), I-EXPLORATION +cefotaxima I-EXPLORATION +(0, I-EXPLORATION +38 I-EXPLORATION +μg/ml), I-EXPLORATION +ciprofloxacina I-EXPLORATION +(0, I-EXPLORATION +5 I-EXPLORATION +μg/ I-EXPLORATION +ml), I-EXPLORATION +linezolid I-EXPLORATION +(0, I-EXPLORATION +016 I-EXPLORATION +μg/ml), I-EXPLORATION +penicilina I-EXPLORATION +G I-EXPLORATION +(0, I-EXPLORATION +25 I-EXPLORATION +μg/ml) I-EXPLORATION +y I-EXPLORATION +vancomicina I-EXPLORATION +(0, I-EXPLORATION +38 I-EXPLORATION +μg/ml). I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +favorable, I-EVOLUTION +remitiendo I-EVOLUTION +su I-EVOLUTION +cuadro I-EVOLUTION +febril I-EVOLUTION +antes I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +iniciada I-EVOLUTION +la I-EVOLUTION +terapia I-EVOLUTION +antimicrobiana I-EVOLUTION +combinada. I-EVOLUTION +Dada B-TREATMENT +su I-TREATMENT +buena I-TREATMENT +evolución, I-TREATMENT +habiendo I-TREATMENT +negativizado I-TREATMENT +los I-TREATMENT +hemocultivos I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +cambios I-TREATMENT +imagenológicos I-TREATMENT +no I-TREATMENT +se I-TREATMENT +planteó I-TREATMENT +una I-TREATMENT +cirugía I-TREATMENT +cardíaca I-TREATMENT +en I-TREATMENT +ese I-TREATMENT +momento, I-TREATMENT +salvo I-TREATMENT +que I-TREATMENT +hubiera I-TREATMENT +algún I-TREATMENT +deterioro I-TREATMENT +clínico. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +16 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +internación, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +nuevamente I-EVOLUTION +fiebre I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +cefalea I-EVOLUTION +frontal, I-EVOLUTION +desorientación I-EVOLUTION +y I-EVOLUTION +escaso I-EVOLUTION +tono I-EVOLUTION +motor I-EVOLUTION +que I-EVOLUTION +evolucionó I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +paresia I-EVOLUTION +braquial I-EVOLUTION +derecha, I-EVOLUTION +hemicara I-EVOLUTION +derecha I-EVOLUTION +y I-EVOLUTION +afasia. I-EVOLUTION +El I-EVOLUTION +cuadro I-EVOLUTION +se I-EVOLUTION +interpretó I-EVOLUTION +como I-EVOLUTION +una I-EVOLUTION +embolia I-EVOLUTION +séptica I-EVOLUTION +cerebral. I-EVOLUTION +Se B-TREATMENT +agregó I-TREATMENT +linezolid I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +por I-TREATMENT +una I-TREATMENT +eventual I-TREATMENT +sobreinfección I-TREATMENT +por I-TREATMENT +microorganismos I-TREATMENT +resistentes I-TREATMENT +en I-TREATMENT +algún I-TREATMENT +otro I-TREATMENT +foco. I-TREATMENT +Ante I-TREATMENT +el I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +embolismo, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +cirugía I-TREATMENT +cardíaca I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +territorio I-TREATMENT +valvular I-TREATMENT +aórtico I-TREATMENT +(procedimiento I-TREATMENT +Ross) I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +superada I-TREATMENT +con I-TREATMENT +éxito. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +post-operatorio I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +hipertensión I-EVOLUTION +intracraneal. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +cerebral I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +infarto I-EXPLORATION +isquémico I-EXPLORATION +por I-EXPLORATION +oclusión I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +cerebral I-EXPLORATION +media I-EXPLORATION +izquierda. I-EXPLORATION +Debido B-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +gravedad, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posteriores. I-EVOLUTION +Los B-EXPLORATION +resultados I-EXPLORATION +microbiológicos I-EXPLORATION +finales I-EXPLORATION +confirmaron I-EXPLORATION +nuevamente I-EXPLORATION +el I-EXPLORATION +aislamiento I-EXPLORATION +de I-EXPLORATION +C. I-EXPLORATION +pseudodiphtheriticum I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +hemocultivos. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +(DM-2) I-PAST_MEDICAL_HISTORY +mal I-PAST_MEDICAL_HISTORY +controlada, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +(ERC) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +etapa I-PAST_MEDICAL_HISTORY +V I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +fístula I-PAST_MEDICAL_HISTORY +arterio-venosa I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pie I-PAST_MEDICAL_HISTORY +diabético I-PAST_MEDICAL_HISTORY +izquierdo, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +amputación I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +ortejo, I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +mes I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +consulta. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +erupciones I-PRESENT_ILLNESS +cutáneas I-PRESENT_ILLNESS +inicialmente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +extendieron I-PRESENT_ILLNESS +hacia I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +superiores. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +confusa, I-EXPLORATION +somnolienta, I-EXPLORATION +con I-EXPLORATION +mala I-EXPLORATION +perfusión I-EXPLORATION +distal I-EXPLORATION +y I-EXPLORATION +taquicárdica. I-EXPLORATION +Los I-EXPLORATION +signos I-EXPLORATION +vitales I-EXPLORATION +eran: I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +118 I-EXPLORATION +latidos/ I-EXPLORATION +min, I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +112/72 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +37, I-EXPLORATION +5 I-EXPLORATION +°C. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +cervicales I-EXPLORATION +múltiples I-EXPLORATION +dolorosas I-EXPLORATION +y I-EXPLORATION +seis I-EXPLORATION +pústulas I-EXPLORATION +con I-EXPLORATION +base I-EXPLORATION +eritematosa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mejilla I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +témporo-occipital I-EXPLORATION +del I-EXPLORATION +cuero I-EXPLORATION +cabelludo I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +placa I-EXPLORATION +costrosa I-EXPLORATION +con I-EXPLORATION +secreción I-EXPLORATION +purulenta I-EXPLORATION +de I-EXPLORATION +mal I-EXPLORATION +olor, I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +brazo I-EXPLORATION +derecho I-EXPLORATION +presentaba I-EXPLORATION +dos I-EXPLORATION +bulas I-EXPLORATION +tensas, I-EXPLORATION +que I-EXPLORATION +posteriormente I-EXPLORATION +se I-EXPLORATION +ulceraron, I-EXPLORATION +evolucionando I-EXPLORATION +con I-EXPLORATION +necrosis. I-EXPLORATION +No I-EXPLORATION +tenía I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +mucosas I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron: I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +3 I-EXPLORATION +mg/dL, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +27.500/mm3, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +513.000/mm3, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR): I-EXPLORATION +78 I-EXPLORATION +mg/dL I-EXPLORATION +(valor I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +5 I-EXPLORATION +mg/dL), I-EXPLORATION +nitrógeno I-EXPLORATION +ureico I-EXPLORATION +98 I-EXPLORATION +mg/ I-EXPLORATION +dL, I-EXPLORATION +pH I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +7, I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +bicarbonato I-EXPLORATION +sérico I-EXPLORATION +13, I-EXPLORATION +8 I-EXPLORATION +mEq/L. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +el I-TREATMENT +escenario I-TREATMENT +clínico I-TREATMENT +de I-TREATMENT +una I-TREATMENT +sepsis I-TREATMENT +con I-TREATMENT +foco I-TREATMENT +de I-TREATMENT +entrada I-TREATMENT +cutánea, I-TREATMENT +recibió I-TREATMENT +volumen I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +antimicrobiana I-TREATMENT +empírica I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +y I-TREATMENT +clindamicina I-TREATMENT +i.v., I-TREATMENT +previa I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +cultivos. I-TREATMENT +Evaluada I-TREATMENT +por I-TREATMENT +infectología I-TREATMENT +y I-TREATMENT +dermatología, I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +antibioterapia I-TREATMENT +a I-TREATMENT +piperacilina/ I-TREATMENT +tazobactam, I-TREATMENT +debido I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +clínica I-TREATMENT +de I-TREATMENT +EG. I-TREATMENT +Los B-EXPLORATION +he-mocultivos I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +efectuó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cutánea I-EXPLORATION +realizándose I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram, I-EXPLORATION +cultivo I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +histopatológico. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +cocáceas I-EXPLORATION +grampositivas I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Staphylococcus I-EXPLORATION +aureus I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +meticilina I-EXPLORATION +(SARM). I-EXPLORATION +El I-EXPLORATION +antibiograma I-EXPLORATION +mostró I-EXPLORATION +sensibilidad I-EXPLORATION +a I-EXPLORATION +vancomicina I-EXPLORATION +(concentración I-EXPLORATION +inhibitoria I-EXPLORATION +mínima I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +75 I-EXPLORATION +ug/mL), I-EXPLORATION +rifampicina I-EXPLORATION +y I-EXPLORATION +cotrimoxazol, I-EXPLORATION +y I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +β I-EXPLORATION +lactámicos, I-EXPLORATION +clindamicina, I-EXPLORATION +ciprofloxacina I-EXPLORATION +y I-EXPLORATION +eritromicina. I-EXPLORATION +Se B-TREATMENT +ajustó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibacteriano I-TREATMENT +adicionándose I-TREATMENT +vancomicina I-TREATMENT +i.v. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +EG, I-EXPLORATION +evidenciándose I-EXPLORATION +una I-EXPLORATION +inflamación I-EXPLORATION +dérmica I-EXPLORATION +supurativa I-EXPLORATION +y I-EXPLORATION +necrosante I-EXPLORATION +con I-EXPLORATION +vasculitis I-EXPLORATION +neutrofílica. I-EXPLORATION + I-EXPLORATION +Evolucionó B-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +lesiones I-EVOLUTION +costrosas I-EVOLUTION +no I-EVOLUTION +exudativas, I-EVOLUTION +afebril I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +durante I-EVOLUTION +su I-EVOLUTION +estadía I-EVOLUTION +hospitalaria I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +necrosis I-EVOLUTION +del I-EVOLUTION +segundo I-EVOLUTION +ortejo I-EVOLUTION +del I-EVOLUTION +pie I-EVOLUTION +izquierdo I-EVOLUTION +realizándose B-TREATMENT +una I-TREATMENT +amputación I-TREATMENT +transmetatarsiana I-TREATMENT +que I-TREATMENT +obligó I-TREATMENT +a I-TREATMENT +prolongar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibacteriano I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +y I-TREATMENT +piperacilina/tazobactam I-TREATMENT +por I-TREATMENT +30 I-TREATMENT +días. I-TREATMENT +Tras I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +cotrimoxazol I-TREATMENT +oral, I-TREATMENT +la B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +afebril I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +cutáneas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +radiculo-patía I-PAST_MEDICAL_HISTORY +lumbar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +trastorno I-PAST_MEDICAL_HISTORY +depresivo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +carbamazepina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +clomipramina I-PAST_MEDICAL_HISTORY +iniciado I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +ingreso. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +°C I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +calofríos, I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +intensa, I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +principalmente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +A B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +estaba I-EXPLORATION +lúcido, I-EXPLORATION +febril, I-EXPLORATION +taquicárdico I-EXPLORATION +e I-EXPLORATION +hipertenso. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +facial, I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +oral, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +púrpura I-EXPLORATION +no I-EXPLORATION +palpable I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +tórax, I-EXPLORATION +con I-EXPLORATION +sensibilidad I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +ade-nopatías I-EXPLORATION +cervicales, I-EXPLORATION +axilares I-EXPLORATION +o I-EXPLORATION +inguinales I-EXPLORATION +palpables. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +discreto I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +eosinófilos I-EXPLORATION +(6% I-EXPLORATION +de I-EXPLORATION +3.300 I-EXPLORATION +leucocitos) I-EXPLORATION +y I-EXPLORATION +escasos I-EXPLORATION +linfocitos I-EXPLORATION +atípicos I-EXPLORATION +(menos I-EXPLORATION +de I-EXPLORATION +1%), I-EXPLORATION +creatinina I-EXPLORATION +1 I-EXPLORATION +mg/dL, I-EXPLORATION +LDH I-EXPLORATION +172 I-EXPLORATION +U/L, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +mixto I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +colestásico I-EXPLORATION +(GPT: I-EXPLORATION +215 I-EXPLORATION +U/L, I-EXPLORATION +GOT: I-EXPLORATION +64 I-EXPLORATION +U/L, I-EXPLORATION +GGT: I-EXPLORATION +598 I-EXPLORATION +U/L, I-EXPLORATION +FA: I-EXPLORATION +257 I-EXPLORATION +U/L, I-EXPLORATION +bilirrubina I-EXPLORATION +total: I-EXPLORATION +0, I-EXPLORATION +72 I-EXPLORATION +mg/dL, I-EXPLORATION +INR: I-EXPLORATION +1, I-EXPLORATION +5) I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva: I-EXPLORATION +22, I-EXPLORATION +2 I-EXPLORATION +mg/dL I-EXPLORATION +(Valor I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +0, I-EXPLORATION +5). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +hepato-esplenomegalia I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +hiperecogenicidad I-EXPLORATION +de I-EXPLORATION +espacios I-EXPLORATION +portales. I-EXPLORATION +Una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +corroboró I-EXPLORATION +la I-EXPLORATION +hepato-esplenomegalia I-EXPLORATION +y I-EXPLORATION +evidenció I-EXPLORATION +adenopatías I-EXPLORATION +peri-portales. I-EXPLORATION +Se I-EXPLORATION +ingresó I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +hepatitis I-EXPLORATION +en I-EXPLORATION +estudio; I-EXPLORATION +probablemente I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +medicamentos I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +etiología I-EXPLORATION +infecciosa. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +extenso I-EXPLORATION +estudio I-EXPLORATION +etiológico. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +urocultivo I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +IgM I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +hepatitis I-EXPLORATION +A, I-EXPLORATION +antígeno I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +hepatitis I-EXPLORATION +B, I-EXPLORATION +anticuerpos I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +hepatitis I-EXPLORATION +C, I-EXPLORATION +IgM I-EXPLORATION +VCA I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein I-EXPLORATION +Barr I-EXPLORATION +(VEB), I-EXPLORATION +citomegalovirus I-EXPLORATION +y I-EXPLORATION +VIH, I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +complementó I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +RPR, I-EXPLORATION +IgM I-EXPLORATION +Toxoplasma I-EXPLORATION +gondii, I-EXPLORATION +IgM I-EXPLORATION +e I-EXPLORATION +IgG I-EXPLORATION +Leptospira I-EXPLORATION +spp., I-EXPLORATION +IgM I-EXPLORATION +sarampión, I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +aglutinación I-EXPLORATION +para I-EXPLORATION +Brucella I-EXPLORATION +abortus/melitensis, I-EXPLORATION +IgG I-EXPLORATION +Brucella I-EXPLORATION +canis, I-EXPLORATION +IgG I-EXPLORATION +Bartonella I-EXPLORATION +hensenlae, I-EXPLORATION +IgG I-EXPLORATION +e I-EXPLORATION +IgM I-EXPLORATION +Borrelia I-EXPLORATION +burgorferi, I-EXPLORATION +IgM I-EXPLORATION +Myco-plasma I-EXPLORATION +pneumoniae I-EXPLORATION +fueron I-EXPLORATION +todas I-EXPLORATION +negativas. I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +panel I-EXPLORATION +molecular I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +respiratorios I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +negativo. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +reumatológico I-EXPLORATION +con I-EXPLORATION +anticuerpos I-EXPLORATION +anti-nucleares, I-EXPLORATION +anti-citoplasmáticos, I-EXPLORATION +anti-músculo I-EXPLORATION +liso, I-EXPLORATION +anti-mitocondriales, I-EXPLORATION +anti-endomisio, I-EXPLORATION +factor I-EXPLORATION +reumatoideo, I-EXPLORATION +y I-EXPLORATION +antitransglutaminasa I-EXPLORATION +tisular I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +estabilidad I-EVOLUTION +clínica, I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +hepática, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +persistente I-EVOLUTION +y I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +cefalea I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +exantema I-EVOLUTION +máculo-papular I-EVOLUTION +morbiliforme I-EVOLUTION +de I-EVOLUTION +predominio I-EVOLUTION +perifolicular, I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cara I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +cuello, I-EVOLUTION +con I-EVOLUTION +posterior I-EVOLUTION +extensión I-EVOLUTION +hacia I-EVOLUTION +el I-EVOLUTION +tórax, I-EVOLUTION +dorso, I-EVOLUTION +abdomen I-EVOLUTION +y I-EVOLUTION +extremidades, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +púrpura I-EVOLUTION +no I-EVOLUTION +palpable I-EVOLUTION +en I-EVOLUTION +extremidades I-EVOLUTION +inferiores. I-EVOLUTION +Dado B-EXPLORATION +que I-EXPLORATION +durante I-EXPLORATION +su I-EXPLORATION +evolución I-EXPLORATION +la I-EXPLORATION +cefalea I-EXPLORATION +se I-EXPLORATION +fue I-EXPLORATION +intensificando, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +lumbar, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +dio I-EXPLORATION +salida I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +líquido I-EXPLORATION +cefalo-raquídeo I-EXPLORATION +(LCR) I-EXPLORATION +incoloro, I-EXPLORATION +transparente, I-EXPLORATION +en I-EXPLORATION +cuyo I-EXPLORATION +análisis I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +30 I-EXPLORATION +células/mm3, I-EXPLORATION +100% I-EXPLORATION +mononucleares, I-EXPLORATION +con I-EXPLORATION +glucosa I-EXPLORATION +y I-EXPLORATION +proteínas I-EXPLORATION +normales, I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +sin I-EXPLORATION +bacterias I-EXPLORATION +y I-EXPLORATION +látex I-EXPLORATION +bacteriano I-EXPLORATION +negativo. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +corriente I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC) I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +para I-EXPLORATION +enterovirus, I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simplex I-EXPLORATION +1-2 I-EXPLORATION +y I-EXPLORATION +virus I-EXPLORATION +varicela I-EXPLORATION +zoster I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Con I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +RPC I-EXPLORATION +cualitativa I-EXPLORATION +para I-EXPLORATION +VHH-6 I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +LCR, I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +ambas I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +VHH-6. I-EXPLORATION +Para I-EXPLORATION +completar I-EXPLORATION +el I-EXPLORATION +estudio, I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +cutáneas. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +dermatitis I-EXPLORATION +perivascular I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +perifolicular I-EXPLORATION +liquenoide I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +eosinófilos, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +reacción I-EXPLORATION +adversa I-EXPLORATION +a I-EXPLORATION +medicamentos. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +presentación I-EXPLORATION +clínica, I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +antecedente I-EXPLORATION +de I-EXPLORATION +uso I-EXPLORATION +reciente I-EXPLORATION +de I-EXPLORATION +carbamazepina, I-EXPLORATION +fármaco I-EXPLORATION +frecuentemente I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +cuadros I-EXPLORATION +de I-EXPLORATION +hipersensibilidad, I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +DRESS I-EXPLORATION +en I-EXPLORATION +concomitancia I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +meningoencefalitis I-EXPLORATION +aguda I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +VHH-6. I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +caso I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +un I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +de I-EXPLORATION +DRESS I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +a I-EXPLORATION +criterios I-EXPLORATION +RegiSCAR I-EXPLORATION +y I-EXPLORATION +DRESS I-EXPLORATION +atípico I-EXPLORATION +según I-EXPLORATION +criterios I-EXPLORATION +JSCAR. I-EXPLORATION +Tras B-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +del I-EVOLUTION +fármaco I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +espontáneamente I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cefalea. I-EVOLUTION +El B-TREATMENT +compromiso I-TREATMENT +cutáneo I-TREATMENT +disminuyó I-TREATMENT +con I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +hidrocortisona I-TREATMENT +tópica, I-TREATMENT +sin I-TREATMENT +requerir I-TREATMENT +corticoesteroides I-TREATMENT +sistémicos. I-TREATMENT +Los B-EVOLUTION +exámenes I-EVOLUTION +de I-EVOLUTION +laboratorio I-EVOLUTION +fueron I-EVOLUTION +mejorando I-EVOLUTION +gradualmente, I-EVOLUTION +llegando I-EVOLUTION +a I-EVOLUTION +tener I-EVOLUTION +pruebas I-EVOLUTION +hepáticas I-EVOLUTION +normales I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +cuadro. I-EVOLUTION +No I-EVOLUTION +se I-EVOLUTION +encontró I-EVOLUTION +eosinofilia I-EVOLUTION +ni I-EVOLUTION +linfoci-tosis I-EVOLUTION +atípica I-EVOLUTION +> I-EVOLUTION +5%. I-EVOLUTION +Debido B-TREATMENT +a I-TREATMENT +su I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +y I-TREATMENT +siendo I-TREATMENT +inmunocompetente I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +no I-TREATMENT +dar I-TREATMENT +tratamiento I-TREATMENT +antiviral, I-TREATMENT +siendo B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +tras I-EVOLUTION +nueve I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +para I-EVOLUTION +ser I-EVOLUTION +observado I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +ambulatoria. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +alta, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +permanecido I-EVOLUTION +estable, I-EVOLUTION +sin I-EVOLUTION +recurrencia I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +residente I-PRESENT_ILLNESS +en B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +provincia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Buenos I-PAST_MEDICAL_HISTORY +Aires, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +paludismo I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +viaje I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +amazónica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Bolivia, I-PAST_MEDICAL_HISTORY +Perú, I-PAST_MEDICAL_HISTORY +Ecuador I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Brasil, I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +mefloquina I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +institución. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +regresó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +área I-PAST_MEDICAL_HISTORY +endémica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tres B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +completado I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +un I-EXPLORATION +peso I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +72 I-EXPLORATION +kg, I-EXPLORATION +palidez I-EXPLORATION +generalizada I-EXPLORATION +y I-EXPLORATION +esplenomegalia I-EXPLORATION +leve. I-EXPLORATION +Entre I-EXPLORATION +los I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +14.300/mm3 I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fórmula I-EXPLORATION +leucocitaria I-EXPLORATION +conservada, I-EXPLORATION +plaquetas I-EXPLORATION +84.000/mm3. I-EXPLORATION +La I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +hepática I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +frotis I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +periférica I-EXPLORATION +(FSP) I-EXPLORATION +observándose I-EXPLORATION +trofozoítos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +P. I-EXPLORATION +vivax, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +parasitemia I-EXPLORATION +< I-EXPLORATION +2%. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +fue I-EXPLORATION +realizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Referencia I-EXPLORATION +en I-EXPLORATION +Parasitología I-EXPLORATION +del I-EXPLORATION +Hospital I-EXPLORATION +de I-EXPLORATION +Enfermedades I-EXPLORATION +Infecciosas I-EXPLORATION +"Francisco I-EXPLORATION +J. I-EXPLORATION +Muñiz". I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cloroquina I-TREATMENT +(CQ) I-TREATMENT +1.500 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +dosis I-TREATMENT +total, I-TREATMENT +constatándose B-EVOLUTION +una I-EVOLUTION +remisión I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +parasitemia I-EVOLUTION +negativa I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h. I-EVOLUTION +El B-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +glucosa-6-fosfato I-EXPLORATION +deshidrogenasa I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +266 I-EXPLORATION +mg/dl I-EXPLORATION +(rango I-EXPLORATION +normal), I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +recibió I-EXPLORATION +PQ I-EXPLORATION +15 I-EXPLORATION +mg I-EXPLORATION +al I-EXPLORATION +día I-EXPLORATION +durante I-EXPLORATION +15 I-EXPLORATION +días, I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +adherencia. I-EXPLORATION +Se B-EVOLUTION +realizaron I-EVOLUTION +parasitemias I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +y I-EVOLUTION +cuarta I-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +resultando I-EVOLUTION +negativas. I-EVOLUTION + I-EVOLUTION +Posteriormente I-EVOLUTION +presentó I-EVOLUTION +dos I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +recaída I-EVOLUTION +por I-EVOLUTION +P. I-EVOLUTION +vivax. I-EVOLUTION +Siete I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +consultó I-EVOLUTION +por I-EVOLUTION +fiebre I-EVOLUTION +de I-EVOLUTION +cuatro I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +calofríos, I-EVOLUTION +cefalea I-EVOLUTION +holocraneana, I-EVOLUTION +artralgias I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +abdominal. I-EVOLUTION +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +palidez I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas, I-EXPLORATION +ictericia I-EXPLORATION +en I-EXPLORATION +conjuntivas I-EXPLORATION +y I-EXPLORATION +petequias I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +recuento I-EXPLORATION +plaquetario I-EXPLORATION +normales, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +bilirrubina I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +indirecto. I-EXPLORATION +El I-EXPLORATION +FSP I-EXPLORATION +informó I-EXPLORATION +una I-EXPLORATION +parasitemia I-EXPLORATION +< I-EXPLORATION +2%. I-EXPLORATION +Completó B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +CQ I-TREATMENT +1.500 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +y I-TREATMENT +PQ I-TREATMENT +30 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días, I-TREATMENT +con B-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +adherencia I-EVOLUTION +y I-EVOLUTION +parasitemia I-EVOLUTION +negativa I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +cuatro I-EVOLUTION +semanas. I-EVOLUTION + I-EVOLUTION +Cinco I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +consultó I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +fiebre I-EVOLUTION +intermitente I-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +cefalea I-EVOLUTION +y I-EVOLUTION +astenia. I-EVOLUTION +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +no I-EXPLORATION +presentaron I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +una I-EXPLORATION +parasitemia I-EXPLORATION +< I-EXPLORATION +2%. I-EXPLORATION +Reinició B-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +esquema I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +adherencia I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +parasitemia I-EVOLUTION +negativa I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +cuatro I-EVOLUTION +semanas. I-EVOLUTION +No I-EVOLUTION +presentó I-EVOLUTION +nuevas I-EVOLUTION +recaídas I-EVOLUTION +durante I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +departamento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +San I-PAST_MEDICAL_HISTORY +Martín I-PAST_MEDICAL_HISTORY +(Amazonía I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Perú), I-PAST_MEDICAL_HISTORY +agricultor. I-PAST_MEDICAL_HISTORY +Tenía I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +malaria, I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +relevancia. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +inició I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ingreso, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mesogastrio, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +falta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +apetito, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +Finalmente I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +intensificación I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +extendía I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +todo I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +abdomen, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +incoercibles, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ausencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +eliminación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gases I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deposiciones. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +quejumbroso, I-EXPLORATION +taquicárdico I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +ictericia I-EXPLORATION +de I-EXPLORATION +escleras. I-EXPLORATION +La I-EXPLORATION +auscultación I-EXPLORATION +reveló I-EXPLORATION +ruidos I-EXPLORATION +cardíacos I-EXPLORATION +arrítmicos, I-EXPLORATION +de I-EXPLORATION +intensidad I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +abdominal I-EXPLORATION +los I-EXPLORATION +ruidos I-EXPLORATION +hidroaéreos I-EXPLORATION +estaban I-EXPLORATION +disminuidos, I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +blanda, I-EXPLORATION +depresible I-EXPLORATION +y I-EXPLORATION +dolorosa I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +difusa. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +visceromegalia. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +fue I-EXPLORATION +considerado I-EXPLORATION +no I-EXPLORATION +contributorio. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +posible I-EXPLORATION +obstrucción I-EXPLORATION +intestinal, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +pie I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +intestinales I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +niveles I-EXPLORATION +hidroaéreos. I-EXPLORATION + I-EXPLORATION +Entre I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +hemoglobina I-EXPLORATION +15, I-EXPLORATION +3 I-EXPLORATION +g/dL, I-EXPLORATION +hematocrito I-EXPLORATION +44%, I-EXPLORATION +11.570 I-EXPLORATION +leucocitos/mm3, I-EXPLORATION +segmentados I-EXPLORATION +81%, I-EXPLORATION +sin I-EXPLORATION +baciliformes I-EXPLORATION +ni I-EXPLORATION +eosinófilos, I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +386 I-EXPLORATION +mg/L, I-EXPLORATION +hiperbilirrubinemia I-EXPLORATION +directa I-EXPLORATION +(bilirrubina I-EXPLORATION +total I-EXPLORATION +3, I-EXPLORATION +3 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +directa I-EXPLORATION +2, I-EXPLORATION +7 I-EXPLORATION +mg/dL), I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +GGT I-EXPLORATION +181 I-EXPLORATION +U/L I-EXPLORATION +(GOT I-EXPLORATION +y I-EXPLORATION +GPT I-EXPLORATION +normales), I-EXPLORATION +hipoalbuminemia I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +4 I-EXPLORATION +g/dL, I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +urea: I-EXPLORATION +61 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +creatinina: I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +mg/dL. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +VIH, I-EXPLORATION +HTLV I-EXPLORATION +1-2 I-EXPLORATION +y I-EXPLORATION +VHC I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +El I-EXPLORATION +HBsAg I-EXPLORATION +y I-EXPLORATION +RPR I-EXPLORATION +también I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +exploratoria I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +probable I-EXPLORATION +obstrucción I-EXPLORATION +intestinal I-EXPLORATION +mecánica. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +intraoperatorios I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +que I-EXPLORATION +demarcaban I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +superficie I-EXPLORATION +formas I-EXPLORATION +lineares I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +ejemplares I-EXPLORATION +de I-EXPLORATION +A. I-EXPLORATION +lumbricoides. I-EXPLORATION +En B-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +médico, I-TREATMENT +procediendo I-TREATMENT +al I-TREATMENT +cierre I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +abdominal. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +posquirúrgica I-EVOLUTION +fue I-EVOLUTION +desfavorable. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +hacia I-EVOLUTION +un I-EVOLUTION +shock I-EVOLUTION +hipovolémico, I-EVOLUTION +observándose I-EVOLUTION +la I-EVOLUTION +salida I-EVOLUTION +espontánea I-EVOLUTION +y I-EVOLUTION +masiva I-EVOLUTION +de I-EVOLUTION +gusanos I-EVOLUTION +adultos I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cavidad I-EVOLUTION +oral I-EVOLUTION +y I-EVOLUTION +fosas I-EVOLUTION +nasales. I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +una I-TREATMENT +re-intervención I-TREATMENT +quirúrgica I-TREATMENT +de I-TREATMENT +urgencia, I-TREATMENT +en I-TREATMENT +que I-TREATMENT +se I-TREATMENT +evidenció I-TREATMENT +una I-TREATMENT +gran I-TREATMENT +dilatación I-TREATMENT +de I-TREATMENT +asas I-TREATMENT +intestinales, I-TREATMENT +con I-TREATMENT +abundante I-TREATMENT +cantidad I-TREATMENT +de I-TREATMENT +ejemplares I-TREATMENT +adultos, I-TREATMENT +con I-TREATMENT +múltiples I-TREATMENT +zonas I-TREATMENT +de I-TREATMENT +aglomeración I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +de I-TREATMENT +ovillos, I-TREATMENT +que I-TREATMENT +obstruían I-TREATMENT +la I-TREATMENT +totalidad I-TREATMENT +del I-TREATMENT +lumen I-TREATMENT +intestinal. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +enterotomía I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +íleon, I-TREATMENT +a I-TREATMENT +40 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +la I-TREATMENT +válvula I-TREATMENT +ileocecal, I-TREATMENT +con I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +20 I-TREATMENT +gusanos. I-TREATMENT +Se I-TREATMENT +ordeñaron I-TREATMENT +las I-TREATMENT +asas I-TREATMENT +intestinales, I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +ángulo I-TREATMENT +de I-TREATMENT +Treitz I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +enterotomía, I-TREATMENT +eliminando I-TREATMENT +abundante I-TREATMENT +cantidad I-TREATMENT +de I-TREATMENT +deposiciones I-TREATMENT +con I-TREATMENT +parásitos. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +líquido I-EXPLORATION +seroso I-EXPLORATION +claro. I-EXPLORATION +El I-EXPLORATION +apéndice I-EXPLORATION +cecal I-EXPLORATION +y I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +eran I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Luego B-TREATMENT +de I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +cirugía, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antiparasitario I-TREATMENT +con I-TREATMENT +albendazol. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +fue I-EVOLUTION +insatisfactoria, I-EVOLUTION +requiriendo I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +intervención I-EVOLUTION +quirúrgica, I-EVOLUTION +soporte I-EVOLUTION +ventilatorio I-EVOLUTION +y I-EVOLUTION +manejo I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cuidados I-EVOLUTION +Intensivos I-EVOLUTION +(UCI). I-EVOLUTION +Durante B-EXPLORATION +su I-EXPLORATION +estadía I-EXPLORATION +en I-EXPLORATION +UCI, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +cursó I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +neumonía I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +ventilador I-EXPLORATION +mecánico I-EXPLORATION +por I-EXPLORATION +Pseudomonas I-EXPLORATION +aeru-ginosa I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +bacteriemia I-EXPLORATION +por I-EXPLORATION +Acinetobacter I-EXPLORATION +baumannii I-EXPLORATION +multiresistentes. I-EXPLORATION +La B-EVOLUTION +eliminación I-EVOLUTION +de I-EVOLUTION +gusanos I-EVOLUTION +adultos I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +cavidad I-EVOLUTION +oral I-EVOLUTION +continuó I-EVOLUTION +hasta I-EVOLUTION +varios I-EVOLUTION +días I-EVOLUTION +posteriores I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +última I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +residente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +área I-PRESENT_ILLNESS +urbana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Santiago I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cali I-PRESENT_ILLNESS +(Valle I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Cauca, I-PRESENT_ILLNESS +Colombia), I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estrato I-PRESENT_ILLNESS +socioeconómico I-PRESENT_ILLNESS +bajo, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ocupación I-PRESENT_ILLNESS +"vendedora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dulces" I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +calle. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +gastritis I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +desnutrición I-PAST_MEDICAL_HISTORY +grave, I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +embarazos I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +hijos I-PAST_MEDICAL_HISTORY +vivos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ligadura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trompas I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +tabaquismo. I-PAST_MEDICAL_HISTORY +Presentaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +hábito I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ingerir I-PAST_MEDICAL_HISTORY +agua I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +potable. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +inició I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +hospitalario, I-PRESENT_ILLNESS +consistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mesogastrio, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +adinamia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores, I-PRESENT_ILLNESS +evolucionando I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +fétida, I-PRESENT_ILLNESS +emesis, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +apetito I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +hemoptoica. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +periférico I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +evidenciaron I-PRESENT_ILLNESS +larvas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +S. I-PRESENT_ILLNESS +stercolaris I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +examen I-PRESENT_ILLNESS +directo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +solución I-PRESENT_ILLNESS +salina I-PRESENT_ILLNESS +fisiológica I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +9% I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lugol. I-PRESENT_ILLNESS +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +con I-TREATMENT +ivermectina I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +(200 I-TREATMENT +μg/kg/día) I-TREATMENT +y I-TREATMENT +albendazol I-TREATMENT +(400 I-TREATMENT +mg/día). I-TREATMENT +Entre B-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +albúmina I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +g/dL, I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +negativa I-EXPLORATION +y I-EXPLORATION +para I-EXPLORATION +HTLV I-EXPLORATION +I-II I-EXPLORATION +positiva. I-EXPLORATION +La I-EXPLORATION +TSH I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +normal. I-EXPLORATION +Siete I-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +remitió I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +Unidad I-EXPLORATION +de I-EXPLORATION +Cuidados I-EXPLORATION +Intensivos I-EXPLORATION +(UCI) I-EXPLORATION +extrainstitucional I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +dificultad I-EXPLORATION +respiratoria. I-EXPLORATION +Los I-EXPLORATION +diagnósticos I-EXPLORATION +presuntivos I-EXPLORATION +fueron I-EXPLORATION +un I-EXPLORATION +trombo-embolismo I-EXPLORATION +pulmonar I-EXPLORATION +(TEP), I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Lóeffler I-EXPLORATION +o I-EXPLORATION +una I-EXPLORATION +neumonía I-EXPLORATION +bacteriana. I-EXPLORATION + I-EXPLORATION +Ingresó B-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +consciente, I-EVOLUTION +con I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +dificultad I-EVOLUTION +respiratoria, I-EVOLUTION +taquicárdica, I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +saturación I-EVOLUTION +arterial I-EVOLUTION +de I-EVOLUTION +oxígeno I-EVOLUTION +(SaO2) I-EVOLUTION +por I-EVOLUTION +oximetría I-EVOLUTION +de I-EVOLUTION +pulso I-EVOLUTION +de I-EVOLUTION +87%, I-EVOLUTION +con I-EVOLUTION +soporte I-EVOLUTION +de I-EVOLUTION +oxígeno I-EVOLUTION +(FiO2 I-EVOLUTION +50%). I-EVOLUTION +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +estertores I-EXPLORATION +finos I-EXPLORATION +pulmonares I-EXPLORATION +bibasales, I-EXPLORATION +abdomen I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal, I-EXPLORATION +edema I-EXPLORATION +grado I-EXPLORATION +III I-EXPLORATION +en I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +y, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +eritematosas, I-EXPLORATION +pruriginosas, I-EXPLORATION +no I-EXPLORATION +descamativas I-EXPLORATION +en I-EXPLORATION +piel, I-EXPLORATION +predominantemente I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +muslos. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +evidenciaban I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +26.200/mm3, I-EXPLORATION +hemoglobina I-EXPLORATION +9, I-EXPLORATION +1 I-EXPLORATION +g/dL, I-EXPLORATION +neutrófilos I-EXPLORATION +86%, I-EXPLORATION +eosinófilos I-EXPLORATION +2%, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +18 I-EXPLORATION +mg/dL, I-EXPLORATION +electrolitos I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rangos I-EXPLORATION +normales, I-EXPLORATION +hipoxemia I-EXPLORATION +grave I-EXPLORATION +sin I-EXPLORATION +trastorno I-EXPLORATION +ácido-base. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +infiltrados I-EXPLORATION +mixtos I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +alveolar I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +difusa. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +dificultad I-EVOLUTION +respiratoria I-EVOLUTION +progresiva, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +requirió I-TREATMENT +finalmente I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasora, I-TREATMENT +sin I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +parámetros I-TREATMENT +ventilatorios I-TREATMENT +altos. I-TREATMENT +Además I-TREATMENT +requirió I-TREATMENT +soporte I-TREATMENT +vasoactivo I-TREATMENT +con I-TREATMENT +norepinefrina I-TREATMENT +por I-TREATMENT +una I-TREATMENT +hipotensión I-TREATMENT +arterial I-TREATMENT +persistente. I-TREATMENT +En B-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +presentó I-EVOLUTION +secreciones I-EVOLUTION +respiratorias I-EVOLUTION +hemáticas I-EVOLUTION +constantes I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +significativo I-EVOLUTION + I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +hemoglobina, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +requirió I-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +glóbulos I-TREATMENT +rojos. I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +una I-TREATMENT +neumonía I-TREATMENT +bacteriana I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +cobertura I-TREATMENT +antibacteriana I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro I-TREATMENT +con I-TREATMENT +piperacilina/tazobactam. I-TREATMENT +Posteriormente B-EXPLORATION +se I-EXPLORATION +informaron I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +urocultivo I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Escherichia I-EXPLORATION +coli I-EXPLORATION +productora I-EXPLORATION +de I-EXPLORATION +betalactamasas I-EXPLORATION +de I-EXPLORATION +espectro I-EXPLORATION +extendido I-EXPLORATION +(BLEE), I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +meropenem. I-TREATMENT +Ante B-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +estrongiloidosis I-EXPLORATION +pulmonar I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +microscopía I-EXPLORATION +en I-EXPLORATION +fresco I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +secreción I-EXPLORATION +orotraqueal, I-EXPLORATION +observándose I-EXPLORATION +larvas I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +stercoralis, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +ivermectina I-TREATMENT +(200 I-TREATMENT +μg/kg) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +albendazol I-TREATMENT +oral I-TREATMENT +(400 I-TREATMENT +mg, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día). I-TREATMENT +También B-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +una I-EXPLORATION +tuberculosis I-EXPLORATION +pulmonar I-EXPLORATION +con I-EXPLORATION +baciloscopias I-EXPLORATION +seriadas I-EXPLORATION +negativas. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +colonoscopia, I-EXPLORATION +cuyo I-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +una I-EXPLORATION +colitis I-EXPLORATION +crónica I-EXPLORATION +leve I-EXPLORATION +inespecífica. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +pruebas I-EXPLORATION +inmunológicas I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +estrongiloidosis. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +el I-TREATMENT +proceso I-TREATMENT +de I-TREATMENT +desvinculación I-TREATMENT +progresiva I-TREATMENT +del I-TREATMENT +soporte I-TREATMENT +ventilatorio, I-TREATMENT +logrando I-TREATMENT +la I-TREATMENT +extubación I-TREATMENT +al I-TREATMENT +quinto I-TREATMENT +día I-TREATMENT +de I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasora. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +completó I-EVOLUTION +una I-EVOLUTION +estancia I-EVOLUTION +hospitalaria I-EVOLUTION +de I-EVOLUTION +12 I-EVOLUTION +días, I-EVOLUTION +período I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +presentó I-EVOLUTION +episodios I-EVOLUTION +repetitivos I-EVOLUTION +de I-EVOLUTION +tos I-EVOLUTION +seca. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +clínico I-EVOLUTION +el I-EVOLUTION +estudio I-EVOLUTION +coproscópico I-EVOLUTION +no I-EVOLUTION +evidenció I-EVOLUTION +parásitos I-EVOLUTION +intestinales, I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +radiografía I-EVOLUTION +de I-EVOLUTION +tórax I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +evidenció I-EVOLUTION +una I-EVOLUTION +resolución I-EVOLUTION +significativa I-EVOLUTION +del I-EVOLUTION +infiltrado I-EVOLUTION +pulmonar. I-EVOLUTION +Completó B-TREATMENT +10 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antihelmíntico I-TREATMENT +con I-TREATMENT +albendazol. I-TREATMENT +La B-EVOLUTION +hemoglobina I-EVOLUTION +de I-EVOLUTION +egreso I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +9, I-EVOLUTION +9 I-EVOLUTION +g/dL. I-EVOLUTION + I-EVOLUTION +Durante B-TREATMENT +la I-TREATMENT +permanencia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +institución I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +fisioterapia, I-TREATMENT +donde B-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +condición I-EVOLUTION +cardiorrespiratoria I-EVOLUTION +y I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +funcionalidad. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +triplanar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tobillo I-PAST_MEDICAL_HISTORY +derecho, I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +quirúrgicamente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +material I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +osteosíntesis I-PAST_MEDICAL_HISTORY +(MOS) I-PAST_MEDICAL_HISTORY +retirado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +cuya I-PAST_MEDICAL_HISTORY +herida I-PAST_MEDICAL_HISTORY +quirúrgica I-PAST_MEDICAL_HISTORY +nunca I-PAST_MEDICAL_HISTORY +cicatrizó. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +retiro I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +MOS I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cambios I-PRESENT_ILLNESS +inflamatorios I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +salida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +material I-PRESENT_ILLNESS +purulento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +olor. I-PRESENT_ILLNESS +No B-EXPLORATION +presentaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +respuesta I-EXPLORATION +inflamatoria I-EXPLORATION +sistémica I-EXPLORATION +y I-EXPLORATION +había I-EXPLORATION +permanecido I-EXPLORATION +afebril. I-EXPLORATION +Recibió B-TREATMENT +un I-TREATMENT +curso I-TREATMENT +de I-TREATMENT +dicloxacilina I-TREATMENT +empírica I-TREATMENT +sin I-TREATMENT +mejoría. I-TREATMENT +Por I-TREATMENT +este I-TREATMENT +motivo I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +aseo I-TREATMENT +y I-TREATMENT +desbridamiento I-TREATMENT +quirúrgico I-TREATMENT +en I-TREATMENT +el I-TREATMENT +que I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +un I-TREATMENT +defecto I-TREATMENT +de I-TREATMENT +continuidad I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +2, I-TREATMENT +5 I-TREATMENT +cm I-TREATMENT +x I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +cm I-TREATMENT +en I-TREATMENT +la I-TREATMENT +región I-TREATMENT +maleolar I-TREATMENT +medial, I-TREATMENT +con I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +un I-TREATMENT +material I-TREATMENT +óseo I-TREATMENT +friable I-TREATMENT +y I-TREATMENT +necrótico. I-TREATMENT +Se B-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +para I-EXPLORATION +cultivo I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +inició I-TREATMENT +cefazolina I-TREATMENT +intravenosa I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +empírica. I-TREATMENT +La B-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +mostró I-EXPLORATION +bacilos I-EXPLORATION +grampositivos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +demostró I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +Bacillus I-EXPLORATION +spp., I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +considerado I-EXPLORATION +como I-EXPLORATION +contaminación I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +continuó I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +prescrito. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +persistió I-TREATMENT +con I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +secreción I-TREATMENT +sero-hemática I-TREATMENT +por I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +nuevo I-TREATMENT +desbridamiento I-TREATMENT +quirúrgico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +a I-TREATMENT +clindamicina I-TREATMENT +intravenosa. I-TREATMENT +En B-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +y I-EXPLORATION +hueso I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +bacilos I-EXPLORATION +grampositivos I-EXPLORATION +identificados I-EXPLORATION +como I-EXPLORATION +Bacillus I-EXPLORATION +spp. I-EXPLORATION +sin I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +especie I-EXPLORATION +ni I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +susceptibilidad I-EXPLORATION +antimicrobiana I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +método I-EXPLORATION +disponible I-EXPLORATION +(sistema I-EXPLORATION +VITEK I-EXPLORATION +2). I-EXPLORATION +El I-EXPLORATION +antibiograma I-EXPLORATION +realizado I-EXPLORATION +por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Kirby I-EXPLORATION +Bauer I-EXPLORATION +mostró I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +clindamicina, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +iniciar I-EXPLORATION +vancomicina I-EXPLORATION +intravenosa. I-EXPLORATION +La I-EXPLORATION +cepa I-EXPLORATION +finalmente I-EXPLORATION +fue I-EXPLORATION +identificada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +metodología I-EXPLORATION +MALDI-TOF I-EXPLORATION +MS I-EXPLORATION +(matrix-assisted I-EXPLORATION +laser I-EXPLORATION +desorption/ionization I-EXPLORATION +time-of-flight I-EXPLORATION +mass I-EXPLORATION +spectrometry) I-EXPLORATION +como I-EXPLORATION +Corynebacterium I-EXPLORATION +striatum. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +vancomicina I-EVOLUTION +la I-EVOLUTION +herida I-EVOLUTION +persistía I-EVOLUTION +con I-EVOLUTION +secreción. I-EVOLUTION +La B-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +del I-EXPLORATION +tobillo I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos, I-EXPLORATION +edema I-EXPLORATION +perióseo, I-EXPLORATION +irregularidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cortical I-EXPLORATION +del I-EXPLORATION +hueso I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +fistuloso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +piel. I-EXPLORATION +En B-TREATMENT +la I-TREATMENT +tercera I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +se I-TREATMENT +corrigió I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +fibrótica I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +nuevas I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +cultivos, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +crecimiento I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +microorganismo, I-EXPLORATION +identificado I-EXPLORATION +igualmente I-EXPLORATION +por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +MALDI-TOF I-EXPLORATION +como I-EXPLORATION +Corynebacterium I-EXPLORATION +striatum. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +antibiograma I-EXPLORATION +manual I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +susceptibilidad I-EXPLORATION +a I-EXPLORATION +vancomicina, I-EXPLORATION +linezolid, I-EXPLORATION +daptomicina I-EXPLORATION +e I-EXPLORATION +imipenem, I-EXPLORATION +y I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +clindamicina, I-EXPLORATION +cefalosporinas, I-EXPLORATION +rifampicina, I-EXPLORATION +levofloxacina I-EXPLORATION +y I-EXPLORATION +cotrimoxazol. I-EXPLORATION +Las B-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +vancomicina I-TREATMENT +se I-TREATMENT +aumentaron I-TREATMENT +hasta I-TREATMENT +alcanzar I-TREATMENT +niveles I-TREATMENT +valle I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +ug/ml. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +última I-EVOLUTION +cirugía I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +ajuste I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +dosis I-EVOLUTION +fue I-EVOLUTION +satisfactoria, I-EVOLUTION +con I-EVOLUTION +término I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +secreción I-EVOLUTION +y I-EVOLUTION +cicatrización I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +herida. I-EVOLUTION +Se B-TREATMENT +continuó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +por I-TREATMENT +28 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +se I-TREATMENT +completó I-TREATMENT +tratamiento I-TREATMENT +ambulatorio I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +más I-TREATMENT +con I-TREATMENT +linezolid I-TREATMENT +oral. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +evaluada I-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +egreso I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +herida I-EVOLUTION +quirúrgica I-EVOLUTION +se I-EVOLUTION +encontró I-EVOLUTION +completamente I-EVOLUTION +sana, I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +inflamatorios I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +reactantes I-EVOLUTION +de I-EVOLUTION +fase I-EVOLUTION +aguda I-EVOLUTION +normales. I-EVOLUTION + I-EVOLUTION + +Preescolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sana, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +calendario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vacunación I-PAST_MEDICAL_HISTORY +PNI I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +incluyendo I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vacuna I-PAST_MEDICAL_HISTORY +conjugada I-PAST_MEDICAL_HISTORY +ACWY-CRM197 I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +Plan I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Acción I-PAST_MEDICAL_HISTORY +W135. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +caracterizó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +coriza I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +°C, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +mialgias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +epistaxis. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +oportunidades I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +SAPU, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +indicó I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +sintomático I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +antiinflamatorio I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +esteroidal. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +siguiente I-PRESENT_ILLNESS +aparecieron I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +violáceas I-PRESENT_ILLNESS +puntiformes I-PRESENT_ILLNESS +generalizadas, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +llevado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia. I-PRESENT_ILLNESS +Ingresó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +paro I-PRESENT_ILLNESS +cardio-respiratorio, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +exantema I-PRESENT_ILLNESS +purpúrico I-PRESENT_ILLNESS +generalizado. I-PRESENT_ILLNESS +Se B-TREATMENT +inició I-TREATMENT +reanimación I-TREATMENT +con I-TREATMENT +masaje I-TREATMENT +cardíaco, I-TREATMENT +adrenalina I-TREATMENT +e I-TREATMENT +intubación I-TREATMENT +orotraqueal, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +ceftriaxona I-TREATMENT +100 I-TREATMENT +mg/kg I-TREATMENT +y I-TREATMENT +vancomicina I-TREATMENT +15 I-TREATMENT +mg/kg/dosis I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +vía I-TREATMENT +intraósea. I-TREATMENT +Falleció B-EVOLUTION +a I-EVOLUTION +consecuencia I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +fibrilación I-EVOLUTION +ventricular, I-EVOLUTION +sin I-EVOLUTION +respuesta I-EVOLUTION +a I-EVOLUTION +cardioversión I-EVOLUTION +eléctrica I-EVOLUTION +y I-EVOLUTION +dosis I-EVOLUTION +sucesivas I-EVOLUTION +de I-EVOLUTION +adrenalina. I-EVOLUTION +La B-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +fue I-EXPLORATION +una I-EXPLORATION +meningococcemia I-EXPLORATION +fulminante. I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +gravedad I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +pudo I-EXPLORATION +realizar I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +LCR. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +tomados I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +reanimación I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +alta I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +etiología I-EXPLORATION +meningocócica, I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +remanente I-EXPLORATION +para I-EXPLORATION +realizar I-EXPLORATION +RPC, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +confirmó I-EXPLORATION +N. I-EXPLORATION +meningitidis I-EXPLORATION +serogrupo I-EXPLORATION +B. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +residido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +transitoria I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Ovalle, I-PAST_MEDICAL_HISTORY +Región I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Coquimbo, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +motivos I-PAST_MEDICAL_HISTORY +laborales I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +parálisis I-PAST_MEDICAL_HISTORY +facial I-PAST_MEDICAL_HISTORY +periférica I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +repetidos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +trastorno I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +equilibrio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vértigo. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso, I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +enflaquecido, I-EXPLORATION +consciente I-EXPLORATION +y I-EXPLORATION +orientado, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +general. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +sin I-EXPLORATION +afasia, I-EXPLORATION +con I-EXPLORATION +prueba I-EXPLORATION +positiva I-EXPLORATION +de I-EXPLORATION +mínima I-EXPLORATION +paresia, I-EXPLORATION +dismetría I-EXPLORATION +y I-EXPLORATION +disdiadococinesia I-EXPLORATION +izquierdas. I-EXPLORATION +Entre I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +tenía I-EXPLORATION +un I-EXPLORATION +hemograma, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva, I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +perfil I-EXPLORATION +hepático, I-EXPLORATION +coagulación I-EXPLORATION +y I-EXPLORATION +orina I-EXPLORATION +completa I-EXPLORATION +normales, I-EXPLORATION +salvo I-EXPLORATION +una I-EXPLORATION +albuminemia I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +4 I-EXPLORATION +g/dl. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +cerebral I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +edema I-EXPLORATION +vasogénico I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +tipo I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +frontal I-EXPLORATION +derecho; I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +imagen I-EXPLORATION +parietal I-EXPLORATION +con I-EXPLORATION +impregnación I-EXPLORATION +de I-EXPLORATION +contomos I-EXPLORATION +irregulares I-EXPLORATION +al I-EXPLORATION +contraste. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +cerebral I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +al I-EXPLORATION +menos I-EXPLORATION +tres I-EXPLORATION +lesiones I-EXPLORATION +hipointensas I-EXPLORATION +con I-EXPLORATION +impregnación I-EXPLORATION +marginal I-EXPLORATION +con I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +y I-EXPLORATION +significativo I-EXPLORATION +edema I-EXPLORATION +perilesional I-EXPLORATION +de I-EXPLORATION +ubicación I-EXPLORATION +frontal, I-EXPLORATION +con I-EXPLORATION +características I-EXPLORATION +de I-EXPLORATION +granulomas, I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +similares I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +frontoparietal I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +posterior I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cerebelar I-EXPLORATION +izquierdo, I-EXPLORATION +menores I-EXPLORATION +a I-EXPLORATION +2, I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +probable I-EXPLORATION +toxoplasmosis I-EXPLORATION +cerebral. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +segmentario I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +candidiasis I-EXPLORATION +orofaríngea I-EXPLORATION +y I-EXPLORATION +leucoplaquia I-EXPLORATION +vellosa I-EXPLORATION +y B-TREATMENT +por I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +una I-TREATMENT +toxoplasmosis I-TREATMENT +cerebral I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +8-10 I-TREATMENT +mg/kg/día I-TREATMENT +(en I-TREATMENT +base I-TREATMENT +a I-TREATMENT +trimetoprim), I-TREATMENT +corticoesteroides I-TREATMENT +sistémicos I-TREATMENT +(dexametasona I-TREATMENT +12-16 I-TREATMENT +mg/día) I-TREATMENT +y I-TREATMENT +fluconazol I-TREATMENT +oral I-TREATMENT +(150 I-TREATMENT +mg/día I-TREATMENT +v.o. I-TREATMENT +por I-TREATMENT +10 I-TREATMENT +días). I-TREATMENT +Las B-EXPLORATION +serologías I-EXPLORATION +por I-EXPLORATION +quimioluminiscencia I-EXPLORATION +de I-EXPLORATION +VIH I-EXPLORATION +y I-EXPLORATION +ELISA I-EXPLORATION +de I-EXPLORATION +T. I-EXPLORATION +cruzi I-EXPLORATION +resultaron I-EXPLORATION +reactivas, I-EXPLORATION +siendo I-EXPLORATION +ambas I-EXPLORATION +confirmadas I-EXPLORATION +posteriormente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +nacional I-EXPLORATION +(ELISA I-EXPLORATION +e I-EXPLORATION +IFI I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +Chagas) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +además I-EXPLORATION +serología I-EXPLORATION +positiva I-EXPLORATION +IgG I-EXPLORATION +para I-EXPLORATION +Toxoplasma I-EXPLORATION +gondii. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +sífilis, I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +fueron I-EXPLORATION +negativas, I-EXPLORATION +sin I-EXPLORATION +detectar I-EXPLORATION +anomalías I-EXPLORATION +al I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +sus I-EXPLORATION +valores I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +para I-EXPLORATION +sífilis, I-EXPLORATION +bacterias, I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +tuberculosis I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +en I-EXPLORATION +esta I-EXPLORATION +primera I-EXPLORATION +punción I-EXPLORATION +lumbar. I-EXPLORATION +Posteriormente, I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +CD4 I-EXPLORATION +de I-EXPLORATION +73 I-EXPLORATION +cél/mm3 I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +VIH I-EXPLORATION +de I-EXPLORATION +54.438 I-EXPLORATION +copias/ml I-EXPLORATION +(log I-EXPLORATION +4, I-EXPLORATION +74). I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +por I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +adenopatías, I-EXPLORATION +visceromegalias I-EXPLORATION +ni I-EXPLORATION +lesiones I-EXPLORATION +residuales I-EXPLORATION +de I-EXPLORATION +tuberculosis. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +rechazo I-EVOLUTION +alimentario, I-EVOLUTION +ánimo I-EVOLUTION +bajo I-EVOLUTION +y I-EVOLUTION +labilidad I-EVOLUTION +emocional. I-EVOLUTION +Se I-EVOLUTION +diagnosticó I-EVOLUTION +un I-EVOLUTION +trastorno I-EVOLUTION +depresivo/adaptativo I-EVOLUTION +grave, I-EVOLUTION +que B-TREATMENT +se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +mirtazapina I-TREATMENT +y I-TREATMENT +olanzapina. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +y I-TREATMENT +26 I-TREATMENT +de I-TREATMENT +hospitalización I-TREATMENT +se I-TREATMENT +inicio I-TREATMENT +terapia I-TREATMENT +antiretroviral I-TREATMENT +(TARV) I-TREATMENT +con I-TREATMENT +abacavir, I-TREATMENT +lamivudina I-TREATMENT +y I-TREATMENT +raltegravir, I-TREATMENT +que I-TREATMENT +toleró I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +adecuada I-TREATMENT +y I-TREATMENT +con I-TREATMENT +estudio I-TREATMENT +previo I-TREATMENT +genotípico I-TREATMENT +para I-TREATMENT +HLA*B5701 I-TREATMENT +negativo. I-TREATMENT +Se I-TREATMENT +desestimó I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +inhibidores I-TREATMENT +de I-TREATMENT +proteasa I-TREATMENT +por I-TREATMENT +eventuales I-TREATMENT +interacciones I-TREATMENT +con I-TREATMENT +psicofármacos I-TREATMENT +y I-TREATMENT +de I-TREATMENT +efavirenz I-TREATMENT +por I-TREATMENT +la I-TREATMENT +depresión I-TREATMENT +concurrente. I-TREATMENT +Durante B-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +TARV I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +diplopía, I-EVOLUTION +nistagmus I-EVOLUTION +y I-EVOLUTION +estrabismo I-EVOLUTION +convergente I-EVOLUTION +del I-EVOLUTION +ojo I-EVOLUTION +derecho, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +marcada I-EVOLUTION +agresividad. I-EVOLUTION +Se B-EXPLORATION +controló I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +RM I-EXPLORATION +cerebral I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +15 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +terapia I-EXPLORATION +con I-EXPLORATION +cotrimoxazol I-EXPLORATION +(+31 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +hospitalización), I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +significativa I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +frontales I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +edema I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +lesiones I-EXPLORATION +cerebelares I-EXPLORATION +estacionarias I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +edema I-EXPLORATION +perilesional. I-EXPLORATION +Se I-EXPLORATION +planteó I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones, I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +primario I-EXPLORATION +de I-EXPLORATION +SNC I-EXPLORATION +y I-EXPLORATION +otros I-EXPLORATION +diagnósticos I-EXPLORATION +diferenciales. I-EXPLORATION +No I-EXPLORATION +obstante, I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +dichas I-EXPLORATION +lesiones I-EXPLORATION +radiológicamente I-EXPLORATION +no I-EXPLORATION +empeoraron, I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +de I-EXPLORATION +Neurocirugía I-EXPLORATION +desestimó I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +abierta. I-EXPLORATION + I-EXPLORATION +Durante B-EVOLUTION +la I-EVOLUTION +cuarta I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +terapia I-EVOLUTION +con I-EVOLUTION +cotrimoxazol I-EVOLUTION +y I-EVOLUTION +tercera I-EVOLUTION +de I-EVOLUTION +TARV, I-EVOLUTION +inició I-EVOLUTION +fiebre I-EVOLUTION +hasta I-EVOLUTION +38°C, I-EVOLUTION +somnolencia I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +sopor I-EVOLUTION +profundo, I-EVOLUTION +paresia I-EVOLUTION +de I-EVOLUTION +hemicuerpo I-EVOLUTION +izquierdo, I-EVOLUTION +del I-EVOLUTION +velo I-EVOLUTION +palatino I-EVOLUTION +izquierdo I-EVOLUTION +y I-EVOLUTION +disartria I-EVOLUTION +intensa, I-EVOLUTION +objetivándose I-EVOLUTION +una I-EVOLUTION +infección I-EVOLUTION +del I-EVOLUTION +tracto I-EVOLUTION +urinario I-EVOLUTION +por I-EVOLUTION +Klebsiella I-EVOLUTION +pneumoniae I-EVOLUTION +multiresistente. I-EVOLUTION +Un B-EXPLORATION +nuevo I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +RM I-EXPLORATION +cerebral, I-EXPLORATION +al I-EXPLORATION +mes I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +cotrimoxazol, I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +progresión I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +cerebrales, I-EXPLORATION +especialmente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +posterior I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +frontal I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +nuevas I-EXPLORATION +lesiones I-EXPLORATION +supra I-EXPLORATION +e I-EXPLORATION +infratentoriales, I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +y I-EXPLORATION +herniación I-EXPLORATION +subfalcina I-EXPLORATION +a I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +planteó I-TREATMENT +un I-TREATMENT +probable I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +SNC I-TREATMENT +por I-TREATMENT +enfermedad I-TREATMENT +de I-TREATMENT +Chagas I-TREATMENT +o I-TREATMENT +un I-TREATMENT +síndrome I-TREATMENT +inflamatorio I-TREATMENT +de I-TREATMENT +reconstitución I-TREATMENT +inmune I-TREATMENT +(SIRI), I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +trasladar I-TREATMENT +a I-TREATMENT +UCI I-TREATMENT +ese I-TREATMENT +mismo I-TREATMENT +día I-TREATMENT +para I-TREATMENT +protección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +aérea I-TREATMENT +(escala I-TREATMENT +Glasgow I-TREATMENT +de I-TREATMENT +coma I-TREATMENT +5-6 I-TREATMENT +puntos) I-TREATMENT +con I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasora I-TREATMENT +y I-TREATMENT +monitorización, I-TREATMENT +manteniéndose I-TREATMENT +la I-TREATMENT +TARV, I-TREATMENT +cotrimoxazol I-TREATMENT +y I-TREATMENT +corticoesteroides. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +empíricamente I-TREATMENT +nifurtimox I-TREATMENT +8 I-TREATMENT +mg/kg/día I-TREATMENT +(120 I-TREATMENT +mg I-TREATMENT +fraccionado I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +horas I-TREATMENT +por I-TREATMENT +SNG), I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +meropenem I-TREATMENT +i.v. I-TREATMENT +para I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +infección I-TREATMENT +urinaria. I-TREATMENT +Se B-EXPLORATION +amplió I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +para I-EXPLORATION +citomegalovirus I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +indetectable I-EXPLORATION +y I-EXPLORATION +hemocultivos I-EXPLORATION +para I-EXPLORATION +micobacterias I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +negativo. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +punción I-EXPLORATION +lumbar, I-EXPLORATION +con I-EXPLORATION +cultivo I-EXPLORATION +corriente, I-EXPLORATION +de I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +tinta I-EXPLORATION +china I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +nuevamente I-EXPLORATION +negativos, I-EXPLORATION +pero I-EXPLORATION +apareció I-EXPLORATION +una I-EXPLORATION +proteinorraquia I-EXPLORATION +de I-EXPLORATION +55 I-EXPLORATION +mg/dL. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +complementario I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +con I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +tripomastigotes, I-EXPLORATION +RPC I-EXPLORATION +con I-EXPLORATION +Xpert I-EXPLORATION +MTB/RIF I-EXPLORATION +para I-EXPLORATION +Mycobacterium I-EXPLORATION +tuberculosis I-EXPLORATION +y I-EXPLORATION +RPC I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simplex-1 I-EXPLORATION +y I-EXPLORATION +2, I-EXPLORATION +varicela I-EXPLORATION +zoster, I-EXPLORATION +Epstein-Barr I-EXPLORATION +y I-EXPLORATION +JC I-EXPLORATION +también I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Además, I-EXPLORATION +la I-EXPLORATION +RPC I-EXPLORATION +para I-EXPLORATION +T. I-EXPLORATION +gondii I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +periférica I-EXPLORATION +y I-EXPLORATION +LCR I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +teniendo I-EXPLORATION +como I-EXPLORATION +target I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +multicopia I-EXPLORATION +B1 I-EXPLORATION +9. I-EXPLORATION +Sin I-EXPLORATION +embargo, I-EXPLORATION +la I-EXPLORATION +RPC I-EXPLORATION +para I-EXPLORATION +T. I-EXPLORATION +cruzi I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +reveló I-EXPLORATION +1.400 I-EXPLORATION +copias/mL, I-EXPLORATION +y I-EXPLORATION +35.000 I-EXPLORATION +copias/mL I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +LCR, I-EXPLORATION +confirmándose I-EXPLORATION +una I-EXPLORATION +encefalitis I-EXPLORATION +chagásica. I-EXPLORATION +Los I-EXPLORATION +targets I-EXPLORATION +utilizados I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +T. I-EXPLORATION +cruzi I-EXPLORATION +fueron I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +minicírculo I-EXPLORATION +contenido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ADN I-EXPLORATION +de I-EXPLORATION +kinetoplasto I-EXPLORATION +(ADNk) I-EXPLORATION +10 I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +repetitiva I-EXPLORATION +de I-EXPLORATION +195 I-EXPLORATION +pb I-EXPLORATION +contenida I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +núcleo, I-EXPLORATION +denominado I-EXPLORATION +ADN I-EXPLORATION +satélite I-EXPLORATION +(ADNsat). I-EXPLORATION +11 I-EXPLORATION +En B-EVOLUTION +su I-EVOLUTION +quinta I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +TARV I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +carga I-EVOLUTION +viral I-EVOLUTION +de I-EVOLUTION +VIH I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +indetectable I-EVOLUTION +(con I-EVOLUTION +reducción I-EVOLUTION +> I-EVOLUTION +1 I-EVOLUTION +log I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +basal), I-EVOLUTION +sin I-EVOLUTION +aumento I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +recuento I-EVOLUTION +CD4 I-EVOLUTION +(30 I-EVOLUTION +céls/μL), I-EVOLUTION +aunque I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +estaba I-EVOLUTION +recibiendo I-EVOLUTION +altas I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +corticoesteroides. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +extrema I-EVOLUTION +gravedad, I-EVOLUTION +necesidad I-EVOLUTION +continua I-EVOLUTION +de I-EVOLUTION +VM I-EVOLUTION +y I-EVOLUTION +aminas I-EVOLUTION +vasoactivas, I-EVOLUTION +sin I-EVOLUTION +mayor I-EVOLUTION +respuesta I-EVOLUTION +neurológica I-EVOLUTION +a I-EVOLUTION +terapias I-EVOLUTION +instauradas. I-EVOLUTION +Luego I-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +falleció I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +hipertensión I-EVOLUTION +intracraneal I-EVOLUTION +y I-EVOLUTION +falla I-EVOLUTION +multiorgánica. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +tuberculosis I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +diagnóstico. I-PAST_MEDICAL_HISTORY +Recibió I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +anti-retroviral I-PAST_MEDICAL_HISTORY +(TARV) I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +adherencia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ocho I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +inmunológica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +virológica I-PAST_MEDICAL_HISTORY +favorable, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +abandonó, I-PAST_MEDICAL_HISTORY +según I-PAST_MEDICAL_HISTORY +refirió, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +mejoría I-PAST_MEDICAL_HISTORY +clínica. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +abandono, I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +nuevamente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tuberculosis, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +ganglionar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +multirresistencia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +fármacos I-PAST_MEDICAL_HISTORY +antituberculosos. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +régimen I-PAST_MEDICAL_HISTORY +individualizado I-PAST_MEDICAL_HISTORY +(amikacina, I-PAST_MEDICAL_HISTORY +pirazinamida, I-PAST_MEDICAL_HISTORY +cicloserina, I-PAST_MEDICAL_HISTORY +etionamida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +levofloxacina) I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +siete I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +reinicio I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +TARV I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +(tenofovir, I-PAST_MEDICAL_HISTORY +lamivudina, I-PAST_MEDICAL_HISTORY +efavirenz). I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +embargo, I-PAST_MEDICAL_HISTORY +finalmente I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +abandonado I-PAST_MEDICAL_HISTORY +ambos I-PAST_MEDICAL_HISTORY +esquemas I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +intolerancia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +medicación. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Además, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +empírica I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +encefalitis I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Toxoplasma I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cotrimoxazol I-PAST_MEDICAL_HISTORY +(5 I-PAST_MEDICAL_HISTORY +mg/kg/día I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trimetoprim, I-PAST_MEDICAL_HISTORY +fraccionado I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +h) I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +semanas, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +favorable I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +imágenes I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +resonancia I-PAST_MEDICAL_HISTORY +magnética I-PAST_MEDICAL_HISTORY +(RM). I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +alta, I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +reiniciado I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antituberculoso, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +continuado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cotrimoxazol, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mantención I-PAST_MEDICAL_HISTORY +(160/800 I-PAST_MEDICAL_HISTORY +mg, I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +24 I-PAST_MEDICAL_HISTORY +h); I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +adherencia I-PAST_MEDICAL_HISTORY +regular. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tres B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +reingresó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Emergencias I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +neurológico, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +paraparesia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores, I-PRESENT_ILLNESS +retención I-PRESENT_ILLNESS +urinaria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +sensitivo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +T8. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +y I-EXPLORATION +médula I-EXPLORATION +espinal I-EXPLORATION +revelando I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +intramedular I-EXPLORATION +captadora I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +en I-EXPLORATION +anillo I-EXPLORATION +(0, I-EXPLORATION +9 I-EXPLORATION +cm I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +6 I-EXPLORATION +cm) I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +perilesional, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +T8. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo I-EXPLORATION +(LCR) I-EXPLORATION +mostró I-EXPLORATION +20 I-EXPLORATION +células I-EXPLORATION +a I-EXPLORATION +predominio I-EXPLORATION +linfomononuclear I-EXPLORATION +(90%), I-EXPLORATION +hiperproteinorraquia I-EXPLORATION +(247 I-EXPLORATION +mg/dL), I-EXPLORATION +glucorraquia I-EXPLORATION +y I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +ADA I-EXPLORATION +(adenosina I-EXPLORATION +deaminasa) I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +microbiológicos I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +para I-EXPLORATION +bacterias I-EXPLORATION +(tinción I-EXPLORATION +Gram I-EXPLORATION +y I-EXPLORATION +cultivo), I-EXPLORATION +hongos I-EXPLORATION +(tinta I-EXPLORATION +china I-EXPLORATION +y I-EXPLORATION +antígeno I-EXPLORATION +para I-EXPLORATION +Cryptococcus) I-EXPLORATION +y I-EXPLORATION +micobacterias I-EXPLORATION +(baciloscopias I-EXPLORATION +y I-EXPLORATION +GeneXpert I-EXPLORATION +MTB/RIF) I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +RPC I-EXPLORATION +para I-EXPLORATION +Toxoplasma I-EXPLORATION +en I-EXPLORATION +LCR, I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +cargas I-EXPLORATION +virales I-EXPLORATION +para I-EXPLORATION +CMV I-EXPLORATION +y I-EXPLORATION +VEB I-EXPLORATION +séricas I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +fueron I-EXPLORATION +indetectables. I-EXPLORATION +El I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +T I-EXPLORATION +CD4+ I-EXPLORATION +fue I-EXPLORATION +11 I-EXPLORATION +céls/mm3, I-EXPLORATION +con I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +VIH I-EXPLORATION +de I-EXPLORATION +548.800 I-EXPLORATION +copias I-EXPLORATION +ARN/ml; I-EXPLORATION +los I-EXPLORATION +títulos I-EXPLORATION +séricos I-EXPLORATION +de I-EXPLORATION +IgG I-EXPLORATION +para I-EXPLORATION +Toxoplasma I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +en I-EXPLORATION +4, I-EXPLORATION +37 I-EXPLORATION +(< I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION += I-EXPLORATION +negativo) I-EXPLORATION +obtenidos I-EXPLORATION +mediante I-EXPLORATION +inmunoanálisis I-EXPLORATION +quimioluminiscente I-EXPLORATION +de I-EXPLORATION +partículas I-EXPLORATION +(CMIA). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +reinició I-TREATMENT +terapia I-TREATMENT +empírica, I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +no I-TREATMENT +se I-TREATMENT +pudo I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +biopsia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +intramedular, I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +i.v. I-TREATMENT +(5 I-TREATMENT +mg/kg I-TREATMENT +de I-TREATMENT +trimetoprim, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día), I-TREATMENT +durante I-TREATMENT +cuatro I-TREATMENT +semanas I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +dexametasona I-TREATMENT +i.v. I-TREATMENT +8 I-TREATMENT +mg, I-TREATMENT +fraccionado I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h, I-TREATMENT +por I-TREATMENT +siete I-TREATMENT +días. I-TREATMENT +Posteriormente I-TREATMENT +continuó I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +a I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +dosis I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +y I-TREATMENT +reducción I-TREATMENT +semanal I-TREATMENT +progresiva I-TREATMENT +de I-TREATMENT +corticoesteroides I-TREATMENT +con I-TREATMENT +prednisona, I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +seis I-TREATMENT +semanas. I-TREATMENT +Tuvo B-EVOLUTION +control I-EVOLUTION +imagenológico I-EVOLUTION +cuatro I-EVOLUTION +semanas I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +tratamiento, I-EVOLUTION +evidenciándose I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +lesión I-EVOLUTION +intramedular, I-EVOLUTION +con I-EVOLUTION +evidente I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +tamaño I-EVOLUTION +y I-EVOLUTION +menor I-EVOLUTION +realce I-EVOLUTION +al I-EVOLUTION +contraste. I-EVOLUTION +Clínicamente I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +empírico, I-EVOLUTION +comenzó I-EVOLUTION +a I-EVOLUTION +evidenciarse I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sensibilidad I-EVOLUTION +discriminatoria I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +fuerza I-EVOLUTION +muscular; I-EVOLUTION +sin I-EVOLUTION +embargo, I-EVOLUTION +persistió I-EVOLUTION +con I-EVOLUTION +compromiso I-EVOLUTION +del I-EVOLUTION +esfínter I-EVOLUTION +urinario I-EVOLUTION +(retención I-EVOLUTION +urinaria). I-EVOLUTION +Ante B-TREATMENT +la I-TREATMENT +mejoría I-TREATMENT +inicial, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +continuar I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +toxoplasmosis I-TREATMENT +(durante I-TREATMENT +seis I-TREATMENT +semanas), I-TREATMENT +y I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +rehabilitación I-TREATMENT +física. I-TREATMENT +Previo I-TREATMENT +al I-TREATMENT +alta I-TREATMENT +se I-TREATMENT +reinició I-TREATMENT +la I-TREATMENT +TARV I-TREATMENT +con I-TREATMENT +mismo I-TREATMENT +esquema I-TREATMENT +recibido I-TREATMENT +previamente. I-TREATMENT +Finalmente, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +continuó I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +antituberculosa I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +regular I-TREATMENT +y I-TREATMENT +con I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +mantención I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +160/800 I-TREATMENT +mg, I-TREATMENT +fraccionado I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h. I-TREATMENT + I-TREATMENT + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +chofer B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ambulancia, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +activo I-PAST_MEDICAL_HISTORY +(5 I-PAST_MEDICAL_HISTORY +cigarrillos/día) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +(IMC I-PAST_MEDICAL_HISTORY +31 I-PAST_MEDICAL_HISTORY +kg/m2) I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mialgias, I-PAST_MEDICAL_HISTORY +tos, I-PAST_MEDICAL_HISTORY +odinofagia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +rinorrea. I-PAST_MEDICAL_HISTORY +Un B-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +agregó I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +cuantitativo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia. I-PRESENT_ILLNESS +Ingresó B-EXPLORATION +al I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Urgencia I-EXPLORATION +comprometido I-EXPLORATION +de I-EXPLORATION +conciencia, I-EXPLORATION +mal I-EXPLORATION +perfundido, I-EXPLORATION +hipotenso I-EXPLORATION +(106/46 I-EXPLORATION +mmHg), I-EXPLORATION +taquicárdico I-EXPLORATION +(106/min), I-EXPLORATION +con I-EXPLORATION +uso I-EXPLORATION +de I-EXPLORATION +musculatura I-EXPLORATION +accesoria, I-EXPLORATION +saturando I-EXPLORATION +60-67% I-EXPLORATION +por I-EXPLORATION +oximetría I-EXPLORATION +de I-EXPLORATION +pulso I-EXPLORATION +a I-EXPLORATION +Fi02 I-EXPLORATION +ambiental I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +roncus I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +campos I-EXPLORATION +pulmonares. I-EXPLORATION +Se I-EXPLORATION +administró I-EXPLORATION +oxigenoterapia I-EXPLORATION +con I-EXPLORATION +mascarilla I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +flujo I-EXPLORATION +sin I-EXPLORATION +respuesta, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +intubó I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +trasladó I-EXPLORATION +a I-EXPLORATION +UCI. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +con I-EXPLORATION +creatinina I-EXPLORATION +plasmática I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +45 I-EXPLORATION +mg/dL I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +y I-EXPLORATION +NU I-EXPLORATION +de I-EXPLORATION +47 I-EXPLORATION +mg/dL. I-EXPLORATION +Tenía I-EXPLORATION +una I-EXPLORATION +PCR I-EXPLORATION +elevada I-EXPLORATION +(200 I-EXPLORATION +mg/L), I-EXPLORATION +con I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos, I-EXPLORATION +eritrocitos I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +normales. I-EXPLORATION +Además, I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +LDH I-EXPLORATION +plasmática I-EXPLORATION +(1.500 I-EXPLORATION +U/L) I-EXPLORATION +y I-EXPLORATION +lactato I-EXPLORATION +arterial I-EXPLORATION +45 I-EXPLORATION +mg/dL I-EXPLORATION +(4,5-14,4). I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +confirmó I-EXPLORATION +una I-EXPLORATION +neumonía I-EXPLORATION +multilobar I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +tratamiento I-EXPLORATION +empírico I-EXPLORATION +con I-EXPLORATION +ceftriaxona, I-EXPLORATION +moxifloxacino I-EXPLORATION +y I-EXPLORATION +oseltamivir. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +evolucionó I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +shock I-EXPLORATION +(con I-EXPLORATION +requerimientos I-EXPLORATION +de I-EXPLORATION +noradrenalina I-EXPLORATION +hasta I-EXPLORATION +0, I-EXPLORATION +15 I-EXPLORATION +μg/kg/min) I-EXPLORATION +e I-EXPLORATION +insuficiencia I-EXPLORATION +respiratoria I-EXPLORATION +catastrófica I-EXPLORATION +en I-EXPLORATION +VM, I-EXPLORATION +decidiéndose I-EXPLORATION +ventilar I-EXPLORATION +en I-EXPLORATION +posición I-EXPLORATION +prono. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +agentes I-EXPLORATION +por I-EXPLORATION +hemocultivos, I-EXPLORATION +urocultivo, I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +aspirado I-EXPLORATION +endotraqueal I-EXPLORATION +o I-EXPLORATION +panel I-EXPLORATION +viral I-EXPLORATION +por I-EXPLORATION +inmunofluorescencia. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +una I-EXPLORATION +influenza I-EXPLORATION +A I-EXPLORATION +H1N1 I-EXPLORATION +pdm09 I-EXPLORATION +por I-EXPLORATION +RPC. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +complementario I-EXPLORATION +por I-EXPLORATION +RPC I-EXPLORATION +reveló I-EXPLORATION +además I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +ADV I-EXPLORATION +y I-EXPLORATION +VRS I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +aérea. I-EXPLORATION + I-EXPLORATION +Desde I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +h I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +disminuyeron I-EXPLORATION +los I-EXPLORATION +requerimientos I-EXPLORATION +de I-EXPLORATION +noradrenalina I-EXPLORATION +(0, I-EXPLORATION +03 I-EXPLORATION +μg/kg/min), I-EXPLORATION +estabilizándose I-EXPLORATION +su I-EXPLORATION +insuficiencia I-EXPLORATION +respiratoria I-EXPLORATION +(PaFi I-EXPLORATION +> I-EXPLORATION +250), I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +volvió I-EXPLORATION +a I-EXPLORATION +posición I-EXPLORATION +supina. I-EXPLORATION +No I-EXPLORATION +obstante, I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +progresión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +IRA, I-EXPLORATION +desde I-EXPLORATION +oliguria I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +anuria, I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +creatinina I-EXPLORATION +hasta I-EXPLORATION +5, I-EXPLORATION +7 I-EXPLORATION +mg/dL, I-EXPLORATION +NU I-EXPLORATION +hasta I-EXPLORATION +98 I-EXPLORATION +mg/dL I-EXPLORATION +e I-EXPLORATION +hiperkalemia I-EXPLORATION +grave. I-EXPLORATION +Se I-EXPLORATION +inició I-EXPLORATION +soporte I-EXPLORATION +dialítico I-EXPLORATION +con I-EXPLORATION +HD I-EXPLORATION +intermitente I-EXPLORATION +diaria. I-EXPLORATION +La I-EXPLORATION +evolución I-EXPLORATION +de I-EXPLORATION +oliguria I-EXPLORATION +a I-EXPLORATION +anuria I-EXPLORATION +no I-EXPLORATION +permitió I-EXPLORATION +realizar I-EXPLORATION +FENa; I-EXPLORATION +sin I-EXPLORATION +embargo, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +había I-EXPLORATION +sido I-EXPLORATION +reanimado I-EXPLORATION +y I-EXPLORATION +estabilizado I-EXPLORATION +hemodinámicamente I-EXPLORATION +(con I-EXPLORATION +mínimo I-EXPLORATION +requerimiento I-EXPLORATION +de I-EXPLORATION +vasoactivos), I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +era I-EXPLORATION +planteable I-EXPLORATION +un I-EXPLORATION +componente I-EXPLORATION +pre-renal I-EXPLORATION +en I-EXPLORATION +ese I-EXPLORATION +contexto. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +pudieron I-EXPLORATION +efectuar I-EXPLORATION +imágenes I-EXPLORATION +abdominales I-EXPLORATION +para I-EXPLORATION +evaluar I-EXPLORATION +la I-EXPLORATION +anatomía I-EXPLORATION +renal, I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +su I-EXPLORATION +condición I-EXPLORATION +inestable I-EXPLORATION +impidió I-EXPLORATION +su I-EXPLORATION +realización. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +presentó I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +deterioro I-EXPLORATION +gasométrico I-EXPLORATION +con I-EXPLORATION +PaFi I-EXPLORATION +menor I-EXPLORATION +a I-EXPLORATION +150, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +hizo I-EXPLORATION +necesario I-EXPLORATION +volver I-EXPLORATION +a I-EXPLORATION +VM I-EXPLORATION +en I-EXPLORATION +posición I-EXPLORATION +prono. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +una I-EXPLORATION +falla I-EXPLORATION +ventricular I-EXPLORATION +por I-EXPLORATION +ecocardiografía I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +administraron I-EXPLORATION +bolos I-EXPLORATION +de I-EXPLORATION +metilprednisolona I-EXPLORATION +62, I-EXPLORATION +5 I-EXPLORATION +mg I-EXPLORATION +por I-EXPLORATION +5 I-EXPLORATION +días I-EXPLORATION +en I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +SDRA I-EXPLORATION +grave. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina, I-EXPLORATION +al I-EXPLORATION +recuperar I-EXPLORATION +la I-EXPLORATION +diuresis, I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +perfil I-EXPLORATION +inflamatorio I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +proteinuria I-EXPLORATION +de I-EXPLORATION +300 I-EXPLORATION +mg/dL, I-EXPLORATION +hematuria I-EXPLORATION +con I-EXPLORATION +eritrocitos I-EXPLORATION +incontables I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +proteinuria/creatininuria I-EXPLORATION +de I-EXPLORATION +7.384 I-EXPLORATION +mg/g. I-EXPLORATION +Por I-EXPLORATION +su I-EXPLORATION +parte, I-EXPLORATION +los I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +CK, I-EXPLORATION +C3 I-EXPLORATION +y I-EXPLORATION +C4 I-EXPLORATION +resultaron I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +autoinmune I-EXPLORATION +con I-EXPLORATION +ANCA-c, I-EXPLORATION +ANCA-p I-EXPLORATION +y I-EXPLORATION +ANA I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +virales I-EXPLORATION +de I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +mejoró I-EXPLORATION +progresivamente I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +cuadro I-EXPLORATION +respiratorio I-EXPLORATION +extubándose I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +21 I-EXPLORATION +días. I-EXPLORATION +En B-TREATMENT +total, I-TREATMENT +se I-TREATMENT +completaron I-TREATMENT +15 I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +HD I-TREATMENT +recuperando I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal, I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +sedimento I-TREATMENT +urinario I-TREATMENT +inflamatorio I-TREATMENT +(proteinuria I-TREATMENT +de I-TREATMENT +30 I-TREATMENT +mg/dL I-TREATMENT +y I-TREATMENT +eritrocitos I-TREATMENT +2-4 I-TREATMENT +por I-TREATMENT +campo) I-TREATMENT +y I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +diuresis. I-TREATMENT +Se B-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +de I-EVOLUTION +internación. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +tenía I-EVOLUTION +indicación I-EVOLUTION +de I-EVOLUTION +vacuna I-EVOLUTION +influenza I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +obesidad I-EVOLUTION +y I-EVOLUTION +ser I-EVOLUTION +personal I-EVOLUTION +de I-EVOLUTION +salud, I-EVOLUTION +pero I-EVOLUTION +no I-EVOLUTION +la I-EVOLUTION +había I-EVOLUTION +recibido. I-EVOLUTION +Se I-EVOLUTION +efectuó I-EVOLUTION +un I-EVOLUTION +control I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +después, I-EVOLUTION +que I-EVOLUTION +mostró I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +sedimento I-EVOLUTION +de I-EVOLUTION +orina I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION +Estudios I-EVOLUTION +moleculares I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +Instituto I-EVOLUTION +de I-EVOLUTION +Salud I-EVOLUTION +Pública I-EVOLUTION +de I-EVOLUTION +Chile I-EVOLUTION +las I-EVOLUTION +muestras I-EVOLUTION +respiratorias I-EVOLUTION +se I-EVOLUTION +sometieron I-EVOLUTION +a I-EVOLUTION +extracción I-EVOLUTION +de I-EVOLUTION +ácidos I-EVOLUTION +nucleicos I-EVOLUTION +totales I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +equipo I-EVOLUTION +automatizado I-EVOLUTION +EASYMAG I-EVOLUTION +de I-EVOLUTION +Nuclisens. I-EVOLUTION +Se I-EVOLUTION +realizó I-EVOLUTION +RT-RPC I-EVOLUTION +usando I-EVOLUTION +el I-EVOLUTION +protocolo I-EVOLUTION +estándar I-EVOLUTION +del I-EVOLUTION +CDC I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +detección I-EVOLUTION +y I-EVOLUTION +subtipificación I-EVOLUTION +de I-EVOLUTION +virus I-EVOLUTION +influenza I-EVOLUTION +(CDC I-EVOLUTION +real I-EVOLUTION +time I-EVOLUTION +RT-PCR I-EVOLUTION +protocol I-EVOLUTION +for I-EVOLUTION +detection I-EVOLUTION +and I-EVOLUTION +characterization I-EVOLUTION +of I-EVOLUTION +influenza, I-EVOLUTION +2012), I-EVOLUTION +y I-EVOLUTION +para I-EVOLUTION +otros I-EVOLUTION +virus I-EVOLUTION +respiratorios I-EVOLUTION +(Real-time I-EVOLUTION +RT-PCR I-EVOLUTION +assay I-EVOLUTION +for I-EVOLUTION +non-influenza I-EVOLUTION +respiratory I-EVOLUTION +viruses) I-EVOLUTION +en I-EVOLUTION +termociclador I-EVOLUTION +7500 I-EVOLUTION +Fast I-EVOLUTION +de I-EVOLUTION +Applied I-EVOLUTION +Biosystems. I-EVOLUTION +Se I-EVOLUTION +amplificó I-EVOLUTION +un I-EVOLUTION +panel I-EVOLUTION +de I-EVOLUTION +virus I-EVOLUTION +respiratorios I-EVOLUTION +que I-EVOLUTION +incluyen I-EVOLUTION +influenza, I-EVOLUTION +virus I-EVOLUTION +respiratorio I-EVOLUTION +sincicial, I-EVOLUTION +metapneumovirus, I-EVOLUTION +parainfluenza I-EVOLUTION +1, I-EVOLUTION +2 I-EVOLUTION +y I-EVOLUTION +3, I-EVOLUTION +adenovirus I-EVOLUTION +y I-EVOLUTION +rinovirus, I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +el I-EVOLUTION +que I-EVOLUTION +permitió I-EVOLUTION +detectar I-EVOLUTION +las I-EVOLUTION +co-infecciones I-EVOLUTION +ya I-EVOLUTION +descritas. I-EVOLUTION + I-EVOLUTION +Además, I-EVOLUTION +para I-EVOLUTION +explorar I-EVOLUTION +la I-EVOLUTION +existencia I-EVOLUTION +de I-EVOLUTION +mutaciones I-EVOLUTION +que I-EVOLUTION +pudieran I-EVOLUTION +estar I-EVOLUTION +potencialmente I-EVOLUTION +asociadas I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +mayor I-EVOLUTION +gravedad I-EVOLUTION +clínica, I-EVOLUTION +se I-EVOLUTION +hizo I-EVOLUTION +un I-EVOLUTION +estudio I-EVOLUTION +de I-EVOLUTION +secuenciación I-EVOLUTION +del I-EVOLUTION +segmento I-EVOLUTION +HA1 I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +hemaglutinina I-EVOLUTION +viral, I-EVOLUTION +mediante I-EVOLUTION +secuenciación I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +método I-EVOLUTION +de I-EVOLUTION +Sanger I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +equipo I-EVOLUTION +Applied I-EVOLUTION +Biosystems/Genetic I-EVOLUTION +analyzer I-EVOLUTION +3500. I-EVOLUTION +Ambas I-EVOLUTION +muestras I-EVOLUTION +fueron I-EVOLUTION +comparadas I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +grupo I-EVOLUTION +de I-EVOLUTION +76 I-EVOLUTION +muestras I-EVOLUTION +de I-EVOLUTION +distintas I-EVOLUTION +regiones I-EVOLUTION +del I-EVOLUTION +país, I-EVOLUTION +tanto I-EVOLUTION +de I-EVOLUTION +pacientes I-EVOLUTION +ambulatorios I-EVOLUTION +como I-EVOLUTION +hospitalizados, I-EVOLUTION +incluyendo I-EVOLUTION +11 I-EVOLUTION +muestras I-EVOLUTION +de I-EVOLUTION +pacientes I-EVOLUTION +fallecidos. I-EVOLUTION +El I-EVOLUTION +análisis I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +secuenciación I-EVOLUTION +del I-EVOLUTION +segmento I-EVOLUTION +HA1 I-EVOLUTION +de I-EVOLUTION +virus I-EVOLUTION +influenza I-EVOLUTION +H1N1pdm09, I-EVOLUTION +comparado I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +cepa I-EVOLUTION +estándar I-EVOLUTION +A/California/07/2009 I-EVOLUTION +demostró I-EVOLUTION +que I-EVOLUTION +ambos I-EVOLUTION +casos I-EVOLUTION +presentaron I-EVOLUTION +las I-EVOLUTION +mismas I-EVOLUTION +ocho I-EVOLUTION +mutaciones I-EVOLUTION +comunes I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +otras I-EVOLUTION +76 I-EVOLUTION +muestras I-EVOLUTION +analizadas I-EVOLUTION +del I-EVOLUTION +año I-EVOLUTION +2015, I-EVOLUTION +indicando I-EVOLUTION +que I-EVOLUTION +fueron I-EVOLUTION +las I-EVOLUTION +mismas I-EVOLUTION +cepas I-EVOLUTION +circulantes I-EVOLUTION +(datos I-EVOLUTION +no I-EVOLUTION +mostrados). I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +la I-EVOLUTION +muestra I-EVOLUTION +del I-EVOLUTION +caso I-EVOLUTION +1 I-EVOLUTION +evidenció I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +única I-EVOLUTION +la I-EVOLUTION +mutación I-EVOLUTION +D222N I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +detectó I-EVOLUTION +en I-EVOLUTION +ninguna I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +otras I-EVOLUTION +muestras I-EVOLUTION +analizadas. I-EVOLUTION +En I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +muestras I-EVOLUTION +analizadas I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +resto I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +muestras I-EVOLUTION +de I-EVOLUTION +esa I-EVOLUTION +temporada, I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +detectaron I-EVOLUTION +otras I-EVOLUTION +mutaciones I-EVOLUTION +previamente I-EVOLUTION +reportadas I-EVOLUTION +como I-EVOLUTION +A90S I-EVOLUTION +ni I-EVOLUTION +K180Q. I-EVOLUTION + I-EVOLUTION + +Preescolar B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sano I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +esquema I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inmunizaciones I-PAST_MEDICAL_HISTORY +completas I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +Tres B-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +respiratorio I-PRESENT_ILLNESS +alto I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +diagnosticó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Guillain I-PRESENT_ILLNESS +Barré, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +terapia I-PRESENT_ILLNESS +intensiva I-PRESENT_ILLNESS +pediátrica. I-PRESENT_ILLNESS +Recibió B-TREATMENT +tratamientos I-TREATMENT +antibacterianos I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro I-TREATMENT +(piperacilina/tazobactam I-TREATMENT +por I-TREATMENT +ocho I-TREATMENT +días I-TREATMENT +por I-TREATMENT +una I-TREATMENT +neumonía I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica, I-TREATMENT +sin I-TREATMENT +aislamiento I-TREATMENT +microbiológico, I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +meropenem I-TREATMENT +durante I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +por I-TREATMENT +una I-TREATMENT +bacteriemia I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +venoso I-TREATMENT +central I-TREATMENT +(CVC) I-TREATMENT +por I-TREATMENT +Klebsiella I-TREATMENT +pneumoniae. I-TREATMENT +Durante I-TREATMENT +su I-TREATMENT +estancia I-TREATMENT +en I-TREATMENT +terapia I-TREATMENT +intensiva I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +una I-TREATMENT +cateterización I-TREATMENT +urinaria I-TREATMENT +permanente I-TREATMENT +y I-TREATMENT +a I-TREATMENT +una I-TREATMENT +traqueostomía. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +meropenem, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +persistió I-EVOLUTION +febril, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +sospechó I-EVOLUTION +una I-EVOLUTION +infección I-EVOLUTION +fúngica. I-EVOLUTION +En B-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +sangre I-EXPLORATION +hubo I-EXPLORATION +aislamiento I-EXPLORATION +de I-EXPLORATION +C. I-EXPLORATION +tropicalis. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +orina I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +levaduras I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +urocultivo I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +con I-EXPLORATION +30.000 I-EXPLORATION +ufc I-EXPLORATION +de I-EXPLORATION +C. I-EXPLORATION +tropicalis I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +CIM I-EXPLORATION +≤ I-EXPLORATION +0, I-EXPLORATION +25 I-EXPLORATION +μg/mL I-EXPLORATION +para I-EXPLORATION +anfotericina I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +caspofungina, I-EXPLORATION +y I-EXPLORATION +≤ I-EXPLORATION +1 I-EXPLORATION +μg/mL I-EXPLORATION +para I-EXPLORATION +fluconazol. I-EXPLORATION +La I-EXPLORATION +cepa I-EXPLORATION +se I-EXPLORATION +identificó I-EXPLORATION +por I-EXPLORATION +CHROMagar; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +asimilación I-EXPLORATION +de I-EXPLORATION +azúcares. I-EXPLORATION +Se I-EXPLORATION +confirmó I-EXPLORATION +C. I-EXPLORATION +tropicalis I-EXPLORATION +por I-EXPLORATION +Vitek I-EXPLORATION +2 I-EXPLORATION +® I-EXPLORATION +2 I-EXPLORATION +compact I-EXPLORATION +60 I-EXPLORATION +(Biomérieux) I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +para I-EXPLORATION +CIM I-EXPLORATION +se I-EXPLORATION +obtuvieron I-EXPLORATION +por I-EXPLORATION +microdilución I-EXPLORATION +en I-EXPLORATION +caldo I-EXPLORATION +según I-EXPLORATION +CLSI. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +deoxicolato I-TREATMENT +1 I-TREATMENT +mg/kg/día. I-TREATMENT +La B-EVOLUTION +fiebre I-EVOLUTION +bajó I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +y B-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +se I-EXPLORATION +negativizaron I-EXPLORATION +al I-EXPLORATION +cuarto I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +terapia. I-EXPLORATION +Anfotericina B-EVOLUTION +B I-EVOLUTION +deoxicolato I-EVOLUTION +fue I-EVOLUTION +bien I-EVOLUTION +tolerada, I-EVOLUTION +manteniéndose I-EVOLUTION +una I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION +Al B-EXPLORATION +séptimo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecotomografía I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +vías I-EXPLORATION +urinarias, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +ambos I-EXPLORATION +riñones I-EXPLORATION +con I-EXPLORATION +cambios I-EXPLORATION +inflamatorios I-EXPLORATION +agudos: I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +medía I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +3, I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +3, I-EXPLORATION +1 I-EXPLORATION +cm, I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +izquierdo, I-EXPLORATION +8, I-EXPLORATION +8 I-EXPLORATION +x I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +4, I-EXPLORATION +6 I-EXPLORATION +cm. I-EXPLORATION +La I-EXPLORATION +vejiga I-EXPLORATION +urinaria I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +engrosada I-EXPLORATION +(4 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +espesor) I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +se I-EXPLORATION +identificó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +única I-EXPLORATION +hiperecogénica I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +proyectaba I-EXPLORATION +sombra I-EXPLORATION +sónica I-EXPLORATION +posterior, I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +discreta I-EXPLORATION +vascularidad I-EXPLORATION +central I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +fungoma, I-EXPLORATION +imagen I-EXPLORATION +que I-EXPLORATION +persistía I-EXPLORATION +al I-EXPLORATION +día I-EXPLORATION +14 I-EXPLORATION +de I-EXPLORATION +tratamiento. I-EXPLORATION +Habiendo B-TREATMENT +completado I-TREATMENT +40 I-TREATMENT +mg/kg I-TREATMENT +de I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +deoxicolato, I-TREATMENT +y I-TREATMENT +por I-TREATMENT +persistencia I-TREATMENT +del I-TREATMENT +fungoma I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +éste I-TREATMENT +por I-TREATMENT +cistoscopia. I-TREATMENT +Macroscópicamente B-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +tenía I-EXPLORATION +un I-EXPLORATION +color I-EXPLORATION +blanquecino I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +blanda. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico, I-EXPLORATION +con I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +hematoxilina-eosina, I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +mucosa I-EXPLORATION +vesical I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +estromal, I-EXPLORATION +erosiones I-EXPLORATION +del I-EXPLORATION +epitelio I-EXPLORATION +transicional I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +macrófagos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +cistitis I-EXPLORATION +crónica. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +tinciones I-EXPLORATION +especiales I-EXPLORATION +para I-EXPLORATION +hongos. I-EXPLORATION +El I-EXPLORATION +urocultivo I-EXPLORATION +se I-EXPLORATION +negativizó I-EXPLORATION +posterior I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +resección I-EXPLORATION +del I-EXPLORATION +fungoma, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +suspendió I-EXPLORATION +el I-EXPLORATION +antifúngico I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +h I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cirugía, I-EXPLORATION +con I-EXPLORATION +ecografía I-EXPLORATION +post-quirúrgica I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +fungoma. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +en I-EVOLUTION +terapia I-EVOLUTION +intensiva I-EVOLUTION +durante I-EVOLUTION +16 I-EVOLUTION +días I-EVOLUTION +y B-DERIVED_FROM/TO +después I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +trasladado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +neurología I-DERIVED_FROM/TO +pediátrica I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +permaneció I-DERIVED_FROM/TO +tres I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +internado. I-DERIVED_FROM/TO +Egresó B-EVOLUTION +sin I-EVOLUTION +traqueostomía I-EVOLUTION +y I-EVOLUTION +sigue I-EVOLUTION +sus I-EVOLUTION +controles I-EVOLUTION +ambulatorios. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +área I-PAST_MEDICAL_HISTORY +urbana I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Santiago I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Estero. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +epidemiológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hemiparesia I-PRESENT_ILLNESS +facio-braquio-crural I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +quística I-PRESENT_ILLNESS +infratemporal I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +TC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cerebro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +tuvo I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +hepático I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +pulmonar. I-PRESENT_ILLNESS +La B-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +HAI I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +hidatidosis I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cirugía. I-EXPLORATION +No I-EXPLORATION +tuvo I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +al I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +diagnóstico. I-EXPLORATION +Inició B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +albendazol I-TREATMENT +30 I-TREATMENT +días I-TREATMENT +previos I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cirugía, I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +con I-EXPLORATION +escólices I-EXPLORATION +de I-EXPLORATION +E. I-EXPLORATION +granulosus I-EXPLORATION +en I-EXPLORATION +estadio I-EXPLORATION +de I-EXPLORATION +degeneración. I-EXPLORATION +Presentó B-EVOLUTION +como I-EVOLUTION +complicación I-EVOLUTION +una I-EVOLUTION +hidrocefalia I-EVOLUTION +transitoria I-EVOLUTION +que B-TREATMENT +no I-TREATMENT +requirió I-TREATMENT +tratamiento. I-TREATMENT +Completó I-TREATMENT +seis I-TREATMENT +semanas I-TREATMENT +post-quirúrgicas I-TREATMENT +de I-TREATMENT +albendazol I-TREATMENT +con B-EVOLUTION +resolución I-EVOLUTION +ad I-EVOLUTION +integrum I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +secuelas. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Río I-PAST_MEDICAL_HISTORY +Negro. I-PAST_MEDICAL_HISTORY +Vivía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +crianza I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ganado I-PAST_MEDICAL_HISTORY +bovino, I-PAST_MEDICAL_HISTORY +ovino I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +vacuno I-PAST_MEDICAL_HISTORY +cercano I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +domicilio. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +convulsiones I-PRESENT_ILLNESS +tónico-clónicas I-PRESENT_ILLNESS +generalizadas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +hemiparesia I-PRESENT_ILLNESS +braquio-crural I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aparición. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +supratentorial I-EXPLORATION +expansivo I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +subcortical I-EXPLORATION +temporo-parietal I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +colapsaba I-EXPLORATION +ventrículos I-EXPLORATION +y I-EXPLORATION +desplazaba I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media. I-EXPLORATION +Imágenes I-EXPLORATION +complementarias I-EXPLORATION +descartaron I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +órganos. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +hidatidosis I-EXPLORATION +por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +HAI I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +No I-EXPLORATION +tuvo I-EXPLORATION +eosinofilia I-EXPLORATION +ni I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +general. I-EXPLORATION +Inició B-TREATMENT +tratamiento I-TREATMENT +previo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +con I-TREATMENT +albendazol I-TREATMENT +por I-TREATMENT +sospecha I-TREATMENT +clínica I-TREATMENT +e I-TREATMENT +imagenológica I-TREATMENT +de I-TREATMENT +hidatidosis. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +exéresis I-TREATMENT +total I-TREATMENT +del I-TREATMENT +quiste. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +con I-EXPLORATION +pared I-EXPLORATION +membranosa I-EXPLORATION +acelular, I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +ácido I-EXPLORATION +peryódico I-EXPLORATION +de I-EXPLORATION +Schiff I-EXPLORATION +(PAS) I-EXPLORATION +positiva, I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +caras, I-EXPLORATION +con I-EXPLORATION +calcoforitos I-EXPLORATION +y I-EXPLORATION +restos I-EXPLORATION +celulares. I-EXPLORATION +Además, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +escólices I-EXPLORATION +con I-EXPLORATION +variables I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +y I-EXPLORATION +degeneración. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +como I-EVOLUTION +secuela I-EVOLUTION +una I-EVOLUTION +hemiparesia I-EVOLUTION +facio-braquio-crural I-EVOLUTION +derecha I-EVOLUTION +que I-EVOLUTION +le I-EVOLUTION +dificultaba I-EVOLUTION +la I-EVOLUTION +deambulación. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +nueve I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +proveniente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +provincia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Buenos I-PAST_MEDICAL_HISTORY +Aires, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cría I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +animales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +granja I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +faenamiento. I-PAST_MEDICAL_HISTORY +Fue B-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tumor I-DERIVED_FROM/TO +quístico I-DERIVED_FROM/TO +supratentorial. I-DERIVED_FROM/TO +Tenía B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vómitos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cefalea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +supratentorial I-EXPLORATION +periventricular I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +desplazaba I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +por I-EXPLORATION +HAI I-EXPLORATION +para I-EXPLORATION +hidatidosis I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +no I-EXPLORATION +mostraba I-EXPLORATION +alteración I-EXPLORATION +significativa. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +pre I-TREATMENT +y I-TREATMENT +postquirúrgico I-TREATMENT +con I-TREATMENT +albendazol. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +del I-TREATMENT +quiste I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +describió I-EXPLORATION +una I-EXPLORATION +estructura I-EXPLORATION +quística I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +pared I-EXPLORATION +con I-EXPLORATION +capa I-EXPLORATION +celular I-EXPLORATION +eosinófila I-EXPLORATION +(cutícula), I-EXPLORATION +germinativa I-EXPLORATION +y I-EXPLORATION +abundantes I-EXPLORATION +escólices. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +dueña B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +casa, I-PAST_MEDICAL_HISTORY +profesional, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +trastorno I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ánimo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +contexto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +separación I-PAST_MEDICAL_HISTORY +conyugal. I-PAST_MEDICAL_HISTORY +Además, I-PAST_MEDICAL_HISTORY +señalaba I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +gustaba I-PAST_MEDICAL_HISTORY +realizar I-PAST_MEDICAL_HISTORY +actividades I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +jardinería I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +domicilio. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refirió I-PRESENT_ILLNESS +expulsar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +"lombriz" I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +deposiciones. I-PRESENT_ILLNESS +Fue B-TREATMENT +evaluada I-TREATMENT +por I-TREATMENT +un I-TREATMENT +médico I-TREATMENT +internista I-TREATMENT +quien I-TREATMENT +la I-TREATMENT +trató I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +empírica I-TREATMENT +con I-TREATMENT +albendazol I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +por I-TREATMENT +día, I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +El I-TREATMENT +EPSD I-TREATMENT +y I-TREATMENT +test I-TREATMENT +de I-TREATMENT +Graham I-TREATMENT +fueron I-TREATMENT +negativos. I-TREATMENT +El B-EXPLORATION +examen I-EXPLORATION +macroscópico I-EXPLORATION +del I-EXPLORATION +verme I-EXPLORATION +llevado I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +correspondió I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +lombriz I-EXPLORATION +de I-EXPLORATION +tierra I-EXPLORATION +o I-EXPLORATION +Lombricus I-EXPLORATION +terrarius. I-EXPLORATION +Un B-EVOLUTION +mes I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +consultar I-EVOLUTION +por I-EVOLUTION +haber I-EVOLUTION +eliminado I-EVOLUTION +por I-EVOLUTION +las I-EVOLUTION +deposiciones I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +"lombriz". I-EVOLUTION +Fue B-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +albendazol I-TREATMENT +por I-TREATMENT +15 I-TREATMENT +días, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +estudio I-TREATMENT +parasitológico I-TREATMENT +sin I-TREATMENT +hallazgos. I-TREATMENT +El B-EXPLORATION +verme I-EXPLORATION +fue I-EXPLORATION +analizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +inicial. I-EXPLORATION + I-EXPLORATION +Dos B-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refirió I-EVOLUTION +que I-EVOLUTION +al I-EVOLUTION +ducharse I-EVOLUTION +notó I-EVOLUTION +la I-EVOLUTION +expulsión I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +lombriz I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +ano, I-EVOLUTION +que I-EVOLUTION +resultó I-EVOLUTION +ser I-EVOLUTION +similar I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +anteriores. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +parasitología I-EXPLORATION +del I-EXPLORATION +espécimen I-EXPLORATION +informó I-EXPLORATION +nuevamente I-EXPLORATION +una I-EXPLORATION +lombriz I-EXPLORATION +de I-EXPLORATION +tierra. I-EXPLORATION +La B-EVOLUTION +paciente, I-EVOLUTION +muy I-EVOLUTION +molesta, I-EVOLUTION +reclamó I-EVOLUTION +que I-EVOLUTION +nadie I-EVOLUTION +encontraba I-EVOLUTION +una I-EVOLUTION +solución I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +mal I-EVOLUTION +en I-EVOLUTION +Chile, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +consultaría I-EVOLUTION +en I-EVOLUTION +otro I-EVOLUTION +país. I-EVOLUTION +Se I-EVOLUTION +le I-EVOLUTION +recomendó I-EVOLUTION +la I-EVOLUTION +evaluación I-EVOLUTION +por I-EVOLUTION +psiquiatría, I-EVOLUTION +sin I-EVOLUTION +embargo, I-EVOLUTION +se I-EVOLUTION +negó I-EVOLUTION +a I-EVOLUTION +considerar I-EVOLUTION +esta I-EVOLUTION +alternativa. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +residente B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Santiago, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +leucemia I-PAST_MEDICAL_HISTORY +mieloide I-PAST_MEDICAL_HISTORY +aguda I-PAST_MEDICAL_HISTORY +(LMA) I-PAST_MEDICAL_HISTORY +M4, I-PAST_MEDICAL_HISTORY +sometido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +precursores I-PAST_MEDICAL_HISTORY +hematopoyéticos I-PAST_MEDICAL_HISTORY +(TPH) I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +rinitis I-PAST_MEDICAL_HISTORY +alérgica. I-PAST_MEDICAL_HISTORY +Evolucionó B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +recaída I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +leucemia I-PRESENT_ILLNESS +tras B-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +un I-TREATMENT +ciclo I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +en I-TREATMENT +preparación I-TREATMENT +a I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +TPH. I-TREATMENT +Ocho B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +se I-EVOLUTION +hospitalizó I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +neutropenia I-EVOLUTION +febril, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +vancomicina, I-TREATMENT +ceftazidima I-TREATMENT +y I-TREATMENT +amikacina. I-TREATMENT +Refirió B-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +fosa I-EVOLUTION +nasal I-EVOLUTION +derecha I-EVOLUTION +e I-EVOLUTION +incisivo I-EVOLUTION +superior, I-EVOLUTION +constatándose I-EVOLUTION +cuatro I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso, I-EVOLUTION +una I-EVOLUTION +erosión I-EVOLUTION +leve I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +fosa I-EVOLUTION +nasal I-EVOLUTION +derecha I-EVOLUTION +(FND) I-EVOLUTION +con I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +sangrado I-EVOLUTION +reciente I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +costra I-EVOLUTION +dolorosa I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +porción I-EVOLUTION +antero-inferior I-EVOLUTION +del I-EVOLUTION +tabique I-EVOLUTION +nasal I-EVOLUTION +izquierdo I-EVOLUTION +(FNI). I-EVOLUTION +Esta B-EXPLORATION +última I-EXPLORATION +se I-EXPLORATION +removió I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +a I-EXPLORATION +cultivo I-EXPLORATION +bacteriano I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +hongos. I-EXPLORATION +Bajo I-EXPLORATION +la I-EXPLORATION +costra I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +del I-EXPLORATION +cartílago I-EXPLORATION +septal I-EXPLORATION +más I-EXPLORATION +adherida I-EXPLORATION +y I-EXPLORATION +negruzca, I-EXPLORATION +cuya I-EXPLORATION +superficie I-EXPLORATION +se I-EXPLORATION +removió I-EXPLORATION +sin I-EXPLORATION +presentar I-EXPLORATION +sangrado. I-EXPLORATION +Se I-EXPLORATION +envió I-EXPLORATION +a I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +calcoflúor, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +evidenció I-EXPLORATION +hifas I-EXPLORATION +septadas I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +voriconazol I-TREATMENT +iv I-TREATMENT +9 I-TREATMENT +mg/kg/dosis, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +La B-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +paranasales I-EXPLORATION +evidenció I-EXPLORATION +cambios I-EXPLORATION +inflamatorios I-EXPLORATION +pansinusales I-EXPLORATION +sin I-EXPLORATION +extensión I-EXPLORATION +extrasinusal. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +precozmente I-TREATMENT +una I-TREATMENT +cirugía I-TREATMENT +endoscópica I-TREATMENT +nasal, I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +una I-TREATMENT +esfenoidotomía I-TREATMENT +derecha, I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +tabique I-TREATMENT +nasal I-TREATMENT +necrótico I-TREATMENT +y I-TREATMENT +del I-TREATMENT +cartílago I-TREATMENT +septal I-TREATMENT +izquierdo. I-TREATMENT +Se B-EXPLORATION +enviaron I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +cornete I-EXPLORATION +superior I-EXPLORATION +y I-EXPLORATION +esfenoides I-EXPLORATION +derecho, I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +tabique I-EXPLORATION +nasal I-EXPLORATION +y I-EXPLORATION +cartílago I-EXPLORATION +septal I-EXPLORATION +izquierdo I-EXPLORATION +a I-EXPLORATION +biopsia. I-EXPLORATION +Las I-EXPLORATION +dos I-EXPLORATION +primeras I-EXPLORATION +se I-EXPLORATION +enviaron I-EXPLORATION +además I-EXPLORATION +a I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +calcoflúor I-EXPLORATION +resultando I-EXPLORATION +negativas I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +cultivo I-EXPLORATION +bacteriano. I-EXPLORATION +Las I-EXPLORATION +muestras I-EXPLORATION +fueron I-EXPLORATION +sembradas I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +Sabouraud I-EXPLORATION +dextrosa I-EXPLORATION +a I-EXPLORATION +temperatura I-EXPLORATION +ambiente I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +35 I-EXPLORATION +°C. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +muestra I-EXPLORATION +quirúrgica I-EXPLORATION +de I-EXPLORATION +tabique I-EXPLORATION +nasal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +cartílago I-EXPLORATION +septal I-EXPLORATION +mostraron I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +h I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +colonias I-EXPLORATION +de I-EXPLORATION +4-6 I-EXPLORATION +mm, I-EXPLORATION +algodonosas, I-EXPLORATION +laxas I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +polvo I-EXPLORATION +de I-EXPLORATION +hollín, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +blanco I-EXPLORATION +grisáceo, I-EXPLORATION +y I-EXPLORATION +color I-EXPLORATION +oliváceo I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +reverso. I-EXPLORATION +La I-EXPLORATION +muestra I-EXPLORATION +del I-EXPLORATION +esfenoides I-EXPLORATION +derecho I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +microscopia I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +hifas I-EXPLORATION +dematiáceas, I-EXPLORATION +con I-EXPLORATION +conidióforos I-EXPLORATION +color I-EXPLORATION +café I-EXPLORATION +claro, I-EXPLORATION +septados, I-EXPLORATION +solitarios I-EXPLORATION +y I-EXPLORATION +geniculados, I-EXPLORATION +zigzageantes I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +apical, I-EXPLORATION +desde I-EXPLORATION +donde I-EXPLORATION +brotaban I-EXPLORATION +conidios I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +simpodial. I-EXPLORATION +Éstos I-EXPLORATION +eran I-EXPLORATION +color I-EXPLORATION +marrón, I-EXPLORATION +cilíndricos, I-EXPLORATION +de I-EXPLORATION +paredes I-EXPLORATION +pigmentadas I-EXPLORATION +gruesas, I-EXPLORATION +con I-EXPLORATION +tres I-EXPLORATION +distoseptos I-EXPLORATION +y I-EXPLORATION +cuatro I-EXPLORATION +células, I-EXPLORATION +con I-EXPLORATION +cicatrices I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +marrón I-EXPLORATION +oscuro I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lugar I-EXPLORATION +de I-EXPLORATION +unión I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +hifa I-EXPLORATION +conidiogénica. I-EXPLORATION +Basados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +macroscopia I-EXPLORATION +y I-EXPLORATION +microscopia I-EXPLORATION +se I-EXPLORATION +identificó I-EXPLORATION +el I-EXPLORATION +agente I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +Curvularia I-EXPLORATION +spicifera. I-EXPLORATION +Para I-EXPLORATION +confirmación I-EXPLORATION +de I-EXPLORATION +género, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(RPC) I-EXPLORATION +universal I-EXPLORATION +y I-EXPLORATION +posterior I-EXPLORATION +secuenciación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +génicos I-EXPLORATION +ITS1, I-EXPLORATION +ITS4 I-EXPLORATION +y I-EXPLORATION +5, I-EXPLORATION +6S I-EXPLORATION +ARNr, I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +colonias I-EXPLORATION +desarrolladas, I-EXPLORATION +identificándose I-EXPLORATION +Curvularia I-EXPLORATION +spp. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +del I-EXPLORATION +tabique I-EXPLORATION +nasal I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +cartílago I-EXPLORATION +septal I-EXPLORATION +izquierdo I-EXPLORATION +mostró I-EXPLORATION +extensas I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +destrucción, I-EXPLORATION +necrosis, I-EXPLORATION +ulceración I-EXPLORATION +y I-EXPLORATION +hemorragia I-EXPLORATION +asociadas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +abundantes I-EXPLORATION +elementos I-EXPLORATION +micóticos I-EXPLORATION +filamentosos I-EXPLORATION +histo I-EXPLORATION +y I-EXPLORATION +angioinvasores. I-EXPLORATION +Los I-EXPLORATION +elementos I-EXPLORATION +micóticos I-EXPLORATION +correspondían I-EXPLORATION +a I-EXPLORATION +filamentos I-EXPLORATION +hialinos I-EXPLORATION +tabicados I-EXPLORATION +con I-EXPLORATION +algunas I-EXPLORATION +dilataciones I-EXPLORATION +globosas I-EXPLORATION +y I-EXPLORATION +crecimiento I-EXPLORATION +variable I-EXPLORATION +de I-EXPLORATION +45° I-EXPLORATION +a I-EXPLORATION +90°, I-EXPLORATION +con I-EXPLORATION +caracteres I-EXPLORATION +de I-EXPLORATION +hialohifomicetes. I-EXPLORATION +La I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +ósteo-condro-mucosa I-EXPLORATION +de I-EXPLORATION +comete I-EXPLORATION +y I-EXPLORATION +esfenoides I-EXPLORATION +derecho I-EXPLORATION +sólo I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +inflamación I-EXPLORATION +crónica I-EXPLORATION +activa I-EXPLORATION +inespecífica. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +sensibilidad I-EXPLORATION +antifúngica I-EXPLORATION +las I-EXPLORATION +colonias I-EXPLORATION +obtenidas I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +Sabouraud I-EXPLORATION +fueron I-EXPLORATION +sembradas I-EXPLORATION +en I-EXPLORATION +agar I-EXPLORATION +agua I-EXPLORATION +para I-EXPLORATION +aumentar I-EXPLORATION +la I-EXPLORATION +producción I-EXPLORATION +de I-EXPLORATION +conidias. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +micro I-EXPLORATION +dilución I-EXPLORATION +según I-EXPLORATION +la I-EXPLORATION +norma I-EXPLORATION +CLSI, I-EXPLORATION +documento I-EXPLORATION +M38-A2, I-EXPLORATION +resultando I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +antifúngicos I-EXPLORATION +estudiados, I-EXPLORATION +con I-EXPLORATION +CIM I-EXPLORATION +a I-EXPLORATION +anfotericina I-EXPLORATION +B I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +μg/ml, I-EXPLORATION +posaconazol I-EXPLORATION +0, I-EXPLORATION +25 I-EXPLORATION +μg/ml I-EXPLORATION +y I-EXPLORATION +voriconazol I-EXPLORATION +0, I-EXPLORATION +25 I-EXPLORATION +μg/ml. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +la I-TREATMENT +identificación I-TREATMENT +etiológica, I-TREATMENT +se I-TREATMENT +ajustó I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +antifúngico I-TREATMENT +asociando I-TREATMENT +anfotericina I-TREATMENT +liposomal I-TREATMENT +5 I-TREATMENT +mg/kg/día I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +aseo I-TREATMENT +quirúrgico I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +después, I-TREATMENT +observándose I-TREATMENT +la I-TREATMENT +mucosa I-TREATMENT +nasal I-TREATMENT +sin I-TREATMENT +necrosis, I-TREATMENT +con I-TREATMENT +tinción I-TREATMENT +de I-TREATMENT +calcoflúor I-TREATMENT +y I-TREATMENT +cultivo I-TREATMENT +negativos. I-TREATMENT +Las B-EVOLUTION +detecciones I-EVOLUTION +de I-EVOLUTION +galactomanano I-EVOLUTION +en I-EVOLUTION +sangre I-EVOLUTION +se I-EVOLUTION +mantuvieron I-EVOLUTION +negativas I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +evolución. I-EVOLUTION +Recibió B-TREATMENT +voriconazol I-TREATMENT +por I-TREATMENT +40 I-TREATMENT +días, I-TREATMENT +con I-TREATMENT +concentraciones I-TREATMENT +plasmáticas I-TREATMENT +variables I-TREATMENT +entre I-TREATMENT +0, I-TREATMENT +2-1, I-TREATMENT +6 I-TREATMENT +mg/L I-TREATMENT +(rango I-TREATMENT +terapéutico I-TREATMENT +1-5 I-TREATMENT +mg/L) I-TREATMENT +y I-TREATMENT +anfotericina I-TREATMENT +liposomal I-TREATMENT +por I-TREATMENT +25 I-TREATMENT +días I-TREATMENT +(dosis I-TREATMENT +acumulada I-TREATMENT +125 I-TREATMENT +mg/kg). I-TREATMENT +Evolucionó B-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +satisfactoria I-EVOLUTION +del I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +otorrinológico. I-EVOLUTION +Recibió B-TREATMENT +un I-TREATMENT +segundo I-TREATMENT +TPH, I-TREATMENT +sin B-EVOLUTION +presentar I-EVOLUTION +lesiones I-EVOLUTION +cutáneas I-EVOLUTION +ni I-EVOLUTION +síntomas I-EVOLUTION +nasales I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +siguientes I-EVOLUTION +meses. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +no I-EVOLUTION +logró I-EVOLUTION +reconstitución I-EVOLUTION +inmune, I-EVOLUTION +falleciendo I-EVOLUTION +por I-EVOLUTION +otras I-EVOLUTION +complicaciones I-EVOLUTION +infecciosas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +tumoración I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +hipocondrio I-DERIVED_FROM/TO +izquierdo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +seis I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +crecimiento I-DERIVED_FROM/TO +progresivo. I-DERIVED_FROM/TO +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +palpaba I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +pétrea, I-EXPLORATION +discretamente I-EXPLORATION +dolorosa. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +no I-EXPLORATION +aportaba I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +retroperitoneal I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +20 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +desplazaba I-EXPLORATION +hacia I-EXPLORATION +delante I-EXPLORATION +la I-EXPLORATION +cola I-EXPLORATION +del I-EXPLORATION +páncreas. I-EXPLORATION +Radiológicamente I-EXPLORATION +su I-EXPLORATION +estructura I-EXPLORATION +era I-EXPLORATION +compleja, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +calcificación, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +baja I-EXPLORATION +malignidad. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +esplenopancreatectomía I-TREATMENT +distal I-TREATMENT +con I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración, I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +un I-TREATMENT +diámetro I-TREATMENT +máximo I-TREATMENT +de I-TREATMENT +24 I-TREATMENT +cm, I-TREATMENT +y I-TREATMENT +estaba I-TREATMENT +adherida I-TREATMENT +al I-TREATMENT +hilio I-TREATMENT +esplénico, I-TREATMENT +bazo, I-TREATMENT +epiplon I-TREATMENT +mayor I-TREATMENT +y I-TREATMENT +gastrocólico, I-TREATMENT +sin I-TREATMENT +aparente I-TREATMENT +fijación I-TREATMENT +al I-TREATMENT +páncreas. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +se I-EXPLORATION +describió I-EXPLORATION +como I-EXPLORATION +neoplasia I-EXPLORATION +epitelial I-EXPLORATION +papilar I-EXPLORATION +sólida-quística I-EXPLORATION +del I-EXPLORATION +páncreas. I-EXPLORATION +Inmunohistoquímica: I-EXPLORATION +vimentina I-EXPLORATION +positivo; I-EXPLORATION +cromogranina I-EXPLORATION +y I-EXPLORATION +marcadores I-EXPLORATION +epiteliales I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +normal I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +controles I-EVOLUTION +normales I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +cuatro I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +reflujo I-PRESENT_ILLNESS +gastroesofágico I-PRESENT_ILLNESS +severo I-PRESENT_ILLNESS +resistente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +altas I-PRESENT_ILLNESS +dosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +omeprazol I-PRESENT_ILLNESS +(60 I-PRESENT_ILLNESS +mg/día) I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cocaína I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +grandes I-PAST_MEDICAL_HISTORY +cantidades I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +fines I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +semana. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +de I-EXPLORATION +tracto I-EXPLORATION +digestivo I-EXPLORATION +superior I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +esofagitis I-EXPLORATION +grave I-EXPLORATION +e I-EXPLORATION +imágenes I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +esófago I-EXPLORATION +de I-EXPLORATION +Barret. I-EXPLORATION +La I-EXPLORATION +pHmetría I-EXPLORATION +esofágica I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +un I-EXPLORATION +intenso I-EXPLORATION +RGE I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +puntuación I-EXPLORATION +de I-EXPLORATION +DeMeester I-EXPLORATION +de I-EXPLORATION +193 I-EXPLORATION +(rango I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +14, I-EXPLORATION +72) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +manometría I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +esfínter I-EXPLORATION +esofágico I-EXPLORATION +inferior I-EXPLORATION +hipotónico I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +mmHg I-EXPLORATION +(rango I-EXPLORATION +normal I-EXPLORATION +8-25 I-EXPLORATION +mmHg). I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +estas I-TREATMENT +pruebas I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +propuesto I-TREATMENT +para I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +una I-TREATMENT +funduplicatura I-TREATMENT +de I-TREATMENT +Nissen I-TREATMENT +laparoscópica. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +profilaxis I-TREATMENT +del I-TREATMENT +tromboembolismo I-TREATMENT +con I-TREATMENT +2.500 I-TREATMENT +U.I. I-TREATMENT +de I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +(Clexane®, I-TREATMENT +Aventis I-TREATMENT +Pharma, I-TREATMENT +España) I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +2 I-TREATMENT +horas I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +y I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +diaria I-TREATMENT +en I-TREATMENT +los I-TREATMENT +tres I-TREATMENT +primeros I-TREATMENT +días I-TREATMENT +postoperatorios. I-TREATMENT +El I-TREATMENT +neumoperitoneo I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +con I-TREATMENT +CO2 I-TREATMENT +a I-TREATMENT +una I-TREATMENT +presión I-TREATMENT +máxima I-TREATMENT +controlada I-TREATMENT +de I-TREATMENT +14 I-TREATMENT +mmHg. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +funduplicatura I-TREATMENT +de I-TREATMENT +Nissen I-TREATMENT +con I-TREATMENT +material I-TREATMENT +irreabsorbible, I-TREATMENT +suturándose I-TREATMENT +los I-TREATMENT +pilares I-TREATMENT +diafragmáticos. I-TREATMENT +No I-TREATMENT +hubo I-TREATMENT +incidencias I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +que I-TREATMENT +duró I-TREATMENT +105 I-TREATMENT +minutos. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +transcurrió I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +durante I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +72 I-EVOLUTION +horas, I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +séptimo I-EVOLUTION +día I-EVOLUTION +postoperatorio, I-EVOLUTION +tras I-EVOLUTION +una I-EVOLUTION +ingesta I-EVOLUTION +copiosa I-EVOLUTION +de I-EVOLUTION +alcohol, I-EVOLUTION +bebidas I-EVOLUTION +gaseosas I-EVOLUTION +y I-EVOLUTION +alimentos, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +desarrolló I-EVOLUTION +repentinamente I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +de I-EVOLUTION +espalda I-EVOLUTION +brusco I-EVOLUTION +e I-EVOLUTION +intenso, I-EVOLUTION +hipertermia, I-EVOLUTION +distensión I-EVOLUTION +abdominal I-EVOLUTION +e I-EVOLUTION +inestabilidad I-EVOLUTION +hemodinámica. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +presentaba I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +12% I-EXPLORATION +de I-EXPLORATION +cayados, I-EXPLORATION +acidosis I-EXPLORATION +metabólica I-EXPLORATION +(pH: I-EXPLORATION +7, I-EXPLORATION +27) I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +del I-EXPLORATION +52%. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +dilatadas, I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +intraabdominal, I-EXPLORATION +hígado I-EXPLORATION +de I-EXPLORATION +estasis I-EXPLORATION +y I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +venosa I-EXPLORATION +mesentérica I-EXPLORATION +y I-EXPLORATION +portal. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +abdomen I-TREATMENT +agudo I-TREATMENT +se I-TREATMENT +intervino I-TREATMENT +quirúrgicamente I-TREATMENT +hallándose I-TREATMENT +isquemia I-TREATMENT +intestinal I-TREATMENT +masiva I-TREATMENT +de I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +y I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +colon, I-TREATMENT +trombosis I-TREATMENT +portal, I-TREATMENT +hígado I-TREATMENT +de I-TREATMENT +estasis I-TREATMENT +y I-TREATMENT +una I-TREATMENT +arteria I-TREATMENT +mesentérica I-TREATMENT +superior I-TREATMENT +espástica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +que I-TREATMENT +no I-TREATMENT +se I-TREATMENT +extrajo I-TREATMENT +ningún I-TREATMENT +trombo I-TREATMENT +en I-TREATMENT +la I-TREATMENT +exploración I-TREATMENT +mediante I-TREATMENT +sonda I-TREATMENT +de I-TREATMENT +Fogarty. I-TREATMENT +La B-EXPLORATION +ecografía I-EXPLORATION +Doppler I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +trombosis I-EXPLORATION +completa I-EXPLORATION +y I-EXPLORATION +neumatosis I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +principal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +porta, I-EXPLORATION +y I-EXPLORATION +gas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +intestinal. I-EXPLORATION +Las I-EXPLORATION +arterias I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +mesentérica I-EXPLORATION +eran I-EXPLORATION +permeables. I-EXPLORATION +No B-TREATMENT +se I-TREATMENT +consideró I-TREATMENT +indicada I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +ningún I-TREATMENT +gesto I-TREATMENT +quirúrgico I-TREATMENT +añadido. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +hipercoagulabilidad I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +posible I-EXPLORATION +obtener I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +fiable I-EXPLORATION +para I-EXPLORATION +detectar I-EXPLORATION +cocaína. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +rápidamente I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +desfavorable, I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +terapia I-EVOLUTION +anticoagulante I-EVOLUTION +con I-EVOLUTION +heparina, I-EVOLUTION +con I-EVOLUTION +inestabilidad I-EVOLUTION +hemodinámica I-EVOLUTION +y I-EVOLUTION +acidosis I-EVOLUTION +irreversible I-EVOLUTION +falleciendo I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica. I-EVOLUTION +La B-EXPLORATION +necropsia I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +masiva I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +mesentérica I-EXPLORATION +inferior I-EXPLORATION +y I-EXPLORATION +vena I-EXPLORATION +porta I-EXPLORATION +con I-EXPLORATION +infarto I-EXPLORATION +hemorrágico I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +úlceras I-EXPLORATION +agudas I-EXPLORATION +mucosas I-EXPLORATION +y I-EXPLORATION +contenido I-EXPLORATION +hemático I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +intestinal. I-EXPLORATION +Infarto I-EXPLORATION +hemorrágico I-EXPLORATION +submasivo I-EXPLORATION +hepático, I-EXPLORATION +hipertrofia I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +microcalcificaciones I-EXPLORATION +focales I-EXPLORATION +en I-EXPLORATION +parénquima I-EXPLORATION +pulmonar I-EXPLORATION +(típico I-EXPLORATION +hallazgo I-EXPLORATION +en I-EXPLORATION +consumidores I-EXPLORATION +crónicos I-EXPLORATION +de I-EXPLORATION +cocaína I-EXPLORATION +inhalada). I-EXPLORATION +Se I-EXPLORATION +estableció I-EXPLORATION +como I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +muerte I-EXPLORATION +el I-EXPLORATION +shock I-EXPLORATION +hipovolémico I-EXPLORATION +y I-EXPLORATION +hemorrágico I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +trombosis I-EXPLORATION +venosa I-EXPLORATION +mesentérica I-EXPLORATION +y I-EXPLORATION +portal. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +(sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés), I-PAST_MEDICAL_HISTORY +derivada B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +prurito I-DERIVED_FROM/TO +generalizado, I-DERIVED_FROM/TO +tinte I-DERIVED_FROM/TO +ictérico, I-DERIVED_FROM/TO +coluria I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +heces I-DERIVED_FROM/TO +acólicas. I-DERIVED_FROM/TO +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +mostraba I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +ictericia I-EXPLORATION +cutaneomucosa, I-EXPLORATION +y I-EXPLORATION +hepatomegalia I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +traveses. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +anamnesis I-EXPLORATION +por I-EXPLORATION +aparatos I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION +Bioquímica: I-EXPLORATION +bilirrubina I-EXPLORATION +directa I-EXPLORATION +22, I-EXPLORATION +13 I-EXPLORATION +mg/dl, I-EXPLORATION +GOT I-EXPLORATION +66 I-EXPLORATION +UI/l, I-EXPLORATION +GPT I-EXPLORATION +91 I-EXPLORATION +UI/l, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +1838 I-EXPLORATION +UI/l, I-EXPLORATION +GGT I-EXPLORATION +37 I-EXPLORATION +UI/l. I-EXPLORATION +Antígeno I-EXPLORATION +CA I-EXPLORATION +19-9 I-EXPLORATION +86 I-EXPLORATION +UI/l I-EXPLORATION +(0-37), I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +bioquímicos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intra-extrahepática I-EXPLORATION +sin I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +litiasis. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +y I-EXPLORATION +colangio I-EXPLORATION +RMN I-EXPLORATION +mostraron I-EXPLORATION +hepatomegalia, I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intra-extrahepática, I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +de I-EXPLORATION +Wirsung, I-EXPLORATION +desestructuración I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +tamaño I-EXPLORATION +del I-EXPLORATION +proceso I-EXPLORATION +uncinado I-EXPLORATION +y I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +páncreas, I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +neoplasia. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +colocar I-TREATMENT +percutáneamente I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +biliar I-TREATMENT +externo-interno I-TREATMENT +para I-TREATMENT +resolver I-TREATMENT +la I-TREATMENT +ictericia I-TREATMENT +obstructiva. I-TREATMENT +Bajo I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +neoplasia I-TREATMENT +pancreática, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +intervino I-TREATMENT +quirúrgicamente; I-TREATMENT +la I-TREATMENT +exploración I-TREATMENT +intraoperatoria I-TREATMENT +mostraba I-TREATMENT +induración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cabeza I-TREATMENT +del I-TREATMENT +páncreas I-TREATMENT +y I-TREATMENT +adenopatías I-TREATMENT +hiliares; I-TREATMENT +de B-EXPLORATION +ambas, I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +intraoperatorias I-EXPLORATION +que I-EXPLORATION +informaron I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +intersticial I-EXPLORATION +y I-EXPLORATION +negativas I-EXPLORATION +para I-EXPLORATION +neoplasia I-EXPLORATION +respectivamente. I-EXPLORATION +Fue B-TREATMENT +practicada I-TREATMENT +duodenopancreatectomía I-TREATMENT +cefálica I-TREATMENT +con I-TREATMENT +preservación I-TREATMENT +pilórica. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +crónica I-EXPLORATION +obstructiva I-EXPLORATION +fibrosante I-EXPLORATION +e I-EXPLORATION +hiperplasia I-EXPLORATION +ductal I-EXPLORATION +inflamatoria I-EXPLORATION +de I-EXPLORATION +conducto I-EXPLORATION +pancreático. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +duodécimo I-EVOLUTION +día I-EVOLUTION +postoperatorio I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +Fue B-EXPLORATION +realizado, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +6º I-EXPLORATION +mes I-EXPLORATION +postoperatorio, I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +N34S I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +SPINK1, I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +negativa. I-EXPLORATION +Dos B-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +IFP I-EXPLORATION +es I-EXPLORATION +una I-EXPLORATION +rara I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +crónica I-EXPLORATION +en I-EXPLORATION +niños. I-EXPLORATION +El I-EXPLORATION +rango I-EXPLORATION +de I-EXPLORATION +edad I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +meses I-EXPLORATION +a I-EXPLORATION +20 I-EXPLORATION +años I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +edad I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +años I-EXPLORATION +(1). I-EXPLORATION +Hasta I-EXPLORATION +la I-EXPLORATION +fecha I-EXPLORATION +sólo I-EXPLORATION +44 I-EXPLORATION +casos I-EXPLORATION +han I-EXPLORATION +sido I-EXPLORATION +publicados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +literatura. I-EXPLORATION +La I-EXPLORATION +etiología I-EXPLORATION +es I-EXPLORATION +desconocida, I-EXPLORATION +aunque I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +determinadas I-EXPLORATION +alteraciones I-EXPLORATION +genéticas I-EXPLORATION +(CFTR, I-EXPLORATION +PRSS1), I-EXPLORATION +destacando I-EXPLORATION +por I-EXPLORATION +su I-EXPLORATION +frecuencia I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +N34S I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +SPINK1, I-EXPLORATION +que I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +relacionado I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +pancreatitis I-EXPLORATION +juvenil I-EXPLORATION +tropical I-EXPLORATION +(1,3,4). I-EXPLORATION +A I-EXPLORATION +diferencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pancreatitis I-EXPLORATION +hereditaria I-EXPLORATION +autonómica I-EXPLORATION +dominante, I-EXPLORATION +los I-EXPLORATION +pacientes I-EXPLORATION +con I-EXPLORATION +IFP I-EXPLORATION +no I-EXPLORATION +presentan I-EXPLORATION +antecedentes I-EXPLORATION +familiares. I-EXPLORATION +La I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +presentación I-EXPLORATION +más I-EXPLORATION +frecuente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +IFP I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +ictericia I-EXPLORATION +obstructiva I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +crisis I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +recidivante I-EXPLORATION +(1,2,5,6,). I-EXPLORATION +Analíticamente, I-EXPLORATION +los I-EXPLORATION +pacientes I-EXPLORATION +con I-EXPLORATION +IFP, I-EXPLORATION +presentan I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +colestásico, I-EXPLORATION +citolítico I-EXPLORATION +y, I-EXPLORATION +ocasionalmente, I-EXPLORATION +una I-EXPLORATION +leve I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +amilasa I-EXPLORATION +sérica I-EXPLORATION +y I-EXPLORATION +urinaria. I-EXPLORATION +Respecto I-EXPLORATION +al I-EXPLORATION +diagnóstico, I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +son I-EXPLORATION +útiles I-EXPLORATION +para I-EXPLORATION +objetivar I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +pancreático I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +obstrucción I-EXPLORATION +de I-EXPLORATION +vía I-EXPLORATION +biliar. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +y I-EXPLORATION +colangioRMN I-EXPLORATION +permiten, I-EXPLORATION +como I-EXPLORATION +sucedió I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +caso, I-EXPLORATION +visualizar I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +nitidez I-EXPLORATION +el I-EXPLORATION +páncreas, I-EXPLORATION +cuya I-EXPLORATION +cabeza I-EXPLORATION +usualmente I-EXPLORATION +estará I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +desestructurada. I-EXPLORATION +El I-EXPLORATION +Wirsung I-EXPLORATION +puede I-EXPLORATION +presentar I-EXPLORATION +dilatación I-EXPLORATION +preestenótica. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +se I-EXPLORATION +consigue I-EXPLORATION +por I-EXPLORATION +exclusión I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +patologías I-EXPLORATION +más I-EXPLORATION +frecuentes I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +(biopsia I-EXPLORATION +o I-EXPLORATION +cirugía). I-EXPLORATION +Histológicamente I-EXPLORATION +el I-EXPLORATION +páncreas I-EXPLORATION +muestra I-EXPLORATION +bandas I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +colagenizado I-EXPLORATION +envolviendo I-EXPLORATION +acinos I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +normal. I-EXPLORATION +El I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +acompañante I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +proliferación I-EXPLORATION +fibrosante I-EXPLORATION +no I-EXPLORATION +suele I-EXPLORATION +ser I-EXPLORATION +prominente I-EXPLORATION +(1,6,). I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +debe I-TREATMENT +comenzar I-TREATMENT +por, I-TREATMENT +en I-TREATMENT +caso I-TREATMENT +de I-TREATMENT +existir, I-TREATMENT +resolver I-TREATMENT +la I-TREATMENT +ictericia I-TREATMENT +obstructiva, I-TREATMENT +en I-TREATMENT +espera I-TREATMENT +del I-TREATMENT +procedimiento I-TREATMENT +quirúrgico I-TREATMENT +definitivo. I-TREATMENT +El I-TREATMENT +drenaje I-TREATMENT +percutáneo I-TREATMENT +de I-TREATMENT +vía I-TREATMENT +biliar I-TREATMENT +o I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +stent I-TREATMENT +por I-TREATMENT +CPRE I-TREATMENT +son I-TREATMENT +las I-TREATMENT +técnicas I-TREATMENT +de I-TREATMENT +elección I-TREATMENT +(1,6,). I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +es I-TREATMENT +controvertido I-TREATMENT +y I-TREATMENT +podemos I-TREATMENT +clasificarlos I-TREATMENT +en I-TREATMENT +derivativos I-TREATMENT +y I-TREATMENT +resectivos. I-TREATMENT +Los I-TREATMENT +primeros I-TREATMENT +(coledocoduodenostomía I-TREATMENT +y I-TREATMENT +coledocoyeyunostomía I-TREATMENT +en I-TREATMENT +Y I-TREATMENT +de I-TREATMENT +Roux) I-TREATMENT +se I-TREATMENT +encuentran I-TREATMENT +en I-TREATMENT +desuso I-TREATMENT +porque I-TREATMENT +no I-TREATMENT +resuelven I-TREATMENT +la I-TREATMENT +obstrucción I-TREATMENT +del I-TREATMENT +Wirsung, I-TREATMENT +persistiendo I-TREATMENT +el I-TREATMENT +dolor I-TREATMENT +abdominal I-TREATMENT +o I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +a I-TREATMENT +insuficiencia I-TREATMENT +pancreática I-TREATMENT +exo-endocrina I-TREATMENT +(1). I-TREATMENT +Entre I-TREATMENT +los I-TREATMENT +procedimientos I-TREATMENT +resectivos I-TREATMENT +destaca I-TREATMENT +la I-TREATMENT +DPC I-TREATMENT +con I-TREATMENT +preservación I-TREATMENT +pilórica. I-TREATMENT +Algunos I-TREATMENT +autores I-TREATMENT +la I-TREATMENT +desanconsejan I-TREATMENT +por I-TREATMENT +la I-TREATMENT +alta I-TREATMENT +frecuencia I-TREATMENT +de I-TREATMENT +diabetes I-TREATMENT +y I-TREATMENT +mala I-TREATMENT +digestión I-TREATMENT +posoperatoria, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +el I-TREATMENT +escaso I-TREATMENT +alivio I-TREATMENT +del I-TREATMENT +dolor I-TREATMENT +a I-TREATMENT +largo I-TREATMENT +plazo. I-TREATMENT +Fue I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +utilizada I-TREATMENT +en I-TREATMENT +nuestro I-TREATMENT +caso I-TREATMENT +y B-EVOLUTION +24 I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +podemos I-EVOLUTION +apoyar I-EVOLUTION +dicha I-EVOLUTION +afirmación. I-EVOLUTION +La B-TREATMENT +pancreatectomía I-TREATMENT +cefálica I-TREATMENT +con I-TREATMENT +preservación I-TREATMENT +duodenal I-TREATMENT +(DPPHR) I-TREATMENT +elimina I-TREATMENT +las I-TREATMENT +complicaciones I-TREATMENT +de I-TREATMENT +las I-TREATMENT +pancreatitis I-TREATMENT +crónicas I-TREATMENT +y I-TREATMENT +proporciona I-TREATMENT +alivio I-TREATMENT +del I-TREATMENT +dolor I-TREATMENT +a I-TREATMENT +largo I-TREATMENT +plazo I-TREATMENT +en I-TREATMENT +más I-TREATMENT +del I-TREATMENT +80% I-TREATMENT +de I-TREATMENT +los I-TREATMENT +pacientes I-TREATMENT +(1). I-TREATMENT + I-TREATMENT +G. I-TREATMENT +Suárez I-TREATMENT +Artacho, I-TREATMENT +J. I-TREATMENT +Rodríguez I-TREATMENT +Muñoz, I-TREATMENT +M. I-TREATMENT +A. I-TREATMENT +Gómez I-TREATMENT +Bravo, I-TREATMENT +F. I-TREATMENT +Docobo I-TREATMENT +Durántez, I-TREATMENT +R. I-TREATMENT +García I-TREATMENT +Lozano I-TREATMENT +y I-TREATMENT +S. I-TREATMENT +P. I-TREATMENT +Alconchel I-TREATMENT +Gonzaga I-TREATMENT + I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Cirugía I-TREATMENT +General I-TREATMENT +y I-TREATMENT +Aparato I-TREATMENT +Digestivo. I-TREATMENT +Hospital I-TREATMENT +Universitario I-TREATMENT +Virgen I-TREATMENT +del I-TREATMENT +Rocío. I-TREATMENT +Sevilla. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +ex-fumadora B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +bebedora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +70 I-PAST_MEDICAL_HISTORY +g I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día. I-PAST_MEDICAL_HISTORY +Menopausia I-PAST_MEDICAL_HISTORY +precoz I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +estrógenos I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hidrotórax I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hidrotórax I-PRESENT_ILLNESS +hepático I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +biopsia I-PRESENT_ILLNESS +hepática I-PRESENT_ILLNESS +diagnóstica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cirrosis I-PRESENT_ILLNESS +macro-micronodular I-PRESENT_ILLNESS +poco I-PRESENT_ILLNESS +evolucionada, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +moderada I-PRESENT_ILLNESS +actividad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +esteatosis I-PRESENT_ILLNESS +focal. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +viral, I-PRESENT_ILLNESS +metabólico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +autoinmune I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hepatopatía I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +negativo. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +descartó I-PRESENT_ILLNESS +patología I-PRESENT_ILLNESS +cardiopulmonar I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +causante I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +derrame I-PRESENT_ILLNESS +pleural, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +patología I-PRESENT_ILLNESS +infecciosa I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +tuberculosa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +neoplásica I-PRESENT_ILLNESS +pleuropulmonar. I-PRESENT_ILLNESS +Ante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +falta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +restricción I-PRESENT_ILLNESS +hidrosalina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +diurético, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +sometida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +toracocentesis I-PRESENT_ILLNESS +evacuadoras I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +colocación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tubo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tórax I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +alivio I-PRESENT_ILLNESS +sintomático. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +tarde I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hidrotórax I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +recidivante. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +hipoventilación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +2/3 I-EXPLORATION +inferiores I-EXPLORATION +del I-EXPLORATION +campo I-EXPLORATION +pulmonar I-EXPLORATION +derecho. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +20.500/µL I-EXPLORATION +con I-EXPLORATION +77% I-EXPLORATION +de I-EXPLORATION +PMN, I-EXPLORATION +sin I-EXPLORATION +anemia I-EXPLORATION +ni I-EXPLORATION +trombopenia. I-EXPLORATION +La I-EXPLORATION +bioquímica I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +creatinina I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +9 I-EXPLORATION +mg/dl, I-EXPLORATION +con I-EXPLORATION +sodio I-EXPLORATION +129 I-EXPLORATION +mEq/litro; I-EXPLORATION +potasio I-EXPLORATION +5, I-EXPLORATION +4 I-EXPLORATION +mEq/litro; I-EXPLORATION +proteínas I-EXPLORATION +totales: I-EXPLORATION +5, I-EXPLORATION +68 I-EXPLORATION +g/dl; I-EXPLORATION +albúmina: I-EXPLORATION +2, I-EXPLORATION +44 I-EXPLORATION +g/dl; I-EXPLORATION +GOT: I-EXPLORATION +107 I-EXPLORATION +UI/L; I-EXPLORATION +GPT: I-EXPLORATION +52 I-EXPLORATION +UI/L; I-EXPLORATION +LDH: I-EXPLORATION +157UI/L; I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +1, I-EXPLORATION +81 I-EXPLORATION +mg/dl; I-EXPLORATION +GGT I-EXPLORATION +370 I-EXPLORATION +UI/L, I-EXPLORATION +F.A. I-EXPLORATION +278 I-EXPLORATION +UI/L; I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +69%; I-EXPLORATION +TTPA I-EXPLORATION +30'', I-EXPLORATION +fibrinógeno I-EXPLORATION +283 I-EXPLORATION +mg/dl. I-EXPLORATION +AFP I-EXPLORATION +6 I-EXPLORATION +ng/ml, I-EXPLORATION +serologías I-EXPLORATION +de I-EXPLORATION +VHB, I-EXPLORATION +VHC, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein-Barr I-EXPLORATION +y I-EXPLORATION +sífilis I-EXPLORATION +negativas; I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +era I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +exudado I-EXPLORATION +(proteínas I-EXPLORATION +totales I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +34 I-EXPLORATION +g/dl; I-EXPLORATION +LDH I-EXPLORATION +427 I-EXPLORATION +UI/L; I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +073, I-EXPLORATION +glucosa I-EXPLORATION +62 I-EXPLORATION +mg/dl; I-EXPLORATION +albúmina I-EXPLORATION +1, I-EXPLORATION +82 I-EXPLORATION +mg/Dl, I-EXPLORATION +leucocitos I-EXPLORATION +648 I-EXPLORATION +cel/mm3 I-EXPLORATION +con I-EXPLORATION +50% I-EXPLORATION +PMN) I-EXPLORATION +con I-EXPLORATION +cultivo I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Staphylococcus I-EXPLORATION +aureus I-EXPLORATION +coagulasa I-EXPLORATION +positivo I-EXPLORATION +oxacilin I-EXPLORATION +sensible. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +tuberculosis I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +bacilos I-EXPLORATION +ácido-alcohol I-EXPLORATION +resistentes I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +gamma-interferón I-EXPLORATION +en I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +negatividad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +Mantoux. I-EXPLORATION +Asímismo I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +malignidad I-EXPLORATION +mediante I-EXPLORATION +citologías I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +y I-EXPLORATION +biopsias I-EXPLORATION +pleurales. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +doppler I-EXPLORATION +abdominal I-EXPLORATION +mostraba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +crónica I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +morfológicos I-EXPLORATION +ni I-EXPLORATION +hemodinámicos I-EXPLORATION +de I-EXPLORATION +hipertensión I-EXPLORATION +portal, I-EXPLORATION +con I-EXPLORATION +ascitis I-EXPLORATION +mínima I-EXPLORATION +y I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +derecho. I-EXPLORATION +Tras B-TREATMENT +comprobar I-TREATMENT +que I-TREATMENT +no I-TREATMENT +había I-TREATMENT +respuesta I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +restricción I-TREATMENT +hidrosalina I-TREATMENT +y I-TREATMENT +diuréticos, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +tubo I-TREATMENT +torácico I-TREATMENT +como I-TREATMENT +tratamiento I-TREATMENT +sintomático I-TREATMENT +del I-TREATMENT +hidrotórax I-TREATMENT +drenando I-TREATMENT +2000-2500 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Como B-EVOLUTION +complicaciones I-EVOLUTION +del I-EVOLUTION +derrame I-EVOLUTION +pleural I-EVOLUTION +presentó I-EVOLUTION +insuficiencia I-EVOLUTION +renal I-EVOLUTION +prerrenal I-EVOLUTION +por I-EVOLUTION +alto I-EVOLUTION +débito I-EVOLUTION +e I-EVOLUTION +hipoproteinemia I-EVOLUTION +con I-EVOLUTION +hipoalbuminemia. I-EVOLUTION +En B-TREATMENT +un I-TREATMENT +intento I-TREATMENT +de I-TREATMENT +controlar I-TREATMENT +la I-TREATMENT +producción I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +pleural I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +minitoracotomía I-TREATMENT +con I-TREATMENT +pleurodesis I-TREATMENT +con I-TREATMENT +talco I-TREATMENT +que I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +efectiva. I-TREATMENT +Ante I-TREATMENT +el I-TREATMENT +fracaso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pleurodesis I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +colocar I-TREATMENT +una I-TREATMENT +DPPI, I-TREATMENT +tras I-TREATMENT +hallar I-TREATMENT +en I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +de I-TREATMENT +presión I-TREATMENT +datos I-TREATMENT +de I-TREATMENT +hipertensión I-TREATMENT +portal I-TREATMENT +leve I-TREATMENT +(gradiente I-TREATMENT +de I-TREATMENT +presión I-TREATMENT +enclavamiento-libre: I-TREATMENT +13 I-TREATMENT +mmHg) I-TREATMENT +sugestivo I-TREATMENT +de I-TREATMENT +hidrotórax I-TREATMENT +de I-TREATMENT +origen I-TREATMENT +hepático. I-TREATMENT +Con I-TREATMENT +ello I-TREATMENT +se I-TREATMENT +consiguió I-TREATMENT +un I-TREATMENT +descenso I-TREATMENT +transitorio I-TREATMENT +(2-3 I-TREATMENT +días) I-TREATMENT +del I-TREATMENT +débito I-TREATMENT +torácico. I-TREATMENT +Se B-EXPLORATION +descartó I-EXPLORATION +disfunción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +DPPI I-EXPLORATION +mediante I-EXPLORATION +eco-doppler. I-EXPLORATION +Se B-TREATMENT +desestimó I-TREATMENT +el I-TREATMENT +trasplante I-TREATMENT +hepático I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +ingesta I-TREATMENT +reciente I-TREATMENT +de I-TREATMENT +alcohol. I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +gravedad I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +y I-TREATMENT +la I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +otras I-TREATMENT +opciones I-TREATMENT +terapéuticas, I-TREATMENT +quince I-TREATMENT +días I-TREATMENT +más I-TREATMENT +tarde I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +octreótido I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +25 I-TREATMENT +µg/h I-TREATMENT +i.v. I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +día, I-TREATMENT +50 I-TREATMENT +el I-TREATMENT +segundo I-TREATMENT +y I-TREATMENT +100 I-TREATMENT +durante I-TREATMENT +otros I-TREATMENT +5 I-TREATMENT +días. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +presentó I-TREATMENT +muy I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +a I-TREATMENT +dicho I-TREATMENT +tratamiento, I-TREATMENT +con I-TREATMENT +disminución I-TREATMENT +progresiva I-TREATMENT +del I-TREATMENT +débito I-TREATMENT +por I-TREATMENT +el I-TREATMENT +tubo I-TREATMENT +de I-TREATMENT +tórax, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +permitió I-TREATMENT +la I-TREATMENT +retirada I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +sin I-TREATMENT +posterior I-TREATMENT +recidiva I-TREATMENT +del I-TREATMENT +derrame I-TREATMENT +pleural. I-TREATMENT +Se I-TREATMENT +pautó I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +10 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +octreótido I-TREATMENT +subcutáneo I-TREATMENT +antes I-TREATMENT +del I-TREATMENT +alta. I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +siguientes, I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +derrame I-EVOLUTION +pleural I-EVOLUTION +ni I-EVOLUTION +ascitis I-EVOLUTION +bajo I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +25 I-EVOLUTION +mg I-EVOLUTION +de I-EVOLUTION +aldactone I-EVOLUTION +al I-EVOLUTION +día. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +institución I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +irradia I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +dorso, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +sub-ictericia, I-PRESENT_ILLNESS +coluria, I-PRESENT_ILLNESS +hipocolia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +escalofríos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presenta: I-EXPLORATION +dolor I-EXPLORATION +y I-EXPLORATION +defensa I-EXPLORATION +leve I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +distensión I-EXPLORATION +abdominal I-EXPLORATION +e I-EXPLORATION +ictericia. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +evaluar I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +vesicular I-EXPLORATION +que I-EXPLORATION +atribuye I-EXPLORATION +al I-EXPLORATION +meteorismo I-EXPLORATION +existente I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +con I-EXPLORATION +paredes I-EXPLORATION +engrosadas I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +sombras I-EXPLORATION +acústicas I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +litiasis. I-EXPLORATION +No I-EXPLORATION +puede I-EXPLORATION +evaluar I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +ni I-EXPLORATION +páncreas. I-EXPLORATION +El I-EXPLORATION +laboratorio I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +franca I-EXPLORATION +leucocitosis, I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bilirrubina I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +directa, I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +cinco I-EXPLORATION +veces I-EXPLORATION +lo I-EXPLORATION +normal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +e I-EXPLORATION +importante I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +transaminasas. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +coledociano, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +sometida I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +minuciosa I-EXPLORATION +exploración, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +hallar I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +biliar. I-EXPLORATION +Se I-EXPLORATION +libera I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extra-hepática I-EXPLORATION +en I-EXPLORATION +todo I-EXPLORATION +su I-EXPLORATION +recorrido I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +colangiografía I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +excepto I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +panlitiasis I-EXPLORATION +coledociana I-EXPLORATION +no I-EXPLORATION +puede I-EXPLORATION +objetivarse I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +biliar. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +efectúa I-TREATMENT +coledocotomía, I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +litos I-TREATMENT +de I-TREATMENT +diferentes I-TREATMENT +tamaños I-TREATMENT +y I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +coledocoduodenostomía. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +alta. I-EVOLUTION +Asintomática I-EVOLUTION +a I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +operada. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +89 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +HTA, I-PAST_MEDICAL_HISTORY +DM I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +accidentes I-PAST_MEDICAL_HISTORY +cerebrovasculares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +consecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +hemiplejía I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alteraciones I-PAST_MEDICAL_HISTORY +deglutorias I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +habían I-PAST_MEDICAL_HISTORY +requerido I-PAST_MEDICAL_HISTORY +nutrición I-PAST_MEDICAL_HISTORY +enteral I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +través I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sonda I-PAST_MEDICAL_HISTORY +nasogástrica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +De B-PRESENT_ILLNESS +acuerdo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +familia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +geriatra I-PRESENT_ILLNESS +habitual I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +indicó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +colocación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sonda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gastrostomía I-PRESENT_ILLNESS +percutánea I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +endoscópico. I-PRESENT_ILLNESS +El B-TREATMENT +procedimiento I-TREATMENT +fue I-TREATMENT +realizado I-TREATMENT +bajo I-TREATMENT +sedación I-TREATMENT +profunda I-TREATMENT +por I-TREATMENT +un I-TREATMENT +anestesiólogo I-TREATMENT +y I-TREATMENT +siguiendo I-TREATMENT +las I-TREATMENT +pautas I-TREATMENT +de I-TREATMENT +profilaxis I-TREATMENT +antibiótica I-TREATMENT +recomendadas I-TREATMENT +actualmente. I-TREATMENT +La I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +colocación I-TREATMENT +por I-TREATMENT +tracción I-TREATMENT +se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +con I-TREATMENT +set I-TREATMENT +comercializado I-TREATMENT +por I-TREATMENT +dos I-TREATMENT +endoscopistas I-TREATMENT +expertos. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +estricta I-TREATMENT +desinfección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +zona, I-TREATMENT +colocando I-TREATMENT +la I-TREATMENT +presilla I-TREATMENT +externa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sonda I-TREATMENT +a I-TREATMENT +una I-TREATMENT +distancia I-TREATMENT +entre I-TREATMENT +2-3 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +la I-TREATMENT +superficie I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +1 I-TREATMENT +cm. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +12 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +proceso I-EVOLUTION +se I-EVOLUTION +inició I-EVOLUTION +alimentación I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +PEG I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +aconsejándose I-EVOLUTION +los I-EVOLUTION +cuidados I-EVOLUTION +domiciliarios I-EVOLUTION +habituales. I-EVOLUTION +Transcurridas I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +ingresa I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencias I-EVOLUTION +de I-EVOLUTION +nuestro I-EVOLUTION +hospital I-EVOLUTION +por I-EVOLUTION +deterioro I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general; I-EVOLUTION +eritema, I-EVOLUTION +edema I-EVOLUTION +e I-EVOLUTION +induración I-EVOLUTION +en I-EVOLUTION +pared I-EVOLUTION +abdominal I-EVOLUTION +con I-EVOLUTION +supuración I-EVOLUTION +de I-EVOLUTION +líquido I-EVOLUTION +purulento I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +y I-EVOLUTION +alrededor I-EVOLUTION +del I-EVOLUTION +orificio I-EVOLUTION +de I-EVOLUTION +gastrostomía. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaban I-EXPLORATION +un I-EXPLORATION +claro I-EXPLORATION +empeoramiento I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +tiraje I-EXPLORATION +intercostal I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hipoperfusión I-EXPLORATION +periférica. I-EXPLORATION +La I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +presentaba I-EXPLORATION +extensa I-EXPLORATION +crepitación, I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +eritema I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +perigastrostomía I-EXPLORATION +con I-EXPLORATION +supuración I-EXPLORATION +espontánea I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +purulento I-EXPLORATION +por I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +gastrostomía. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +mostraba I-EXPLORATION +intensa I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +izquierda, I-EXPLORATION +plaquetopenia I-EXPLORATION +y I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +tiempos I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +y I-EXPLORATION +cefalina. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +urgente I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +extenso I-EXPLORATION +enfisema I-EXPLORATION +subcutáneo I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +: I-EXPLORATION +imagen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +abscesificación I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +subyacente I-EXPLORATION +a I-EXPLORATION +gastrostomía; I-EXPLORATION +importante I-EXPLORATION +íleo I-EXPLORATION +paralítico I-EXPLORATION +y I-EXPLORATION +pneumoperitoneo. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +antibióticos I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro, I-TREATMENT +desbridamiento I-TREATMENT +quirúrgico I-TREATMENT +del I-TREATMENT +absceso I-TREATMENT +abdominal I-TREATMENT +y I-TREATMENT +estrictos I-TREATMENT +cuidados I-TREATMENT +locales I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida. I-TREATMENT +Pese B-EVOLUTION +a I-EVOLUTION +todo I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento. I-EVOLUTION +El B-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +tomada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +resultó I-EXPLORATION +positivo I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +diez I-EXPLORATION +días I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +para I-EXPLORATION +Pseudomonas I-EXPLORATION +putrida I-EXPLORATION +y I-EXPLORATION +Acinetobacter. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +gastrectomía I-PRESENT_ILLNESS +total I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +reconstrucción I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Roux I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +adenocarcinoma I-PRESENT_ILLNESS +gástrico I-PRESENT_ILLNESS +pobremente I-PRESENT_ILLNESS +diferenciado I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +antes. I-PRESENT_ILLNESS +Se B-TREATMENT +asoció I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +la I-TREATMENT +pauta I-TREATMENT +cisplatino I-TREATMENT +e I-TREATMENT +iridotecán, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +12 I-TREATMENT +ciclos. I-TREATMENT +Requirió I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +rescate I-TREATMENT +18 I-TREATMENT +meses I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +1ª I-TREATMENT +cirugía I-TREATMENT +por I-TREATMENT +recidiva I-TREATMENT +tumoral I-TREATMENT +extraluminal I-TREATMENT +local: I-TREATMENT +anastomosis I-TREATMENT +terminolateral I-TREATMENT +con I-TREATMENT +nueva I-TREATMENT +reconstrucción I-TREATMENT +en I-TREATMENT +Y I-TREATMENT +de I-TREATMENT +Roux I-TREATMENT +y I-TREATMENT +colectomía I-TREATMENT +subtotal I-TREATMENT +con I-TREATMENT +anastomosis I-TREATMENT +ileocólica I-TREATMENT +terminolateral I-TREATMENT +con I-TREATMENT +ileostomía I-TREATMENT +asociada. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +se I-EXPLORATION +pudo I-EXPLORATION +comprobar I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +peritoneo, I-EXPLORATION +colon, I-EXPLORATION +asa I-EXPLORATION +intestinal I-EXPLORATION +ascendida I-EXPLORATION +previamente I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +rodete I-EXPLORATION +esofágico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +resección. I-EXPLORATION + I-EXPLORATION +Es B-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Aparato I-DERIVED_FROM/TO +Digestivo I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +disfagia I-DERIVED_FROM/TO +progresiva I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +cirugía, I-DERIVED_FROM/TO +acompañada I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +pérdida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +peso. I-DERIVED_FROM/TO +Se B-EXPLORATION +realizó I-EXPLORATION +esofagograma I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +estenosis I-EXPLORATION +esofágica I-EXPLORATION +distal I-EXPLORATION +y I-EXPLORATION +posteriormente, I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +una I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta: I-EXPLORATION +estenosis I-EXPLORATION +esofágica I-EXPLORATION +distal I-EXPLORATION +con I-EXPLORATION +mucosa I-EXPLORATION +normal, I-EXPLORATION +con I-EXPLORATION +biopsias I-EXPLORATION +negativas I-EXPLORATION +para I-EXPLORATION +malignidad; I-EXPLORATION +además I-EXPLORATION +había I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +sutura I-EXPLORATION +y I-EXPLORATION +grapas I-EXPLORATION +quirúrgicas. I-EXPLORATION +Se B-TREATMENT +optó I-TREATMENT +por I-TREATMENT +retirar I-TREATMENT +los I-TREATMENT +puntos I-TREATMENT +de I-TREATMENT +sutura I-TREATMENT +y I-TREATMENT +se I-TREATMENT +hicieron I-TREATMENT +6 I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +dilatación I-TREATMENT +neumática, I-TREATMENT +siendo I-TREATMENT +ineficaces. I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +infiltración I-TREATMENT +neoplásica I-TREATMENT +transmural I-TREATMENT +y I-TREATMENT +el I-TREATMENT +mantenimiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +disfagia, I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +esofágica I-TREATMENT +no I-TREATMENT +recubierta I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +cm. I-TREATMENT +Al B-EXPLORATION +expandirse I-EXPLORATION +la I-EXPLORATION +prótesis, I-EXPLORATION +permitió I-EXPLORATION +ver I-EXPLORATION +la I-EXPLORATION +infiltración I-EXPLORATION +neoplásica. I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +pudo I-EVOLUTION +tomar I-EVOLUTION +dieta I-EVOLUTION +blanda, I-EVOLUTION +y I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +franca I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +disfagia. I-EVOLUTION +La B-TREATMENT +paciente I-TREATMENT +ha I-TREATMENT +recibido I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +paliativos I-TREATMENT +asociados. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +colocación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +prótesis, I-EVOLUTION +aparece I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +disfagia I-EVOLUTION +y I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +peso. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +realizada I-EXPLORATION +se I-EXPLORATION +vio I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neoplasia I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +prótesis I-EXPLORATION +; I-EXPLORATION +se B-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +esofágica I-TREATMENT +recubierta I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +longitud. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +reiniciar I-EVOLUTION +la I-EVOLUTION +alimentación I-EVOLUTION +oral, I-EVOLUTION +mejorando I-EVOLUTION +su I-EVOLUTION +disfagia. I-EVOLUTION +Falleció I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +por I-EVOLUTION +invasión I-EVOLUTION +tumoral I-EVOLUTION +sistémica. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +69 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +gastrectomía I-PRESENT_ILLNESS +total I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Roux I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +adenocarcinoma I-PRESENT_ILLNESS +gástrico I-PRESENT_ILLNESS +pobremente I-PRESENT_ILLNESS +diferenciado I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +Como B-TREATMENT +tratamiento I-TREATMENT +adyuvante I-TREATMENT +recibió I-TREATMENT +radioterapia I-TREATMENT +y I-TREATMENT +quimioterapia, I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +implantes I-TREATMENT +peritoneales I-TREATMENT +en I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +histológico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +quirúrgica. I-TREATMENT +Se B-EXPLORATION +realiza I-EXPLORATION +endoscopia I-EXPLORATION +alta I-EXPLORATION +por I-EXPLORATION +disfagia I-EXPLORATION +progresiva I-EXPLORATION +y I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +peso, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +anillo I-EXPLORATION +fibroso I-EXPLORATION +en I-EXPLORATION +anastomosis I-EXPLORATION +esofagoenteral, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +yeyunal I-EXPLORATION +próxima I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +anastomosis. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativas I-EXPLORATION +para I-EXPLORATION +malignidad. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +recidiva I-TREATMENT +local I-TREATMENT +por I-TREATMENT +carcinomatosis I-TREATMENT +peritoneal, I-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +prótesis I-TREATMENT +esofágica I-TREATMENT +expandible I-TREATMENT +no I-TREATMENT +recubierta I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +longitud. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +fallece I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +por I-EVOLUTION +invasión I-EVOLUTION +tumoral I-EVOLUTION +sistémica. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +cigarrillos/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +bebedor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +> I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +g I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol/día, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +hepatopatía I-PAST_MEDICAL_HISTORY +conocida, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +melenas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +"posos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +café". I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +el I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +nutricional, I-EXPLORATION +los I-EXPLORATION +estigmas I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +crónica, I-EXPLORATION +una I-EXPLORATION +hepatomegalia I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm, I-EXPLORATION +edemas I-EXPLORATION +bimaleolares I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +ascitis I-EXPLORATION +grado I-EXPLORATION +2-3. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +normocítica-normocrómica I-EXPLORATION +(Hb: I-EXPLORATION +9 I-EXPLORATION +g/dl; I-EXPLORATION +Hct: I-EXPLORATION +26, I-EXPLORATION +6%; I-EXPLORATION +VCM: I-EXPLORATION +92 I-EXPLORATION +fl) I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +transaminasas I-EXPLORATION +(AST: I-EXPLORATION +145 I-EXPLORATION +U/l; I-EXPLORATION +ALT: I-EXPLORATION +75 I-EXPLORATION +U/l; I-EXPLORATION +GGT: I-EXPLORATION +166 I-EXPLORATION +U/l) I-EXPLORATION +con I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +bilirrubina, I-EXPLORATION +albúmina I-EXPLORATION +y I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +virales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +cirrosis I-EXPLORATION +e I-EXPLORATION +hipertensión I-EXPLORATION +portal, I-EXPLORATION +con I-EXPLORATION +ascitis I-EXPLORATION +moderada. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +gastroscopia I-EXPLORATION +urgente I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +hallazgos: I-EXPLORATION +varices I-EXPLORATION +esofágicas I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +moderado I-EXPLORATION +ocupando I-EXPLORATION +menos I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tercio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +esofágica, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +alarma I-EXPLORATION +y I-EXPLORATION +gastropatía I-EXPLORATION +hipertensiva. I-EXPLORATION +Dos I-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentó I-EXPLORATION +febrícula I-EXPLORATION +y I-EXPLORATION +malestar I-EXPLORATION +abdominal, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +paracentesis I-EXPLORATION +diagnóstica, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +siguiente I-EXPLORATION +resultado: I-EXPLORATION +leucocitos: I-EXPLORATION +3.500/mm3 I-EXPLORATION +(2.975 I-EXPLORATION +PMN); I-EXPLORATION +proteínas I-EXPLORATION +totales: I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +g/dl; I-EXPLORATION +albúmina: I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +g/dl; I-EXPLORATION +glucosa: I-EXPLORATION +95 I-EXPLORATION +mg/dl; I-EXPLORATION +LDH: I-EXPLORATION +150 I-EXPLORATION +U/l; I-EXPLORATION +cultivo: I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Streptococcus I-EXPLORATION +pneumoniae. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +81 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +pluripatológico, B-PAST_MEDICAL_HISTORY +acude B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +persistentes. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +mostraba I-EXPLORATION +ictericia I-EXPLORATION +escleral I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +sin I-EXPLORATION +peritonismo. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +Abdominal I-EXPLORATION +evidenciaban I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +con I-EXPLORATION +aerobilia, I-EXPLORATION +vesícula I-EXPLORATION +mal I-EXPLORATION +delimitada I-EXPLORATION +con I-EXPLORATION +litiasis; I-EXPLORATION +gran I-EXPLORATION +cálculo I-EXPLORATION +biliar I-EXPLORATION +en I-EXPLORATION +bulbo I-EXPLORATION +duodenal I-EXPLORATION +que I-EXPLORATION +condiciona I-EXPLORATION +obstrucción I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cámara I-EXPLORATION +gástrica. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +observando I-EXPLORATION +contenido I-EXPLORATION +líquido I-EXPLORATION +en I-EXPLORATION +cavidad I-EXPLORATION +gástrica I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +bulbo I-EXPLORATION +duodenal I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +cálculo I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +práctica I-EXPLORATION +totalidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz. I-EXPLORATION +Con B-TREATMENT +ayuda I-TREATMENT +del I-TREATMENT +endoscopio I-TREATMENT +lateral I-TREATMENT +y I-TREATMENT +litotriptor I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +fragmentación I-TREATMENT +parcial I-TREATMENT +del I-TREATMENT +cálculo, I-TREATMENT +con I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +los I-TREATMENT +mismos, I-TREATMENT +quedando I-TREATMENT +en I-TREATMENT +duodeno I-TREATMENT +un I-TREATMENT +fragmento I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +2 I-TREATMENT +cm. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +notable I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ictericia I-EVOLUTION +y I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +endoscopia I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +observando I-EVOLUTION +imagen I-EVOLUTION +sugestiva I-EVOLUTION +de I-EVOLUTION +fístula I-EVOLUTION +bilio-duodenal I-EVOLUTION +y I-EVOLUTION +ausencia I-EVOLUTION +del I-EVOLUTION +cálculo I-EVOLUTION +descrito. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +en I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +notable I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +colestasis. I-EVOLUTION +Dado I-EVOLUTION +el I-EVOLUTION +alto I-EVOLUTION +riesgo I-EVOLUTION +quirúrgico I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +actitud I-EVOLUTION +expectante, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +sintomático I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +rectal I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +nota I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +tacto I-PRESENT_ILLNESS +rectal I-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +estreñimiento I-PRESENT_ILLNESS +crónico I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +requería I-PRESENT_ILLNESS +alguna I-PRESENT_ILLNESS +digitalización. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +y I-EXPLORATION +anuscopia-rectoscopia, I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +nodular I-EXPLORATION +submucosa I-EXPLORATION +única I-EXPLORATION +a I-EXPLORATION +3-4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +margen I-EXPLORATION +anal I-EXPLORATION +de I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +móvil, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +amarillento I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +rectal. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +exéresis I-TREATMENT +local I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +respetando I-TREATMENT +la I-TREATMENT +muscular I-TREATMENT +al I-TREATMENT +no I-TREATMENT +estar I-TREATMENT +adherido I-TREATMENT +a I-TREATMENT +ella. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +carcinoide I-EXPLORATION +rectal I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +bien I-EXPLORATION +diferenciado, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +atipias, I-EXPLORATION +desarrollado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +submucosa. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +invasión I-EXPLORATION +vascular, I-EXPLORATION +linfática I-EXPLORATION +o I-EXPLORATION +perineural. I-EXPLORATION +En I-EXPLORATION +superficie I-EXPLORATION +aparece I-EXPLORATION +cubierta I-EXPLORATION +por I-EXPLORATION +mucosa I-EXPLORATION +rectal I-EXPLORATION +bien I-EXPLORATION +diferenciada. I-EXPLORATION +En I-EXPLORATION +su I-EXPLORATION +base I-EXPLORATION +muestra I-EXPLORATION +escaso I-EXPLORATION +margen I-EXPLORATION +de I-EXPLORATION +seguridad I-EXPLORATION +afectando I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +bordes, I-EXPLORATION +si I-EXPLORATION +bien I-EXPLORATION +no I-EXPLORATION +muestra I-EXPLORATION +invasión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muscular I-EXPLORATION +propia. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +este I-TREATMENT +hallazgo I-TREATMENT +se I-TREATMENT +propone I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +un I-TREATMENT +seguimiento I-TREATMENT +clínico I-TREATMENT +y I-TREATMENT +una I-TREATMENT +biopsia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cicatriz I-TREATMENT +mucosa I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +meses. I-TREATMENT +La B-EXPLORATION +exéresis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +pericicatricial I-EXPLORATION +no I-EXPLORATION +evidencia I-EXPLORATION +restos I-EXPLORATION +tumorales. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +completó I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +otros I-EXPLORATION +tumores. I-EXPLORATION +Tras B-EVOLUTION +21 I-EVOLUTION +meses I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +sana, I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diarrea, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +estaba I-PRESENT_ILLNESS +tomando I-PRESENT_ILLNESS +anovulatorios I-PRESENT_ILLNESS +orales I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presenta I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +derecha. I-EXPLORATION +Presentaba I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +importante I-EXPLORATION +desviación I-EXPLORATION +izquierda. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +y I-EXPLORATION +radiológicos I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +apendicitis I-TREATMENT +aguda I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +laparotomía I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +encontrándose I-TREATMENT +una I-TREATMENT +apendicitis I-TREATMENT +aguda I-TREATMENT +gangrenosa I-TREATMENT +(anat. I-TREATMENT +patológica: I-TREATMENT +apendicitis I-TREATMENT +aguda), I-TREATMENT +realizándose I-TREATMENT +apendicectomía. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +administró I-TREATMENT +empíricamente I-TREATMENT +1 I-TREATMENT +g/8 I-TREATMENT +h I-TREATMENT +endovenoso I-TREATMENT +de I-TREATMENT +amoxicilina-clavulánico, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +en I-TREATMENT +el I-TREATMENT +5º I-TREATMENT +día I-TREATMENT +postoperatorio I-TREATMENT +empezó I-TREATMENT +con I-TREATMENT +fiebre I-TREATMENT +"en I-TREATMENT +picos" I-TREATMENT +de I-TREATMENT +hasta I-TREATMENT +40 I-TREATMENT +ºC. I-TREATMENT +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +siendo I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +mesentérica I-EXPLORATION +superior I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +ramas I-EXPLORATION +ileocólicas, I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +la I-TREATMENT +instauró I-TREATMENT +sueroterapia, I-TREATMENT +reposo I-TREATMENT +intestinal I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +enoxiparina I-TREATMENT +subcutánea I-TREATMENT +60 I-TREATMENT +mg/12 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +meropenem I-TREATMENT +endovenoso I-TREATMENT +1 I-TREATMENT +g/8 I-TREATMENT +h. I-TREATMENT +Se B-EVOLUTION +completan I-EVOLUTION +14 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +antibiótico I-EVOLUTION +y I-EVOLUTION +ante I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +problemas I-EVOLUTION +digestivos I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +causa I-EVOLUTION +alta I-EVOLUTION +el I-EVOLUTION +24º I-EVOLUTION +día I-EVOLUTION +del I-EVOLUTION +postoperatorio I-EVOLUTION +con I-EVOLUTION +acenocumarol I-EVOLUTION +oral. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +intraoperatorios I-EXPLORATION +crecieron I-EXPLORATION +Proteus I-EXPLORATION +mirabilis I-EXPLORATION +y I-EXPLORATION +Escherichia I-EXPLORATION +coli I-EXPLORATION +sensibles I-EXPLORATION +a I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +antibióticos I-EXPLORATION +testados. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +intraoperatorio I-EXPLORATION +para I-EXPLORATION +gérmenes I-EXPLORATION +anaerobios I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Dos I-EXPLORATION +hemocultivos I-EXPLORATION +resultaron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Bacteroides I-EXPLORATION +fragilis I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +clindamicina I-EXPLORATION +y I-EXPLORATION +penicilina, I-EXPLORATION +siendo I-EXPLORATION +sensible I-EXPLORATION +al I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +antibióticos I-EXPLORATION +testados. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +para I-EXPLORATION +anticuerpos I-EXPLORATION +antifosfolípido I-EXPLORATION +resultó I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Al B-EVOLUTION +mes I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +ingresada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +tromboembolismo I-PRESENT_ILLNESS +pulmonar I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +terapia I-PRESENT_ILLNESS +anticoagulante I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +enoxaparina, I-PRESENT_ILLNESS +iniciándose B-TREATMENT +a I-TREATMENT +las I-TREATMENT +72 I-TREATMENT +horas I-TREATMENT +paso I-TREATMENT +a I-TREATMENT +anticoagulación I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +acenocumarol. I-TREATMENT +Al B-EVOLUTION +octavo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +ingreso, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +INR I-EVOLUTION +de I-EVOLUTION +2, I-EVOLUTION +1, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +desarrolla, I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +emético I-EVOLUTION +autolimitado, I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +malestar I-EVOLUTION +general, I-EVOLUTION +sudación, I-EVOLUTION +tendencia I-EVOLUTION +a I-EVOLUTION +hipotensión I-EVOLUTION +arterial I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +hipogástrico I-EVOLUTION +sin I-EVOLUTION +peritonismo, I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +practica I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +que I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +intraabdominal I-EXPLORATION +hipogástrica I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +x I-EXPLORATION +11 I-EXPLORATION +cm. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +hipogástrica I-EXPLORATION +subperitoneal I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +x I-EXPLORATION +15 I-EXPLORATION +x I-EXPLORATION +11 I-EXPLORATION +cm, I-EXPLORATION +dependiente I-EXPLORATION +del I-EXPLORATION +recto I-EXPLORATION +abdominal I-EXPLORATION +anterior I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +ocupa I-EXPLORATION +gran I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +pélvica. I-EXPLORATION +Se I-EXPLORATION +objetiva I-EXPLORATION +importante I-EXPLORATION +anemización I-EXPLORATION +(descenso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +4, I-EXPLORATION +2 I-EXPLORATION +g/dl I-EXPLORATION +en I-EXPLORATION +72 I-EXPLORATION +horas), I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +shock I-EXPLORATION +hemorrágico I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +hematoma I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +se B-TREATMENT +instaura I-TREATMENT +tratamiento I-TREATMENT +enérgico I-TREATMENT +con I-TREATMENT +reposición I-TREATMENT +de I-TREATMENT +volemia, I-TREATMENT +se I-TREATMENT +revierte I-TREATMENT +la I-TREATMENT +anticoagulación I-TREATMENT +y I-TREATMENT +se I-TREATMENT +solicita I-TREATMENT +valoración I-TREATMENT +quirúrgica I-TREATMENT +urgente. I-TREATMENT +Ante B-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +inestabilidad I-EVOLUTION +hemodinámica I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +manejo I-EVOLUTION +conservador I-EVOLUTION +inicial I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +semiología I-EVOLUTION +de I-EVOLUTION +abdomen I-EVOLUTION +agudo, I-EVOLUTION +se B-TREATMENT +decide I-TREATMENT +practicar I-TREATMENT +laparotomía I-TREATMENT +urgente I-TREATMENT +que I-TREATMENT +muestra I-TREATMENT +"estallido" I-TREATMENT +del I-TREATMENT +peritoneo I-TREATMENT +parietal I-TREATMENT +y I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +recto I-TREATMENT +anterior I-TREATMENT +derecho I-TREATMENT +con I-TREATMENT +gran I-TREATMENT +hemoperitoneo I-TREATMENT +secundario I-TREATMENT +que I-TREATMENT +diseca I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +espacio I-TREATMENT +prevesical, I-TREATMENT +objetivándose I-TREATMENT +sangrado I-TREATMENT +arterial I-TREATMENT +por I-TREATMENT +laceración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +epigástrica I-TREATMENT +derecha I-TREATMENT +que I-TREATMENT +se I-TREATMENT +liga I-TREATMENT +y I-TREATMENT +sutura, I-TREATMENT +procediéndose I-TREATMENT +a I-TREATMENT +evacuar I-TREATMENT +aproximadamente I-TREATMENT +2 I-TREATMENT +litros I-TREATMENT +de I-TREATMENT +hemoperitoneo I-TREATMENT +con I-TREATMENT +grandes I-TREATMENT +coágulos I-TREATMENT +prevesicales, I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +con I-TREATMENT +malla I-TREATMENT +de I-TREATMENT +polipropileno I-TREATMENT +por I-TREATMENT +defecto I-TREATMENT +de I-TREATMENT +músculo I-TREATMENT +suprafascial. I-TREATMENT +Tras I-TREATMENT +soporte I-TREATMENT +en I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Cuidados I-TREATMENT +Intensivos I-TREATMENT +e I-TREATMENT +implantación I-TREATMENT +de I-TREATMENT +filtro I-TREATMENT +temporal I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +inferior, I-TREATMENT +la B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta, I-EVOLUTION +reinstaurándose B-TREATMENT +terapia I-TREATMENT +anticoagulante I-TREATMENT +con I-TREATMENT +acenocumarol. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +hematoma I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +es I-EXPLORATION +una I-EXPLORATION +entidad I-EXPLORATION +infrecuente I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +difícil I-EXPLORATION +diagnóstico I-EXPLORATION +que I-EXPLORATION +generalmente I-EXPLORATION +está I-EXPLORATION +relacionada I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +anticoagulación I-EXPLORATION +sistémica. I-EXPLORATION +En I-EXPLORATION +su I-EXPLORATION +patogenia I-EXPLORATION +se I-EXPLORATION +involucra I-EXPLORATION +la I-EXPLORATION +anticoagulación I-EXPLORATION +como I-EXPLORATION +factor I-EXPLORATION +predisponerte I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +contracción I-EXPLORATION +vigorosa I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +rectos I-EXPLORATION +del I-EXPLORATION +abdomen I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +de I-EXPLORATION +movimientos I-EXPLORATION +de I-EXPLORATION +Valsalva I-EXPLORATION +enérgicos I-EXPLORATION +y I-EXPLORATION +bruscos I-EXPLORATION +(tos, I-EXPLORATION +vómitos, I-EXPLORATION +estreñimiento) I-EXPLORATION +como I-EXPLORATION +factor I-EXPLORATION +desencadenante. I-EXPLORATION +En I-EXPLORATION +varios I-EXPLORATION +trabajos I-EXPLORATION +previos I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +documentado I-EXPLORATION +la I-EXPLORATION +laceración I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +epigástricas I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +del I-EXPLORATION +hematoma I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +(1-6). I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +se I-EXPLORATION +basa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +clínico I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +abdominal. I-EXPLORATION +La I-EXPLORATION +presentación I-EXPLORATION +clínica I-EXPLORATION +habitual I-EXPLORATION +consiste I-EXPLORATION +en I-EXPLORATION +dolor I-EXPLORATION +abdominal, I-EXPLORATION +pudiendo I-EXPLORATION +objetivarse I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +o I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +y/o I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +superficial. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +suele I-EXPLORATION +documentar I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +elección I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +permite I-EXPLORATION +definir I-EXPLORATION +y I-EXPLORATION +precisar I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +del I-EXPLORATION +proceso I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +vecinos. I-EXPLORATION + I-EXPLORATION +Su I-EXPLORATION +manejo I-EXPLORATION +es, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +general, I-EXPLORATION +conservador, I-EXPLORATION +incluso I-EXPLORATION +ante I-EXPLORATION +hallazgos I-EXPLORATION +clínicos I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +agudo I-EXPLORATION +(1,3), I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +propio I-EXPLORATION +hematoma I-EXPLORATION +ejerce I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +auto-taponamiento, I-EXPLORATION +siendo I-EXPLORATION +suficientes I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +sintomático I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +transfusión I-EXPLORATION +sanguínea I-EXPLORATION +en I-EXPLORATION +casos I-EXPLORATION +necesarios. I-EXPLORATION +No B-TREATMENT +obstante, I-TREATMENT +existen I-TREATMENT +situaciones I-TREATMENT +en I-TREATMENT +las I-TREATMENT +que I-TREATMENT +la I-TREATMENT +hemorragia I-TREATMENT +puede I-TREATMENT +ser I-TREATMENT +muy I-TREATMENT +severa I-TREATMENT +y I-TREATMENT +llega I-TREATMENT +a I-TREATMENT +comprometer I-TREATMENT +la I-TREATMENT +vida, I-TREATMENT +precisándose I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +quirúrgico I-TREATMENT +para I-TREATMENT +localizar I-TREATMENT +el I-TREATMENT +punto I-TREATMENT +sangrante I-TREATMENT +y I-TREATMENT +drenar I-TREATMENT +el I-TREATMENT +hematoma. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +ha I-TREATMENT +descrito I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +exitoso I-TREATMENT +mediante I-TREATMENT +embolización I-TREATMENT +endovascular I-TREATMENT +de I-TREATMENT +los I-TREATMENT +vasos I-TREATMENT +sangrantes I-TREATMENT +(1). I-TREATMENT +La I-TREATMENT +inestabilidad I-TREATMENT +hemodinámica I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +intensivo I-TREATMENT +y/o I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +complicaciones I-TREATMENT +(hemoperitoneo, I-TREATMENT +sobre-infección, I-TREATMENT +etc.) I-TREATMENT +son I-TREATMENT +las I-TREATMENT +principales I-TREATMENT +indicaciones I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +quirúrgico, I-TREATMENT +como I-TREATMENT +ocurrió I-TREATMENT +en I-TREATMENT +el I-TREATMENT +caso I-TREATMENT +que I-TREATMENT +presentamos. I-TREATMENT + I-TREATMENT +Nuestra B-EXPLORATION +experiencia I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +importancia I-EXPLORATION +del I-EXPLORATION +diagnóstico I-EXPLORATION +precoz I-EXPLORATION +del I-EXPLORATION +hematoma I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +necesidad I-EXPLORATION +de I-EXPLORATION +llevar I-EXPLORATION +a I-EXPLORATION +cabo I-EXPLORATION +un I-EXPLORATION +manejo I-EXPLORATION +individualizado I-EXPLORATION +del I-EXPLORATION +mismo, I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +entidad I-EXPLORATION +que, I-EXPLORATION +aunque I-EXPLORATION +generalmente I-EXPLORATION +es I-EXPLORATION +leve I-EXPLORATION +y I-EXPLORATION +autolimitada, I-EXPLORATION +puede I-EXPLORATION +presentar I-EXPLORATION +complicaciones I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +magnitud I-EXPLORATION +(shock I-EXPLORATION +hemorrágico I-EXPLORATION +refractario I-EXPLORATION +a I-EXPLORATION +soporte I-EXPLORATION +médico, I-EXPLORATION +hemoperitoneo, I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +vísceras I-EXPLORATION +abdomino-pélvicas, I-EXPLORATION +etc.) I-EXPLORATION +que B-TREATMENT +llegan I-TREATMENT +a I-TREATMENT +poner I-TREATMENT +en I-TREATMENT +peligro I-TREATMENT +la I-TREATMENT +vida I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +requieren I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +quirúrgico. I-TREATMENT + I-TREATMENT +J. B-EXPLORATION +F. I-EXPLORATION +Varona, I-EXPLORATION +R. I-EXPLORATION +Díaz-Conradi1, I-EXPLORATION +M. I-EXPLORATION +Valle, I-EXPLORATION +F. I-EXPLORATION +Muñoz2 I-EXPLORATION +y I-EXPLORATION +M. I-EXPLORATION +A. I-EXPLORATION +Bufalá I-EXPLORATION +Departamentos I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +Interna, I-EXPLORATION +1Cirugía I-EXPLORATION +General I-EXPLORATION +y I-EXPLORATION +2Radiodiagnóstico. I-EXPLORATION +Hospital I-EXPLORATION +El I-EXPLORATION +Escorial. I-EXPLORATION +San I-EXPLORATION +Lorenzo I-EXPLORATION +del I-EXPLORATION +Escorial, I-EXPLORATION +Madrid I-EXPLORATION + I-EXPLORATION + +MRB. B-PRESENT_ILLNESS +Varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Hermano. B-FAMILY_HISTORY +Casado I-FAMILY_HISTORY +y I-FAMILY_HISTORY +con I-FAMILY_HISTORY +2 I-FAMILY_HISTORY +hijos, I-FAMILY_HISTORY +uno I-FAMILY_HISTORY +afecto I-FAMILY_HISTORY +de I-FAMILY_HISTORY +esclerosis I-FAMILY_HISTORY +múltiple. I-FAMILY_HISTORY +Rinitis B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +faringitis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia. I-PAST_MEDICAL_HISTORY +Lesiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +psoriasis I-PAST_MEDICAL_HISTORY +generalizada, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +codos, I-PAST_MEDICAL_HISTORY +rodillas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cuero I-PAST_MEDICAL_HISTORY +cabelludo I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +leucopenia I-EXPLORATION +mantenida I-EXPLORATION +(3.700), I-EXPLORATION +acompañada I-EXPLORATION +de I-EXPLORATION +ligero I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +ferritina I-EXPLORATION +(21 I-EXPLORATION +ng/ml) I-EXPLORATION +sin I-EXPLORATION +anemia I-EXPLORATION +asociada I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +séricos I-EXPLORATION +de I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +(177 I-EXPLORATION +pg/ml). I-EXPLORATION +La I-EXPLORATION +TTG I-EXPLORATION +estaba I-EXPLORATION +discretamente I-EXPLORATION +elevada I-EXPLORATION +(1, I-EXPLORATION +74 I-EXPLORATION +U/ml) I-EXPLORATION +(N I-EXPLORATION +≤ I-EXPLORATION +1). I-EXPLORATION +Es I-EXPLORATION +DQ2 I-EXPLORATION +(+) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +duodenal I-EXPLORATION +fue I-EXPLORATION +interpretada I-EXPLORATION +como I-EXPLORATION +normal I-EXPLORATION +(estadio I-EXPLORATION +0 I-EXPLORATION +de I-EXPLORATION +Marsh). I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +diagnosticó I-TREATMENT +de I-TREATMENT +EC I-TREATMENT +hace I-TREATMENT +6 I-TREATMENT +meses I-TREATMENT +y I-TREATMENT +se I-TREATMENT +puso I-TREATMENT +a I-TREATMENT +DSG I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +analítica I-EVOLUTION +al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +ellos. I-EVOLUTION + I-EVOLUTION + +FGR. B-PRESENT_ILLNESS +Mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Sobrina. B-PAST_MEDICAL_HISTORY +Hija I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +JoRB I-PAST_MEDICAL_HISTORY +(caso I-PAST_MEDICAL_HISTORY +4). I-PAST_MEDICAL_HISTORY +Soltera. I-PAST_MEDICAL_HISTORY +Nacida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +vuelta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cordón I-PAST_MEDICAL_HISTORY +umbilical I-PAST_MEDICAL_HISTORY +alrededor I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cuello I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +distócico. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +consecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ello, I-PAST_MEDICAL_HISTORY +padece I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +parálisis I-PAST_MEDICAL_HISTORY +cerebral I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +importante I-PAST_MEDICAL_HISTORY +retraso I-PAST_MEDICAL_HISTORY +mental I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +psicomotriz, I-PAST_MEDICAL_HISTORY +camina I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dificultad I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +muletas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +utiliza I-PAST_MEDICAL_HISTORY +parcialmente I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +silla I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ruedas. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +encuentra I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +hinchada I-PAST_MEDICAL_HISTORY +habitualmente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +sientan I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +mal I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +comidas. I-PAST_MEDICAL_HISTORY +Ardores I-PAST_MEDICAL_HISTORY +epigástricos I-PAST_MEDICAL_HISTORY +frecuentes, I-PAST_MEDICAL_HISTORY +acompañados I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +reflujo. I-PAST_MEDICAL_HISTORY +Hábito I-PAST_MEDICAL_HISTORY +intestinal I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +estreñido, I-PAST_MEDICAL_HISTORY +precisando I-PAST_MEDICAL_HISTORY +empleo I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +laxantes. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +existe I-EXPLORATION +un I-EXPLORATION +descenso I-EXPLORATION +persistente I-EXPLORATION +de I-EXPLORATION +ferritina I-EXPLORATION +(6 I-EXPLORATION +ng/ml) I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +IST I-EXPLORATION +(13,4%) I-EXPLORATION +sin I-EXPLORATION +anemia I-EXPLORATION +acompañante. I-EXPLORATION +Presenta I-EXPLORATION +anticuerpos I-EXPLORATION +anti-tiroideos I-EXPLORATION +ligeramente I-EXPLORATION +positivos I-EXPLORATION +(163 I-EXPLORATION +U/ml), I-EXPLORATION +con I-EXPLORATION +normofunción I-EXPLORATION +tiroidea. I-EXPLORATION +La I-EXPLORATION +TTG I-EXPLORATION +es I-EXPLORATION +ligeramente I-EXPLORATION +positiva I-EXPLORATION +(1,9), I-EXPLORATION +el I-EXPLORATION +DQ2 I-EXPLORATION +es I-EXPLORATION +negativo, I-EXPLORATION +siendo I-EXPLORATION +DQ8 I-EXPLORATION +(+) I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +biopsias I-EXPLORATION +duodenales I-EXPLORATION +mostraron I-EXPLORATION +un I-EXPLORATION +claro I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +linfocitos I-EXPLORATION +intraepiteliales I-EXPLORATION +(estadio I-EXPLORATION +1 I-EXPLORATION +de I-EXPLORATION +Marsh). I-EXPLORATION + I-EXPLORATION + +JRA. B-PRESENT_ILLNESS +Varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Sobrino. I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Asintomático. B-EXPLORATION +Erupciones I-EXPLORATION +cutáneas I-EXPLORATION +generalizadas, I-EXPLORATION +especialmente I-EXPLORATION +en I-EXPLORATION +cara, I-EXPLORATION +brazos I-EXPLORATION +y I-EXPLORATION +piernas, I-EXPLORATION +muy I-EXPLORATION +pruriginosas I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +infancia, I-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +dermatitis I-EXPLORATION +herpetiforme I-EXPLORATION +(DH). I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destaca I-EXPLORATION +una I-EXPLORATION +ligera I-EXPLORATION +leucopenia I-EXPLORATION +(4.800), I-EXPLORATION +con I-EXPLORATION +descenso I-EXPLORATION +del I-EXPLORATION +colesterol I-EXPLORATION +total I-EXPLORATION +(116 I-EXPLORATION +mg/dl). I-EXPLORATION +La I-EXPLORATION +TTG I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +(0, I-EXPLORATION +88 I-EXPLORATION +U/ml). I-EXPLORATION +Es I-EXPLORATION +DQ2 I-EXPLORATION +(-) I-EXPLORATION +y I-EXPLORATION +DQ8 I-EXPLORATION +(+). I-EXPLORATION +Las I-EXPLORATION +biopsias I-EXPLORATION +duodenales I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +(estadio I-EXPLORATION +0 I-EXPLORATION +de I-EXPLORATION +Marsh). I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +puso I-TREATMENT +a I-TREATMENT +DSG I-TREATMENT +hace I-TREATMENT +10 I-TREATMENT +meses, I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +analítica, I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +cutáneas. I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +emesis I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +algunos I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +arcadas. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +hemorragias I-PAST_MEDICAL_HISTORY +previas. I-PAST_MEDICAL_HISTORY +Una B-EXPLORATION +endoscopia I-EXPLORATION +alta I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +desgarro I-EXPLORATION +amplio I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +afectaba I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +submucosa I-EXPLORATION +del I-EXPLORATION +esófago I-EXPLORATION +distal, I-EXPLORATION +respetando I-EXPLORATION +un I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +largo I-EXPLORATION +proximal I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +Z. I-EXPLORATION +La B-TREATMENT +laceración I-TREATMENT +presentaba I-TREATMENT +una I-TREATMENT +hemorragia I-TREATMENT +rezumante I-TREATMENT +lenta I-TREATMENT +que I-TREATMENT +se I-TREATMENT +detuvo I-TREATMENT +con I-TREATMENT +la I-TREATMENT +inyección I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +adrenalina I-TREATMENT +al I-TREATMENT +1: I-TREATMENT +10000 I-TREATMENT +y I-TREATMENT +la I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +17 I-TREATMENT +endoclips I-TREATMENT +para I-TREATMENT +cerrar I-TREATMENT +la I-TREATMENT +laceración. I-TREATMENT +La I-TREATMENT +recurrencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hemorragia I-TREATMENT +8 I-TREATMENT +días I-TREATMENT +después I-TREATMENT +se I-TREATMENT +controló I-TREATMENT +con I-TREATMENT +la I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +otros I-TREATMENT +4 I-TREATMENT +endoclips. I-TREATMENT +No B-EVOLUTION +hubo I-EVOLUTION +ninguna I-EVOLUTION +otra I-EVOLUTION +recurrencia I-EVOLUTION +hemorrágica I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +repitió I-EVOLUTION +la I-EVOLUTION +endoscopia I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +6 I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +24, I-EVOLUTION +no I-EVOLUTION +observándose I-EVOLUTION +lesión I-EVOLUTION +alguna. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +hipogástrico, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +3 I-EXPLORATION +ºC, I-EXPLORATION +115 I-EXPLORATION +lat./min, I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +130/80 I-EXPLORATION +mmHg, I-EXPLORATION +dolor I-EXPLORATION +hipogástrico I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal. I-EXPLORATION +Analítica: I-EXPLORATION +leucocitos I-EXPLORATION +18.000µ/l I-EXPLORATION +y I-EXPLORATION +fibrinógeno I-EXPLORATION +939, I-EXPLORATION +9 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +TAC I-EXPLORATION +abdominal: I-EXPLORATION +el I-EXPLORATION +duodeno I-EXPLORATION +presenta I-EXPLORATION +malrotación, I-EXPLORATION +haciendo I-EXPLORATION +un I-EXPLORATION +tirabuzón I-EXPLORATION +alrededor I-EXPLORATION +del I-EXPLORATION +eje I-EXPLORATION +venoso I-EXPLORATION +mesentérico. I-EXPLORATION +Se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +con I-EXPLORATION +burbujas I-EXPLORATION +de I-EXPLORATION +gas I-EXPLORATION +y I-EXPLORATION +líquido I-EXPLORATION +que I-EXPLORATION +engloba I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +proximidad I-EXPLORATION +al I-EXPLORATION +fundus I-EXPLORATION +uterino I-EXPLORATION +y I-EXPLORATION +receso I-EXPLORATION +vesicouterino, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +apéndice I-EXPLORATION +inflamado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +periapendicular I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuadrante I-EXPLORATION +inferior I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +intervenida I-TREATMENT +quirúrgicamente, I-TREATMENT +encontrándose I-TREATMENT +la I-TREATMENT +malrotación I-TREATMENT +intestinal I-TREATMENT +descrita I-TREATMENT +con I-TREATMENT +el I-TREATMENT +duodeno I-TREATMENT +en I-TREATMENT +el I-TREATMENT +lado I-TREATMENT +derecho I-TREATMENT +y I-TREATMENT +el I-TREATMENT +ciego I-TREATMENT +descansando I-TREATMENT +en I-TREATMENT +el I-TREATMENT +cuadrante I-TREATMENT +superior I-TREATMENT +izquierdo I-TREATMENT +del I-TREATMENT +abdomen. I-TREATMENT +El I-TREATMENT +apéndice I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +inflamado I-TREATMENT +con I-TREATMENT +un I-TREATMENT +importante I-TREATMENT +absceso I-TREATMENT +pélvico I-TREATMENT +asociado. I-TREATMENT +Realizamos I-TREATMENT +apendicectomía, I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +absceso I-TREATMENT +pélvico I-TREATMENT +y I-TREATMENT +liberación I-TREATMENT +de I-TREATMENT +asas I-TREATMENT +de I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +previa I-TREATMENT +sección I-TREATMENT +de I-TREATMENT +las I-TREATMENT +bandas I-TREATMENT +de I-TREATMENT +Ladd. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +recupera I-EVOLUTION +satisfactoriamente I-EVOLUTION +tras I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +con B-TREATMENT +tratamiento I-TREATMENT +antibiótico. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +ingresado I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ictericia. I-PRESENT_ILLNESS +La B-EXPLORATION +RMN I-EXPLORATION +y I-EXPLORATION +colangio-RMN I-EXPLORATION +establecieron I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +colangiocarcinoma. I-EXPLORATION +En B-TREATMENT +el I-TREATMENT +curso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +consiguó I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +una I-TREATMENT +masa I-TREATMENT +en I-TREATMENT +el I-TREATMENT +área I-TREATMENT +de I-TREATMENT +la I-TREATMENT +bifurcación I-TREATMENT +biliar I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +continuidad I-TREATMENT +biliar I-TREATMENT +mediante I-TREATMENT +anastomosis I-TREATMENT +segmentarias I-TREATMENT +a I-TREATMENT +un I-TREATMENT +asa I-TREATMENT +desfuncionalizada I-TREATMENT +yeyunal I-TREATMENT +en I-TREATMENT +Y I-TREATMENT +de I-TREATMENT +Roux. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +reveló I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +carcinoide. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +hipertensa, I-PAST_MEDICAL_HISTORY +dislipémica, I-PAST_MEDICAL_HISTORY +apendicectomizada, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +practicó I-PAST_MEDICAL_HISTORY +antrectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +reconstrucción I-PAST_MEDICAL_HISTORY +Billroth-II I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +ulcerosa I-PAST_MEDICAL_HISTORY +péptica. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Durante B-EXPLORATION +su I-EXPLORATION +exploración I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +ni I-EXPLORATION +ictericia I-EXPLORATION +ni I-EXPLORATION +fiebre. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +cambios I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +(GGT I-EXPLORATION +386 I-EXPLORATION +IU/L, I-EXPLORATION +AP I-EXPLORATION +337 I-EXPLORATION +IU/L, I-EXPLORATION +AST I-EXPLORATION +245 I-EXPLORATION +U/L, I-EXPLORATION +ALT I-EXPLORATION +342 I-EXPLORATION +U/L, I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +0, I-EXPLORATION +03 I-EXPLORATION +g/l). I-EXPLORATION +Se I-EXPLORATION +detectaron I-EXPLORATION +también I-EXPLORATION +hiperamilasemia I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva; I-EXPLORATION +además, I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +colecistitis, I-EXPLORATION +colelitiasis, I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extrahepática. I-EXPLORATION +Basándose I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +estos, I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +colecistopancreatitis I-EXPLORATION +aguda I-EXPLORATION +litiásica. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +por I-EXPLORATION +contraste I-EXPLORATION +oral I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +drenaje I-EXPLORATION +biliar I-EXPLORATION +al I-EXPLORATION +asa I-EXPLORATION +eferente. I-EXPLORATION +Por I-EXPLORATION +otra I-EXPLORATION +parte, I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +endoscópicos I-EXPLORATION +no I-EXPLORATION +aportaron I-EXPLORATION +nuevos I-EXPLORATION +datos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(CT) I-EXPLORATION +reveló I-EXPLORATION +marcada I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extrahepática, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +asa I-EXPLORATION +yeyunal; I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +incremento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +colecistitis I-EXPLORATION +mostrados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +inicial, I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ictericia I-EXPLORATION +obstructiva. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +otro I-EXPLORATION +lado, I-EXPLORATION +se I-EXPLORATION +fueron I-EXPLORATION +incrementando I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +hiperbilirrubinemia I-EXPLORATION +(0, I-EXPLORATION +097 I-EXPLORATION +g/l) I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepáticas I-EXPLORATION +(AST I-EXPLORATION +600 I-EXPLORATION +U/L) I-EXPLORATION +tras I-EXPLORATION +quince I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +hospitalización. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +laparotomía I-TREATMENT +en I-TREATMENT +base I-TREATMENT +al I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +colecistitis I-TREATMENT +aguda I-TREATMENT +litiásica I-TREATMENT +e I-TREATMENT +ictericia I-TREATMENT +obstructiva I-TREATMENT +progresiva I-TREATMENT +que I-TREATMENT +involucraba I-TREATMENT +al I-TREATMENT +asa I-TREATMENT +aferente I-TREATMENT +de I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +Billroth-II. I-TREATMENT +Se B-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +dilatada I-EXPLORATION +y I-EXPLORATION +necrótica, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +del I-EXPLORATION +asa I-EXPLORATION +aferente I-EXPLORATION +volvulada I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +asa I-EXPLORATION +eferente I-EXPLORATION +provocando I-EXPLORATION +la I-EXPLORATION +ictericia I-EXPLORATION +obstructiva. I-EXPLORATION +Se B-TREATMENT +resecó I-TREATMENT +el I-TREATMENT +asa I-TREATMENT +aferente I-TREATMENT +estenótica, I-TREATMENT +se I-TREATMENT +drenó I-TREATMENT +el I-TREATMENT +éstasis I-TREATMENT +biliar I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +reconstrucción I-TREATMENT +mediante I-TREATMENT +Y-Roux I-TREATMENT +yeyuno-yeyunal. I-TREATMENT +Así I-TREATMENT +mismo I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +colecistectomía, I-TREATMENT +y I-TREATMENT +colangiografía I-TREATMENT +intraoperatoria, I-TREATMENT +obtenida I-TREATMENT +a I-TREATMENT +la I-TREATMENT +finalización I-TREATMENT +del I-TREATMENT +procedimiento, I-TREATMENT +mostrando I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +satisfactorio I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +papila I-TREATMENT +de I-TREATMENT +Vater I-TREATMENT +hacia I-TREATMENT +el I-TREATMENT +duodeno I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +transanastomótico I-TREATMENT +y I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +largo I-TREATMENT +del I-TREATMENT +yeyuno. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +postoperatorio I-EVOLUTION +los I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +amilasemia I-EVOLUTION +y I-EVOLUTION +bilirrubina I-EVOLUTION +se I-EVOLUTION +normalizaron I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +exploración I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología. I-EVOLUTION +La I-EVOLUTION +ictericia I-EVOLUTION +desapareció I-EVOLUTION +completamente I-EVOLUTION +antes I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +hospitalaria. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +estudio I-EVOLUTION +histopatológico I-EVOLUTION +del I-EVOLUTION +espécimen I-EVOLUTION +reveló I-EVOLUTION +colecistitis I-EVOLUTION +crónica, I-EVOLUTION +colelitiasis, I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +asa I-EVOLUTION +intestinal I-EVOLUTION +presentó I-EVOLUTION +signos I-EVOLUTION +inespecíficos I-EVOLUTION +inflamatorios I-EVOLUTION +y I-EVOLUTION +atrofia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mucosa. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +aquejado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +ponderal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +kg, I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +intensa, I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +estreñimiento I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +transcurso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +última I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +además, I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hemiabdomen I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +escasa I-PRESENT_ILLNESS +mejoría I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +analgésicos I-PRESENT_ILLNESS +habituales. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destaca I-EXPLORATION +aceptable I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +palidez I-EXPLORATION +mucocutánea, I-EXPLORATION +auscultación I-EXPLORATION +cardiorrespiratoria I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +profunda, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +5-6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +cuadrante I-EXPLORATION +inferior I-EXPLORATION +izdo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +ingreso, I-EXPLORATION +destaca: I-EXPLORATION +Hb: I-EXPLORATION +10.8 I-EXPLORATION +g, I-EXPLORATION +Hcto: I-EXPLORATION +38%, I-EXPLORATION +VCM: I-EXPLORATION +78, I-EXPLORATION +leucocitos: I-EXPLORATION +13.600/μl, I-EXPLORATION +con I-EXPLORATION +neutrofilia, I-EXPLORATION +Fe: I-EXPLORATION +8, I-EXPLORATION +úrico: I-EXPLORATION +9, I-EXPLORATION +6, I-EXPLORATION +LDH: I-EXPLORATION +876 I-EXPLORATION +y I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +8 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso, I-EVOLUTION +se I-EVOLUTION +agudiza I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +importante I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +fosa I-EVOLUTION +ilíaca I-EVOLUTION +izquierda, I-EVOLUTION +irradiándose I-EVOLUTION +este I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +centroabdominal. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presenta, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +referida I-EXPLORATION +sensación I-EXPLORATION +de I-EXPLORATION +masa, I-EXPLORATION +una I-EXPLORATION +crepitación I-EXPLORATION +difusa I-EXPLORATION +en I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +peritonismo. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +urgente, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +: I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +intestinales I-EXPLORATION +producida I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo, I-EXPLORATION +situada I-EXPLORATION +en I-EXPLORATION +pelvis I-EXPLORATION +izquierda, I-EXPLORATION +que I-EXPLORATION +condiciona I-EXPLORATION +estenosis I-EXPLORATION +y I-EXPLORATION +obstrucción I-EXPLORATION +intestinal I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +sigma. I-EXPLORATION +La I-EXPLORATION +masa, I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +mamelonados I-EXPLORATION +infiltra I-EXPLORATION +el I-EXPLORATION +músculo I-EXPLORATION +ilíaco I-EXPLORATION +izquierdo, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +porción I-EXPLORATION +superior I-EXPLORATION +parece I-EXPLORATION +ulcerada I-EXPLORATION +y I-EXPLORATION +fistulizada I-EXPLORATION +a I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +anterior, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +está I-EXPLORATION +marcadamente I-EXPLORATION +engrosada, I-EXPLORATION +con I-EXPLORATION +aire I-EXPLORATION +y I-EXPLORATION +colección I-EXPLORATION +líquida, I-EXPLORATION +más I-EXPLORATION +evidente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +Diagnóstico: I-EXPLORATION +neoplasia I-EXPLORATION +de I-EXPLORATION +sigma I-EXPLORATION +fistulizada I-EXPLORATION +a I-EXPLORATION +pared I-EXPLORATION +abdominal, I-EXPLORATION +con I-EXPLORATION +abscesificación. I-EXPLORATION +Enfisema I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +abdominal. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +desfavorablemente, I-EVOLUTION +presentando I-EVOLUTION +un I-EVOLUTION +shock I-EVOLUTION +séptico I-EVOLUTION +refractario I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica, I-EVOLUTION +falleciendo I-EVOLUTION +horas I-EVOLUTION +después. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +necropsia I-EVOLUTION +se I-EVOLUTION +corroboran I-EVOLUTION +los I-EVOLUTION +diagnósticos I-EVOLUTION +realizados I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +prueba I-EVOLUTION +de I-EVOLUTION +imagen, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +la I-EVOLUTION +neoplasia I-EVOLUTION +de I-EVOLUTION +colon I-EVOLUTION +que I-EVOLUTION +resultó I-EVOLUTION +ser I-EVOLUTION +un I-EVOLUTION +adenocarcinoma. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +intermitente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ileítis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Crohn I-PAST_MEDICAL_HISTORY +desapareciendo I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +esteroides. I-PAST_MEDICAL_HISTORY +Cinco B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +anemia I-PRESENT_ILLNESS +ferropénica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +desnutrición I-PRESENT_ILLNESS +severa. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +TAC B-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tránsito I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +trayectos I-EXPLORATION +extraluminares I-EXPLORATION +desde I-EXPLORATION +ciego/íleon I-EXPLORATION +terminal I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +posteriores I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +fístulas. I-EXPLORATION +Se B-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +nutrición I-TREATMENT +enteral, I-TREATMENT +metronidazol I-TREATMENT +y I-TREATMENT +corticoides I-TREATMENT +a I-TREATMENT +bajas I-TREATMENT +dosis. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +evolución, I-EVOLUTION +pero I-EVOLUTION +diez I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +acude I-EVOLUTION +por I-EVOLUTION +supuración I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +del I-EVOLUTION +glúteo I-EVOLUTION +y I-EVOLUTION +absceso I-EVOLUTION +retroperitoneal I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +ileocecal I-TREATMENT +y I-TREATMENT +anastomosis I-TREATMENT +ileocólica I-TREATMENT +látero-lateral. I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +EC I-TREATMENT +se I-TREATMENT +han I-TREATMENT +descrito I-TREATMENT +tres I-TREATMENT +enfoques I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +los I-TREATMENT +abscesos: I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +con I-TREATMENT +antibióticos I-TREATMENT +y I-TREATMENT +esteroides, I-TREATMENT +drenaje I-TREATMENT +percutáneo I-TREATMENT +y I-TREATMENT +cirugía I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +los I-TREATMENT +segmentos I-TREATMENT +intestinales I-TREATMENT +afectados. I-TREATMENT + I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +inicial I-TREATMENT +estaría I-TREATMENT +basado I-TREATMENT +en I-TREATMENT +la I-TREATMENT +utilización I-TREATMENT +de I-TREATMENT +5-ASA, I-TREATMENT +antibióticos I-TREATMENT +y I-TREATMENT +corticosteroides, I-TREATMENT +azatioprina I-TREATMENT +o I-TREATMENT +6-mercaptopurina I-TREATMENT +en I-TREATMENT +caso I-TREATMENT +de I-TREATMENT +refractariedad I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +convencional I-TREATMENT +(2). I-TREATMENT +La I-TREATMENT +siguiente I-TREATMENT +línea I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +basa I-TREATMENT +en I-TREATMENT +la I-TREATMENT +utilización I-TREATMENT +de I-TREATMENT +infliximab I-TREATMENT +(anticuerpo I-TREATMENT +monoclonal I-TREATMENT +anti I-TREATMENT +TNF-a) I-TREATMENT +habiéndose I-TREATMENT +observado I-TREATMENT +una I-TREATMENT +reducción I-TREATMENT +en I-TREATMENT +el I-TREATMENT +número I-TREATMENT +de I-TREATMENT +intervenciones I-TREATMENT +quirúrgicas I-TREATMENT +en I-TREATMENT +este I-TREATMENT +grupo I-TREATMENT +de I-TREATMENT +pacientes. I-TREATMENT +Una I-TREATMENT +alternativa I-TREATMENT +terapéutica I-TREATMENT +para I-TREATMENT +los I-TREATMENT +pacientes I-TREATMENT +con I-TREATMENT +enfermedad I-TREATMENT +de I-TREATMENT +Crohn I-TREATMENT +fistulizante I-TREATMENT +refractaria I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anti-TNF-a I-TREATMENT +sería I-TREATMENT +la I-TREATMENT +utilización I-TREATMENT +de I-TREATMENT +inmunosupresores I-TREATMENT +anticalcineurínicos I-TREATMENT +como I-TREATMENT +el I-TREATMENT +tacrolimus I-TREATMENT +con I-TREATMENT +remisiones I-TREATMENT +completas I-TREATMENT +de I-TREATMENT +hasta I-TREATMENT +un I-TREATMENT +40% I-TREATMENT +y I-TREATMENT +parciales I-TREATMENT +del I-TREATMENT +50% I-TREATMENT +(3). I-TREATMENT + I-TREATMENT +El I-TREATMENT +drenaje I-TREATMENT +percutáneo I-TREATMENT +guiado I-TREATMENT +radiológicamente I-TREATMENT +en I-TREATMENT +su I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +convirtió I-TREATMENT +en I-TREATMENT +la I-TREATMENT +principal I-TREATMENT +alternativa I-TREATMENT +terapéutica I-TREATMENT +llegando I-TREATMENT +incluso I-TREATMENT +a I-TREATMENT +obviar I-TREATMENT +la I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +resección I-TREATMENT +intestinal. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +pueden I-TREATMENT +llegar I-TREATMENT +a I-TREATMENT +presentar I-TREATMENT +hasta I-TREATMENT +un I-TREATMENT +100% I-TREATMENT +de I-TREATMENT +recidivas I-TREATMENT +(4). I-TREATMENT +Hay I-TREATMENT +autores I-TREATMENT +que I-TREATMENT +defienden I-TREATMENT +que I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +definitivo I-TREATMENT +de I-TREATMENT +un I-TREATMENT +absceso I-TREATMENT +de I-TREATMENT +psoas I-TREATMENT +debe I-TREATMENT +incluir I-TREATMENT +además, I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +de I-TREATMENT +tubo I-TREATMENT +digestivo I-TREATMENT +afectada I-TREATMENT +(5). I-TREATMENT + I-TREATMENT +En I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +casos I-TREATMENT +de I-TREATMENT +EC I-TREATMENT +fistulizante I-TREATMENT +con I-TREATMENT +abscesos I-TREATMENT +intraabdominales I-TREATMENT +presentados I-TREATMENT +hemos I-TREATMENT +podido I-TREATMENT +observar I-TREATMENT +dos I-TREATMENT +tipos I-TREATMENT +de I-TREATMENT +experiencias I-TREATMENT +en I-TREATMENT +cuanto I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +caso I-TREATMENT +se I-TREATMENT +pudo I-TREATMENT +resolver I-TREATMENT +el I-TREATMENT +absceso I-TREATMENT +tras I-TREATMENT +drenaje I-TREATMENT +quirúrgico I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +conservador. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +segundo I-TREATMENT +caso I-TREATMENT +no I-TREATMENT +tuvimos I-TREATMENT +la I-TREATMENT +oportunidad I-TREATMENT +de I-TREATMENT +tratar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +con I-TREATMENT +anti-TNF I-TREATMENT +dado I-TREATMENT +que I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +clínico I-TREATMENT +se I-TREATMENT +presentó I-TREATMENT +en I-TREATMENT +1999 I-TREATMENT +y I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +fue I-TREATMENT +la I-TREATMENT +mejor I-TREATMENT +opción, I-TREATMENT +tras I-TREATMENT +el I-TREATMENT +fracaso I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +conservador. I-TREATMENT + I-TREATMENT +En I-TREATMENT +conclusión, I-TREATMENT +los I-TREATMENT +pacientes I-TREATMENT +con I-TREATMENT +EC I-TREATMENT +fistulizante I-TREATMENT +con I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +abscesos I-TREATMENT +intraabdominales I-TREATMENT +pueden I-TREATMENT +ser I-TREATMENT +tratados I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +conservadora I-TREATMENT +inicialmente I-TREATMENT +llegando I-TREATMENT +a I-TREATMENT +resolverse I-TREATMENT +en I-TREATMENT +algunos I-TREATMENT +casos, I-TREATMENT +ya I-TREATMENT +sea I-TREATMENT +con I-TREATMENT +drenaje I-TREATMENT +radiológico, I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anti-TNF I-TREATMENT +o I-TREATMENT +con I-TREATMENT +los I-TREATMENT +nuevos I-TREATMENT +inmunosupresores I-TREATMENT +(tacrolimus). I-TREATMENT +La I-TREATMENT +resección I-TREATMENT +quirúrgica I-TREATMENT +del I-TREATMENT +asa I-TREATMENT +intestinal I-TREATMENT +enferma I-TREATMENT +se I-TREATMENT +reservaría I-TREATMENT +para I-TREATMENT +los I-TREATMENT +casos I-TREATMENT +con I-TREATMENT +fracaso I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +conservador I-TREATMENT +o I-TREATMENT +recurrencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +EC I-TREATMENT +fistulosa I-TREATMENT +(6). I-TREATMENT + I-TREATMENT +M. I-TREATMENT +Valdés I-TREATMENT +Mas, I-TREATMENT +J. I-TREATMENT +A. I-TREATMENT +Pons I-TREATMENT +Miñano I-TREATMENT +y I-TREATMENT +F. I-TREATMENT +Carballo I-TREATMENT +Álvarez I-TREATMENT + I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Aparato I-TREATMENT +Digestivo. I-TREATMENT +Hospital I-TREATMENT +Universitario I-TREATMENT +Virgen I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Arrixaca. I-TREATMENT +Murcia I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +primípara I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +del I-EXPLORATION +29%, I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +12, I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +109/L I-EXPLORATION +con I-EXPLORATION +89, I-EXPLORATION +7% I-EXPLORATION +de I-EXPLORATION +neutrófilos, I-EXPLORATION +amilasemia I-EXPLORATION +de I-EXPLORATION +1.684 I-EXPLORATION +UI/L, I-EXPLORATION +AST I-EXPLORATION +de I-EXPLORATION +41 I-EXPLORATION +UI/L, I-EXPLORATION +ALT I-EXPLORATION +de I-EXPLORATION +75 I-EXPLORATION +UI/L, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +de I-EXPLORATION +81 I-EXPLORATION +UI/L I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +bGT I-EXPLORATION +de I-EXPLORATION +28 I-EXPLORATION +UI/L. I-EXPLORATION +Una I-EXPLORATION +ecografía I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +colecistitis I-EXPLORATION +litiásica, I-EXPLORATION +una I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +y I-EXPLORATION +extrahepática I-EXPLORATION +y I-EXPLORATION +páncreas I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +Una I-EXPLORATION +ecografía I-EXPLORATION +fetal I-EXPLORATION +comprobó I-EXPLORATION +una I-EXPLORATION +gestación I-EXPLORATION +de I-EXPLORATION +18 I-EXPLORATION +semanas I-EXPLORATION +sin I-EXPLORATION +complicaciones. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +ingresó I-TREATMENT +bajo I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +antibiótico I-TREATMENT +pero I-TREATMENT +con I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +horas. I-TREATMENT +Se I-TREATMENT +decidió I-TREATMENT +CL I-TREATMENT +electiva. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +CL I-TREATMENT +hallando I-TREATMENT +una I-TREATMENT +colelitiasis I-TREATMENT +simple I-TREATMENT +con I-TREATMENT +mínimos I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +colecistitis, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +presión I-TREATMENT +intraabdominal I-TREATMENT +inferior I-TREATMENT +a I-TREATMENT +12 I-TREATMENT +mmHg I-TREATMENT +y I-TREATMENT +en I-TREATMENT +un I-TREATMENT +tiempo I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +minutos. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +embarazo I-EVOLUTION +transcurrieron I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +gestante B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +semanas, I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +cuadro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cinco I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +náuseas, I-DERIVED_FROM/TO +vómitos I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +hemiabdomen I-DERIVED_FROM/TO +superior. I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +murphy I-EXPLORATION +positivo. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +x I-EXPLORATION +109/L, I-EXPLORATION +amilasemia I-EXPLORATION +de I-EXPLORATION +1.300 I-EXPLORATION +UI/L, I-EXPLORATION +AST I-EXPLORATION +de I-EXPLORATION +78 I-EXPLORATION +UI/L, I-EXPLORATION +ALT I-EXPLORATION +de I-EXPLORATION +272 I-EXPLORATION +UI/L, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +de I-EXPLORATION +288 I-EXPLORATION +UI/L I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +bGT I-EXPLORATION +de I-EXPLORATION +108 I-EXPLORATION +UI/L. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +halla I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +litiasis I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +no I-EXPLORATION +dilatada. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +claros I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +colecistitis I-EXPLORATION +aguda I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +pancreática I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +El B-EVOLUTION +estado I-EVOLUTION +clínico I-EVOLUTION +se I-EVOLUTION +deterioró I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +estar I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +trimestre, I-EVOLUTION +se B-TREATMENT +decidió I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +realizándose I-TREATMENT +CL I-TREATMENT +con I-TREATMENT +una I-TREATMENT +presión I-TREATMENT +intraabdominal I-TREATMENT +inferior I-TREATMENT +a I-TREATMENT +12 I-TREATMENT +mmHg I-TREATMENT +en I-TREATMENT +un I-TREATMENT +tiempo I-TREATMENT +de I-TREATMENT +55 I-TREATMENT +minutos. I-TREATMENT +Una B-EXPLORATION +colangiografía I-EXPLORATION +intraoperatoria I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +El B-EVOLUTION +postoperatorio I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +gestación I-EVOLUTION +transcurrió I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION + I-EVOLUTION +Durante I-EVOLUTION +la I-EVOLUTION +gestación, I-EVOLUTION +al I-EVOLUTION +igual I-EVOLUTION +que I-EVOLUTION +las I-EVOLUTION +pacientes I-EVOLUTION +que I-EVOLUTION +toman I-EVOLUTION +anticonceptivos I-EVOLUTION +orales I-EVOLUTION +o I-EVOLUTION +estrógenos I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +periodo I-EVOLUTION +menopáusico, I-EVOLUTION +la I-EVOLUTION +incidencia I-EVOLUTION +de I-EVOLUTION +colelitiasis I-EVOLUTION +está I-EVOLUTION +aumentada I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +estímulo I-EVOLUTION +estrogénico I-EVOLUTION +hormonal I-EVOLUTION +(2). I-EVOLUTION +Las I-EVOLUTION +gestantes I-EVOLUTION +no I-EVOLUTION +escapan I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +posibilidad I-EVOLUTION +de I-EVOLUTION +sufrir I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +colecistitis I-EVOLUTION +o I-EVOLUTION +colelitiasis I-EVOLUTION +y I-EVOLUTION +su I-EVOLUTION +manejo I-EVOLUTION +es I-EVOLUTION +similar I-EVOLUTION +al I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +gestante, I-EVOLUTION +incluyendo I-EVOLUTION +una I-EVOLUTION +monitorización I-EVOLUTION +fetal. I-EVOLUTION +La I-EVOLUTION +CL I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +gestación I-EVOLUTION +no I-EVOLUTION +está I-EVOLUTION +exenta I-EVOLUTION +de I-EVOLUTION +riesgos I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +feto I-EVOLUTION +pese I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +gran I-EVOLUTION +aceptación. I-EVOLUTION +Así, I-EVOLUTION +el I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +dióxido I-EVOLUTION +de I-EVOLUTION +carbono I-EVOLUTION +para I-EVOLUTION +realizar I-EVOLUTION +el I-EVOLUTION +pneumoperitoneo I-EVOLUTION +puede I-EVOLUTION +producir I-EVOLUTION +una I-EVOLUTION +acidosis I-EVOLUTION +respiratoria I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +madre I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +feto, I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +propuesto I-EVOLUTION +el I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +óxido I-EVOLUTION +nitroso I-EVOLUTION +(3). I-EVOLUTION +Aun I-EVOLUTION +así, I-EVOLUTION +los I-EVOLUTION +efectos I-EVOLUTION +a I-EVOLUTION +corto I-EVOLUTION +plazo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +acidosis I-EVOLUTION +fetal I-EVOLUTION +severa I-EVOLUTION +en I-EVOLUTION +animales I-EVOLUTION +no I-EVOLUTION +han I-EVOLUTION +demostrado I-EVOLUTION +efectos I-EVOLUTION +adversos I-EVOLUTION +(4). I-EVOLUTION +Además, I-EVOLUTION +un I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +presión I-EVOLUTION +intraabdominal I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +presión I-EVOLUTION +del I-EVOLUTION +útero I-EVOLUTION +sobre I-EVOLUTION +la I-EVOLUTION +vena I-EVOLUTION +cava I-EVOLUTION +inferior I-EVOLUTION +pueden I-EVOLUTION +disminuir I-EVOLUTION +el I-EVOLUTION +flujo I-EVOLUTION +del I-EVOLUTION +retorno I-EVOLUTION +venoso I-EVOLUTION +y I-EVOLUTION +disminuir I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +consiguiente I-EVOLUTION +el I-EVOLUTION +gasto I-EVOLUTION +cardiaco, I-EVOLUTION +el I-EVOLUTION +riego I-EVOLUTION +uterino I-EVOLUTION +y I-EVOLUTION +aparecer I-EVOLUTION +hipoxia I-EVOLUTION +fetal. I-EVOLUTION +Algunos I-EVOLUTION +autores I-EVOLUTION +usan I-EVOLUTION +presiones I-EVOLUTION +intraabdominales I-EVOLUTION +mínimas I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +posición I-EVOLUTION +de I-EVOLUTION +decúbito I-EVOLUTION +lateral I-EVOLUTION +izquierdo I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +mínima I-EVOLUTION +posición I-EVOLUTION +de I-EVOLUTION +anti-Trendelenberg I-EVOLUTION +(4). I-EVOLUTION +Algún I-EVOLUTION +estudio I-EVOLUTION +demuestra I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +puede I-EVOLUTION +trabajar I-EVOLUTION +con I-EVOLUTION +presiones I-EVOLUTION +de I-EVOLUTION +aire I-EVOLUTION +mínimas, I-EVOLUTION +pero I-EVOLUTION +el I-EVOLUTION +riesgo I-EVOLUTION +de I-EVOLUTION +reconversión I-EVOLUTION +es I-EVOLUTION +mayor I-EVOLUTION +(5). I-EVOLUTION +Se I-EVOLUTION +recomienda I-EVOLUTION +colocar I-EVOLUTION +primero I-EVOLUTION +un I-EVOLUTION +trocar I-EVOLUTION +epigástrico I-EVOLUTION +(6). I-EVOLUTION +La I-EVOLUTION +colangiografía I-EVOLUTION +intraoperatoria I-EVOLUTION +no I-EVOLUTION +está I-EVOLUTION +recomendada I-EVOLUTION +de I-EVOLUTION +rutina I-EVOLUTION +y I-EVOLUTION +solo I-EVOLUTION +en I-EVOLUTION +pacientes I-EVOLUTION +con I-EVOLUTION +factores I-EVOLUTION +de I-EVOLUTION +riesgo I-EVOLUTION +para I-EVOLUTION +desarrollar I-EVOLUTION +coledocolitiasis I-EVOLUTION +(historia I-EVOLUTION +de I-EVOLUTION +pancreatitis, I-EVOLUTION +de I-EVOLUTION +ictericia I-EVOLUTION +o I-EVOLUTION +de I-EVOLUTION +dilatación I-EVOLUTION +coledocal) I-EVOLUTION +(7). I-EVOLUTION +Hay I-EVOLUTION +un I-EVOLUTION +mayor I-EVOLUTION +riesgo I-EVOLUTION +de I-EVOLUTION +complicaciones I-EVOLUTION +obstétricas I-EVOLUTION +como I-EVOLUTION +el I-EVOLUTION +aborto I-EVOLUTION +espontáneo I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +trimestre I-EVOLUTION +(7). I-EVOLUTION +La I-EVOLUTION +CL I-EVOLUTION +en I-EVOLUTION +gestantes I-EVOLUTION +debería I-EVOLUTION +de I-EVOLUTION +ser I-EVOLUTION +pospuesta I-EVOLUTION +al I-EVOLUTION +segundo I-EVOLUTION +trimestre I-EVOLUTION +(4). I-EVOLUTION + I-EVOLUTION +Existe I-EVOLUTION +una I-EVOLUTION +amplia I-EVOLUTION +experiencia I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +CL I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +demostrado I-EVOLUTION +una I-EVOLUTION +menor I-EVOLUTION +tasa I-EVOLUTION +de I-EVOLUTION +complicaciones I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +madre I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +feto I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +grupo I-EVOLUTION +de I-EVOLUTION +pacientes I-EVOLUTION +intervenidos I-EVOLUTION +respecto I-EVOLUTION +al I-EVOLUTION +grupo I-EVOLUTION +de I-EVOLUTION +gestantes I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +manejo I-EVOLUTION +conservador I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +patología I-EVOLUTION +biliar I-EVOLUTION +(8). I-EVOLUTION +La I-EVOLUTION +CL I-EVOLUTION +ofrece I-EVOLUTION +ventajas I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +colecistectomía I-EVOLUTION +abierta I-EVOLUTION +y I-EVOLUTION +debe I-EVOLUTION +de I-EVOLUTION +plantearse I-EVOLUTION +como I-EVOLUTION +primera I-EVOLUTION +opción I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +gestación I-EVOLUTION +(9). I-EVOLUTION +Requiere I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +experiencia I-EVOLUTION +quirúrgica I-EVOLUTION +para I-EVOLUTION +conseguir I-EVOLUTION +un I-EVOLUTION +tiempo I-EVOLUTION +quirúrgico I-EVOLUTION +menor I-EVOLUTION +y I-EVOLUTION +debe I-EVOLUTION +de I-EVOLUTION +acompañarse I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +serie I-EVOLUTION +de I-EVOLUTION +medidas I-EVOLUTION +encaminadas I-EVOLUTION +a I-EVOLUTION +disminuir I-EVOLUTION +las I-EVOLUTION +posibles I-EVOLUTION +complicaciones I-EVOLUTION +maternofetales I-EVOLUTION +(10). I-EVOLUTION + I-EVOLUTION +R. I-EVOLUTION +Vilallonga, I-EVOLUTION +J. I-EVOLUTION +J. I-EVOLUTION +Olsina, I-EVOLUTION +C. I-EVOLUTION +Margarit† I-EVOLUTION +y I-EVOLUTION +J. I-EVOLUTION +Balsells I-EVOLUTION + I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cirugía I-EVOLUTION +Hepatobiliopancreática I-EVOLUTION +y I-EVOLUTION +Trasplante I-EVOLUTION +Hepático. I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Cirugía I-EVOLUTION +General I-EVOLUTION +y I-EVOLUTION +del I-EVOLUTION +Aparato I-EVOLUTION +Digestivo. I-EVOLUTION +Hospital I-EVOLUTION +Vall I-EVOLUTION +d´Hebron. I-EVOLUTION +Universidad I-EVOLUTION +Autónoma I-EVOLUTION +de I-EVOLUTION +Barcelona I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +parálisis I-PAST_MEDICAL_HISTORY +facial I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +once I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +fumadora I-PAST_MEDICAL_HISTORY +habitual, I-PAST_MEDICAL_HISTORY +dispepsia I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +ulcerosa, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +ansioso-depresivo, I-PAST_MEDICAL_HISTORY +menstruaciones I-PAST_MEDICAL_HISTORY +irregulares, I-PAST_MEDICAL_HISTORY +multípara I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +sexuales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +veces I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Urgencias I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +doloroso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +hipocondrio I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +lumbar I-PAST_MEDICAL_HISTORY +irradiado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +genitales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +miccional, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +veces I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cólico I-PAST_MEDICAL_HISTORY +nefrítico. I-PAST_MEDICAL_HISTORY +Desde B-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +diámetro I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +dispareunia, I-PRESENT_ILLNESS +leucorrea, I-PRESENT_ILLNESS +disuria, I-PRESENT_ILLNESS +orinas I-PRESENT_ILLNESS +oscuras I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +mugüet I-PRESENT_ILLNESS +oral. I-PRESENT_ILLNESS +Presentando I-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +transtornos I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hábito I-PRESENT_ILLNESS +intestinal. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +presenta I-EXPLORATION +abdomen I-EXPLORATION +doloroso I-EXPLORATION +con I-EXPLORATION +puño-percusión I-EXPLORATION +renal I-EXPLORATION +positiva I-EXPLORATION +y I-EXPLORATION +oleada I-EXPLORATION +ascítica. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +anamnesis I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +se I-EXPLORATION +pensó I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +serie I-EXPLORATION +de I-EXPLORATION +diagnósticos I-EXPLORATION +diferenciales I-EXPLORATION +tales I-EXPLORATION +como: I-EXPLORATION +carcimomatosis I-EXPLORATION +peritoneal, I-EXPLORATION +hepatopatía, I-EXPLORATION +neoplasia I-EXPLORATION +ovárica, I-EXPLORATION +celiaquía, I-EXPLORATION +tuberculosis I-EXPLORATION +intestinal I-EXPLORATION +y I-EXPLORATION +EPI I-EXPLORATION +con I-EXPLORATION +infección I-EXPLORATION +perihepática I-EXPLORATION +(síndrome I-EXPLORATION +de I-EXPLORATION +Fitz-Hugh-Curtis) I-EXPLORATION +por I-EXPLORATION +gonococos I-EXPLORATION +o I-EXPLORATION +chlamidias, I-EXPLORATION +entre I-EXPLORATION +otras I-EXPLORATION +entidades I-EXPLORATION +patológicas. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +presentó I-EXPLORATION +neutrofilia I-EXPLORATION +sin I-EXPLORATION +leucocitosis, I-EXPLORATION +linfopenia, I-EXPLORATION +anemia I-EXPLORATION +microcítica I-EXPLORATION +hipocrómica, I-EXPLORATION +plaquetas I-EXPLORATION +disminuidas, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +VSG I-EXPLORATION +(111 I-EXPLORATION +mm/h, I-EXPLORATION +n I-EXPLORATION +< I-EXPLORATION +10) I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +PCR I-EXPLORATION +(182 I-EXPLORATION +mg/l, I-EXPLORATION +n I-EXPLORATION +< I-EXPLORATION +5). I-EXPLORATION +Además I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +hipoalbuminemia I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +g/l, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +globulinas, I-EXPLORATION +aumento I-EXPLORATION +discreto I-EXPLORATION +de I-EXPLORATION +bilirrubina. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +sometió I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +ginecológico, I-EXPLORATION +resultando I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +Mantoux I-EXPLORATION +fue I-EXPLORATION +negativa, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +Brucella, I-EXPLORATION +Retrovirus, I-EXPLORATION +VHC I-EXPLORATION +y I-EXPLORATION +VHB. I-EXPLORATION +Se I-EXPLORATION +encontró I-EXPLORATION +elevado I-EXPLORATION +el I-EXPLORATION +ADA I-EXPLORATION +(25, I-EXPLORATION +8 I-EXPLORATION +U/l, I-EXPLORATION +n I-EXPLORATION +< I-EXPLORATION +18, I-EXPLORATION +2) I-EXPLORATION +y I-EXPLORATION +muy I-EXPLORATION +elevado I-EXPLORATION +el I-EXPLORATION +antígeno I-EXPLORATION +neoplásico I-EXPLORATION +Ca-125 I-EXPLORATION +(714 I-EXPLORATION +U/ml, I-EXPLORATION +n I-EXPLORATION +< I-EXPLORATION +35). I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +un I-EXPLORATION +exudado I-EXPLORATION +faríngeo I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +S. I-EXPLORATION +aureus. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +antigliadina I-EXPLORATION +y I-EXPLORATION +antiendomisio I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +su I-EXPLORATION +vez I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +orina I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +bilirrubina I-EXPLORATION +moderado, I-EXPLORATION +indicio I-EXPLORATION +de I-EXPLORATION +cuerpos I-EXPLORATION +cetónicos, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +urocultivo I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +heces I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +Ziehl-Neelsen I-EXPLORATION +para I-EXPLORATION +BAAR I-EXPLORATION +en I-EXPLORATION +dos I-EXPLORATION +ocasiones, I-EXPLORATION +y I-EXPLORATION +negativo I-EXPLORATION +también I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +Lowenstein. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +paracentesis I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +ascítico I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +un I-EXPLORATION +líquido I-EXPLORATION +claro I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +1.476 I-EXPLORATION +células/ml, I-EXPLORATION +siendo I-EXPLORATION +un I-EXPLORATION +80% I-EXPLORATION +polimorfos I-EXPLORATION +nucleares I-EXPLORATION +(n I-EXPLORATION +< I-EXPLORATION +20%), I-EXPLORATION +LDH I-EXPLORATION +muy I-EXPLORATION +elevada, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +S. I-EXPLORATION +haemoliticus, I-EXPLORATION +resultando I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Ziehl-Neelsen I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiología I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +podemos I-EXPLORATION +comprobar I-EXPLORATION +una I-EXPLORATION +distribución I-EXPLORATION +de I-EXPLORATION +gas I-EXPLORATION +normal I-EXPLORATION +aunque I-EXPLORATION +con I-EXPLORATION +cierta I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +situarse I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +centro, I-EXPLORATION +no I-EXPLORATION +pudiendo I-EXPLORATION +valorarse I-EXPLORATION +adecuadamente I-EXPLORATION +al I-EXPLORATION +no I-EXPLORATION +poder I-EXPLORATION +visualizarse I-EXPLORATION +los I-EXPLORATION +flancos. I-EXPLORATION +En I-EXPLORATION +pelvis I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +signos I-EXPLORATION +que I-EXPLORATION +indican I-EXPLORATION +la I-EXPLORATION +presentación I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +libre. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +nos I-EXPLORATION +muestra I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +peritoneal, I-EXPLORATION +no I-EXPLORATION +existiendo I-EXPLORATION +hallazgos I-EXPLORATION +significativos I-EXPLORATION +en I-EXPLORATION +vísceras I-EXPLORATION +abdominales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +baritado I-EXPLORATION +gastroduodenal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +alteración I-EXPLORATION +del I-EXPLORATION +tránsito I-EXPLORATION +intestinal. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +abominal I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +abundante I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +y I-EXPLORATION +engrosamiento I-EXPLORATION +peritoneal I-EXPLORATION +como I-EXPLORATION +signos I-EXPLORATION +más I-EXPLORATION +llamativos. I-EXPLORATION + I-EXPLORATION +Sin I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +clara I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +patología I-EXPLORATION +principal I-EXPLORATION +que I-EXPLORATION +originó I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +y I-EXPLORATION +teniendo I-EXPLORATION +en I-EXPLORATION +mente I-EXPLORATION +la I-EXPLORATION +carcinomatosis I-EXPLORATION +peritoneal, I-EXPLORATION +una I-EXPLORATION +infección I-EXPLORATION +difusa I-EXPLORATION +intraperitoneal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +propia I-EXPLORATION +tuberculosis I-EXPLORATION +peritoneal, I-EXPLORATION +se I-EXPLORATION +ingresó I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +para I-EXPLORATION +ser I-EXPLORATION +sometida I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +laparoscopia I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +reglada. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +entrar I-EXPLORATION +en I-EXPLORATION +cavidad I-EXPLORATION +nos I-EXPLORATION +encontramos I-EXPLORATION +multitud I-EXPLORATION +de I-EXPLORATION +adherencias I-EXPLORATION +y I-EXPLORATION +septos I-EXPLORATION +intraperitoneales I-EXPLORATION +y I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +distintos I-EXPLORATION +órganos I-EXPLORATION +abdominales, I-EXPLORATION +destacando I-EXPLORATION +las I-EXPLORATION +adherencias I-EXPLORATION +hepáticas. I-EXPLORATION +Además I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +siembra I-EXPLORATION +peritoneal I-EXPLORATION +muy I-EXPLORATION +extensa I-EXPLORATION +de I-EXPLORATION +tuberculomas. I-EXPLORATION +Se I-EXPLORATION +tomó I-EXPLORATION +biopsia I-EXPLORATION +peritoneal I-EXPLORATION +de I-EXPLORATION +tuberculomas I-EXPLORATION +y I-EXPLORATION +hepática, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +liberaron I-EXPLORATION +las I-EXPLORATION +adherencias I-EXPLORATION +más I-EXPLORATION +llamativas. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +dieron I-EXPLORATION +a I-EXPLORATION +conocer I-EXPLORATION +una I-EXPLORATION +granulomatosis I-EXPLORATION +peritoneal I-EXPLORATION +de I-EXPLORATION +etiología I-EXPLORATION +sugestivamente I-EXPLORATION +tuberculosa I-EXPLORATION +con I-EXPLORATION +hígado I-EXPLORATION +con I-EXPLORATION +granulomatosis I-EXPLORATION +capsular I-EXPLORATION +de I-EXPLORATION +etiología I-EXPLORATION +sugestivamente I-EXPLORATION +tuberculosa I-EXPLORATION +de I-EXPLORATION +alteraciones I-EXPLORATION +inflamatorias I-EXPLORATION +parenquimatosas I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +reactivo. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +28 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +postprandrial, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +diarrea. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +estaba I-EXPLORATION +pálida I-EXPLORATION +y I-EXPLORATION +presentaba I-EXPLORATION +dolor I-EXPLORATION +epigástrico I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +abdominal. I-EXPLORATION +Analítica: I-EXPLORATION +Hb I-EXPLORATION +8, I-EXPLORATION +6 I-EXPLORATION +g/dl, I-EXPLORATION +Htco I-EXPLORATION +28%, I-EXPLORATION +VCM I-EXPLORATION +64, I-EXPLORATION +Fe I-EXPLORATION +6 I-EXPLORATION +mcg/dl, I-EXPLORATION +ferritina I-EXPLORATION +1 I-EXPLORATION +ng/ml, I-EXPLORATION +saturación I-EXPLORATION +transferrina I-EXPLORATION +1, I-EXPLORATION +5%, I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +fólico I-EXPLORATION +normales. I-EXPLORATION +Anticuerpos I-EXPLORATION +antigliadina I-EXPLORATION +24, I-EXPLORATION +5 I-EXPLORATION +(0-20 I-EXPLORATION +UI/ml) I-EXPLORATION +y I-EXPLORATION +antiendomisio I-EXPLORATION +> I-EXPLORATION +20. I-EXPLORATION +Resto I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +biológicos I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +Ca19.9, I-EXPLORATION +CEA, I-EXPLORATION +alfafetoproteína I-EXPLORATION +normales. I-EXPLORATION +Hemólisis I-EXPLORATION +negativo. I-EXPLORATION +Rx I-EXPLORATION +gastroduodenal-tránsito I-EXPLORATION +intestinal: I-EXPLORATION +varias I-EXPLORATION +estenosis I-EXPLORATION +duodenales, I-EXPLORATION +con I-EXPLORATION +ulceración I-EXPLORATION +e I-EXPLORATION +imágenes I-EXPLORATION +diverticulares I-EXPLORATION +en I-EXPLORATION +duodeno I-EXPLORATION +distal-yeyuno. I-EXPLORATION +Esofagogastroscopia: I-EXPLORATION +mucosa I-EXPLORATION +duodenal I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +atrófico I-EXPLORATION +y I-EXPLORATION +ulceraciones I-EXPLORATION +lineales I-EXPLORATION +postbulbares. I-EXPLORATION +Anatomía I-EXPLORATION +patológica: I-EXPLORATION +atrofia I-EXPLORATION +vellositaria I-EXPLORATION +severa I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +extensa I-EXPLORATION +inflamatoria. I-EXPLORATION +No I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +granulomas, I-EXPLORATION +tejido I-EXPLORATION +linfoide I-EXPLORATION +ni I-EXPLORATION +carcinoma. I-EXPLORATION +Biopsia I-EXPLORATION +con I-EXPLORATION +cápsula I-EXPLORATION +de I-EXPLORATION +Crosby I-EXPLORATION +dirigida I-EXPLORATION +a I-EXPLORATION +zona I-EXPLORATION +estenótica: I-EXPLORATION +hallazgos I-EXPLORATION +histológicos I-EXPLORATION +similares. I-EXPLORATION +TAC I-EXPLORATION +abdominal: I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +dieta I-TREATMENT +sin I-TREATMENT +gluten I-TREATMENT +con B-EVOLUTION +mejoría I-EVOLUTION +analítica I-EVOLUTION +y I-EVOLUTION +clínica I-EVOLUTION +progresiva I-EVOLUTION +y I-EVOLUTION +posterior I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +parámetros. I-EVOLUTION +Ocho I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +asintomática I-EVOLUTION +con I-EVOLUTION +controles I-EVOLUTION +anuales. I-EVOLUTION +La B-EXPLORATION +endoscopia I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +histología I-EXPLORATION +objetivaron I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +intestinal I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +analítica, I-EXPLORATION +incluidos I-EXPLORATION +anticuerpos I-EXPLORATION +de I-EXPLORATION +celiaquia, I-EXPLORATION +no I-EXPLORATION +presenta I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +estenosis I-EXPLORATION +del I-EXPLORATION +duodeno I-EXPLORATION +es I-EXPLORATION +una I-EXPLORATION +forma I-EXPLORATION +inusual I-EXPLORATION +del I-EXPLORATION +presentación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +celiaca I-EXPLORATION +(3). I-EXPLORATION +La I-EXPLORATION +ulceración I-EXPLORATION +intestinal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +estenosis I-EXPLORATION +se I-EXPLORATION +cree I-EXPLORATION +que I-EXPLORATION +aparecen I-EXPLORATION +en I-EXPLORATION +zonas I-EXPLORATION +con I-EXPLORATION +mucosa I-EXPLORATION +inflamatoria. I-EXPLORATION +Estas I-EXPLORATION +lesiones I-EXPLORATION +típicamente I-EXPLORATION +se I-EXPLORATION +localizan I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +proximal I-EXPLORATION +y I-EXPLORATION +generalmente I-EXPLORATION +se I-EXPLORATION +describen I-EXPLORATION +en I-EXPLORATION +fases I-EXPLORATION +avanzadas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +celiaca I-EXPLORATION +(1,2). I-EXPLORATION +Más I-EXPLORATION +recientemente, I-EXPLORATION +Schweger I-EXPLORATION +y I-EXPLORATION +Murray I-EXPLORATION +(3) I-EXPLORATION +han I-EXPLORATION +descrito I-EXPLORATION +5 I-EXPLORATION +casos I-EXPLORATION +más I-EXPLORATION +indicando I-EXPLORATION +que I-EXPLORATION +estas I-EXPLORATION +complicaciones, I-EXPLORATION +si I-EXPLORATION +bien I-EXPLORATION +raras, I-EXPLORATION +pueden I-EXPLORATION +presentarse I-EXPLORATION +más I-EXPLORATION +frecuentemente I-EXPLORATION +que I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +pensaba I-EXPLORATION +y I-EXPLORATION +parece I-EXPLORATION +que I-EXPLORATION +podrían I-EXPLORATION +aparecer I-EXPLORATION +más I-EXPLORATION +temprano I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +curso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad. I-EXPLORATION +Las I-EXPLORATION +erosiones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +duodenal I-EXPLORATION +en I-EXPLORATION +pacientes I-EXPLORATION +celiacos I-EXPLORATION +han I-EXPLORATION +sido I-EXPLORATION +descritas I-EXPLORATION +recientemente I-EXPLORATION +endoscópicamente I-EXPLORATION +(4). I-EXPLORATION +Nuestra I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +clínica I-EXPLORATION +típica I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +celiaca, I-EXPLORATION +presentando I-EXPLORATION +estreñimiento I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +epigástrico. I-EXPLORATION +La I-EXPLORATION +radiología I-EXPLORATION +objetivó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +estenosis I-EXPLORATION +duodenal I-EXPLORATION +y I-EXPLORATION +ulceración, I-EXPLORATION +y I-EXPLORATION +tuvimos I-EXPLORATION +que I-EXPLORATION +realizar I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +entre I-EXPLORATION +enfermedad I-EXPLORATION +celiaca I-EXPLORATION +y I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn, I-EXPLORATION +linfoma, I-EXPLORATION +carcinoma I-EXPLORATION +intestinal, I-EXPLORATION +y I-EXPLORATION +yeyunitis I-EXPLORATION +ulcerativa. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +analíticos, I-EXPLORATION +endoscópicos I-EXPLORATION +e I-EXPLORATION +histológicos, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +evolución I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +dieta I-EXPLORATION +sin I-EXPLORATION +gluten, I-EXPLORATION +confirmaron I-EXPLORATION +la I-EXPLORATION +enfermedad. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +celiaca I-EXPLORATION +debe I-EXPLORATION +ser I-EXPLORATION +tenido I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +el I-EXPLORATION +desarrollo I-EXPLORATION +temprano I-EXPLORATION +de I-EXPLORATION +estenosis I-EXPLORATION +duodenal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +ulceraciones, I-EXPLORATION +y I-EXPLORATION +más I-EXPLORATION +en I-EXPLORATION +aquellos I-EXPLORATION +pacientes I-EXPLORATION +con I-EXPLORATION +síntomas I-EXPLORATION +no I-EXPLORATION +típicos I-EXPLORATION +o I-EXPLORATION +con I-EXPLORATION +hallazgos I-EXPLORATION +radiológicos I-EXPLORATION +inespecíficos, I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +cambios I-EXPLORATION +radiológicos I-EXPLORATION +antes I-EXPLORATION +mencionados I-EXPLORATION +pueden I-EXPLORATION +preceder I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +clínico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad. I-EXPLORATION + I-EXPLORATION +A. I-EXPLORATION +Castiella, I-EXPLORATION +I. I-EXPLORATION +Aramberri1, I-EXPLORATION +J. I-EXPLORATION +Fernández, I-EXPLORATION +C. I-EXPLORATION +Carrera1, I-EXPLORATION +L. I-EXPLORATION +Legasa2, I-EXPLORATION +I. I-EXPLORATION +Ruiz3 I-EXPLORATION +y I-EXPLORATION +E. I-EXPLORATION +Zapata I-EXPLORATION + I-EXPLORATION +Unidad I-EXPLORATION +de I-EXPLORATION +Gastroenterología, I-EXPLORATION +1Medicina I-EXPLORATION +de I-EXPLORATION +Familia, I-EXPLORATION +2Servicios I-EXPLORATION +de I-EXPLORATION +Radiología I-EXPLORATION +y I-EXPLORATION +3Anatomía I-EXPLORATION +Patológica. I-EXPLORATION +Hospital I-EXPLORATION +Mendaro. I-EXPLORATION +Gipuzkoa I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diagnosticada B-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +14 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +PQH I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +poliquistosis I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sometida I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +drenaje I-PAST_MEDICAL_HISTORY +percutáneo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +quistes I-PAST_MEDICAL_HISTORY +hepáticos. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +incluida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +lista I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +espera I-PRESENT_ILLNESS +(LE) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +trasplante I-PRESENT_ILLNESS +hepático I-PRESENT_ILLNESS +(TH) I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +PQH I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +criterios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hepatomegalia I-PRESENT_ILLNESS +gigantesca, I-PRESENT_ILLNESS +caquexia, I-PRESENT_ILLNESS +hipertensión I-PRESENT_ILLNESS +portal, I-PRESENT_ILLNESS +ascitis, I-PRESENT_ILLNESS +minusvalía I-PRESENT_ILLNESS +física I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +social I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +grado I-PRESENT_ILLNESS +II I-PRESENT_ILLNESS +(creatinemia I-PRESENT_ILLNESS +2, I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mg/dl). I-PRESENT_ILLNESS +La B-EXPLORATION +puntuación I-EXPLORATION +MELD I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +23. I-EXPLORATION +El B-TREATMENT +TH I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +con I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +preservación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +inferior I-TREATMENT +(técnica I-TREATMENT +de I-TREATMENT +piggy-back), I-TREATMENT +sin I-TREATMENT +by-pass I-TREATMENT +veno-venoso I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +biliar I-TREATMENT +mediante I-TREATMENT +colédoco-yeyunostomía I-TREATMENT +sobre I-TREATMENT +asa I-TREATMENT +desfuncionalizada I-TREATMENT +en I-TREATMENT +Y I-TREATMENT +de I-TREATMENT +Roux. I-TREATMENT +El I-TREATMENT +injerto I-TREATMENT +se I-TREATMENT +perfundió I-TREATMENT +y I-TREATMENT +almacenó I-TREATMENT +con I-TREATMENT +la I-TREATMENT +solución I-TREATMENT +de I-TREATMENT +preservación I-TREATMENT +de I-TREATMENT +Celsior. I-TREATMENT +Tiempo I-TREATMENT +de I-TREATMENT +isquemia I-TREATMENT +fría: I-TREATMENT +5 I-TREATMENT +h I-TREATMENT +50 I-TREATMENT +min. I-TREATMENT +Peso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +de I-TREATMENT +hepatectomía: I-TREATMENT +14 I-TREATMENT +kg. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +presentó I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +reperfusión. I-TREATMENT +Duración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención: I-TREATMENT +6 I-TREATMENT +h I-TREATMENT +25 I-TREATMENT +min. I-TREATMENT +Transfusión: I-TREATMENT +2.620 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes I-TREATMENT +y I-TREATMENT +2.370 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +plasma. I-TREATMENT +Debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +insuficiencia I-TREATMENT +renal, I-TREATMENT +la I-TREATMENT +inducción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +inmunosupresión I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +con I-TREATMENT +basiliximab I-TREATMENT +y I-TREATMENT +corticoides; I-TREATMENT +al I-TREATMENT +4º I-TREATMENT +día I-TREATMENT +del I-TREATMENT +trasplante, I-TREATMENT +siendo I-TREATMENT +normal I-TREATMENT +la I-TREATMENT +creatinina I-TREATMENT +(1 I-TREATMENT +mg/dl), I-TREATMENT +se I-TREATMENT +introdujo I-TREATMENT +tacrolimus. I-TREATMENT +La B-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +UCI I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +4 I-EVOLUTION +días. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +14 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +TH I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +hospitalaria. I-EVOLUTION +Actualmente I-EVOLUTION +han I-EVOLUTION +transcurrido I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +TH, I-EVOLUTION +la I-EVOLUTION +enferma I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +bien, I-EVOLUTION +hace I-EVOLUTION +vida I-EVOLUTION +normal I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +pruebas I-EVOLUTION +de I-EVOLUTION +función I-EVOLUTION +hepática I-EVOLUTION +son I-EVOLUTION +normales. I-EVOLUTION + I-EVOLUTION + +Una B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +es B-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +ante I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +hallazgo I-DERIVED_FROM/TO +ambulatorio I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +TAC I-DERIVED_FROM/TO +abdominal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +lesión I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +7 I-DERIVED_FROM/TO +cm I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +lóbulo I-DERIVED_FROM/TO +hepático I-DERIVED_FROM/TO +izquierdo. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-PAST_MEDICAL_HISTORY +trata I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +sana I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +acudido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cabecera I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +realizarse I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +chequeo I-PRESENT_ILLNESS +rutinario I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +detectó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +analítica I-PRESENT_ILLNESS +convencional I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +discreta I-PRESENT_ILLNESS +elevación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +transaminasas, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +decidió I-PRESENT_ILLNESS +completar I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +prueba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +imagen. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +ninguna I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +reseñable I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aparatos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +llamando I-EXPLORATION +únicamente I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +discreta I-EXPLORATION +molestia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +nuestra I-EXPLORATION +unidad I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +pruebas I-EXPLORATION +complementarias: I-EXPLORATION + I-EXPLORATION +Hemograma I-EXPLORATION +y I-EXPLORATION +coagulación: I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Bioquímica: I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +1, I-EXPLORATION +12, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +690 I-EXPLORATION +(n I-EXPLORATION +< I-EXPLORATION +258), I-EXPLORATION +LDH I-EXPLORATION +359, I-EXPLORATION +GOT I-EXPLORATION +(AST) I-EXPLORATION +185 I-EXPLORATION +(n I-EXPLORATION +< I-EXPLORATION +40), I-EXPLORATION +GPT I-EXPLORATION +(ALT) I-EXPLORATION +211 I-EXPLORATION +(n I-EXPLORATION +< I-EXPLORATION +40), I-EXPLORATION +GGT I-EXPLORATION +673 I-EXPLORATION +(n I-EXPLORATION +< I-EXPLORATION +36), I-EXPLORATION +resto I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Marcadores I-EXPLORATION +tumorales: I-EXPLORATION +CA I-EXPLORATION +19.9, I-EXPLORATION +10.9, I-EXPLORATION +alfafetoproteína I-EXPLORATION +386, I-EXPLORATION +9 I-EXPLORATION +(n I-EXPLORATION +< I-EXPLORATION +10), I-EXPLORATION +CEA I-EXPLORATION +1.12. I-EXPLORATION + I-EXPLORATION +EKG: I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION + I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +TAC I-EXPLORATION +abdominal: I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +delimitados, I-EXPLORATION +centrada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +medial I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +izquierdo, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +al I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +derecho. I-EXPLORATION +La I-EXPLORATION +masa I-EXPLORATION +produce I-EXPLORATION +compresión I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +principal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +porta I-EXPLORATION +y, I-EXPLORATION +sobre I-EXPLORATION +todo, I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rama I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +discreta I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +árbol I-EXPLORATION +biliar I-EXPLORATION +izquierdo. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +está I-EXPLORATION +poco I-EXPLORATION +vascularizada I-EXPLORATION +y I-EXPLORATION +muestra I-EXPLORATION +importantes I-EXPLORATION +áreas I-EXPLORATION +necróticas. I-EXPLORATION + I-EXPLORATION +Biopsia I-EXPLORATION +hepática: I-EXPLORATION +cambios I-EXPLORATION +de I-EXPLORATION +hiperplasia I-EXPLORATION +nodular I-EXPLORATION +con I-EXPLORATION +marcada I-EXPLORATION +esteatosis, I-EXPLORATION +no I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +malignidad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +material I-EXPLORATION +remitido. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +discordancia I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +y I-EXPLORATION +analíticas, I-EXPLORATION +que I-EXPLORATION +orientaban I-EXPLORATION +hacia I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +neoplásico, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +(no I-EXPLORATION +concluyente I-EXPLORATION +de I-EXPLORATION +malignidad) I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +explicar I-EXPLORATION +la I-EXPLORATION +situación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +ofreciéndole I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cirugía. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +acepta I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +practicándosele I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +los I-TREATMENT +segmentos I-TREATMENT +IV I-TREATMENT +y I-TREATMENT +V I-TREATMENT +hepáticos. I-TREATMENT + I-TREATMENT +Durante B-EXPLORATION +la I-EXPLORATION +operación I-EXPLORATION +se I-EXPLORATION +envía I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +intraoperatoria I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +informada I-EXPLORATION +nuevamente I-EXPLORATION +como I-EXPLORATION +biopsia I-EXPLORATION +no I-EXPLORATION +concluyente I-EXPLORATION +de I-EXPLORATION +malignidad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +material I-EXPLORATION +remitido, I-EXPLORATION +pero I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +macroscópicamente I-EXPLORATION +se I-EXPLORATION +diferencia I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +bien I-EXPLORATION +delimitado I-EXPLORATION +y I-EXPLORATION +encapsulado, I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +central I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño, I-EXPLORATION +necrosado I-EXPLORATION +y I-EXPLORATION +multilobulado. I-EXPLORATION +Microscópicamente I-EXPLORATION +se I-EXPLORATION +diferencian I-EXPLORATION +áreas I-EXPLORATION +extensas I-EXPLORATION +sin I-EXPLORATION +atipias, I-EXPLORATION +con I-EXPLORATION +abundantes I-EXPLORATION +vacuolas I-EXPLORATION +lipídicas I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +muy I-EXPLORATION +bajo I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +áreas I-EXPLORATION +con I-EXPLORATION +alta I-EXPLORATION +celuraridad, I-EXPLORATION +núcleos I-EXPLORATION +atípicos, I-EXPLORATION +mitosis I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +en I-EXPLORATION +torno I-EXPLORATION +al I-EXPLORATION +15%. I-EXPLORATION +Finalmente I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +es I-EXPLORATION +catalogado I-EXPLORATION +como I-EXPLORATION +hepatocarcinoma I-EXPLORATION +bien I-EXPLORATION +diferenciado I-EXPLORATION +(grado I-EXPLORATION +II) I-EXPLORATION +rico I-EXPLORATION +en I-EXPLORATION +lípidos. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +ninguna I-EVOLUTION +complicación I-EVOLUTION +reseñable I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +posterior I-EVOLUTION +seguimiento I-EVOLUTION +en I-EVOLUTION +consultas I-EVOLUTION +externas. I-EVOLUTION +Actualmente B-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +asintomática I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +comprobado I-EXPLORATION +la I-EXPLORATION +normalización I-EXPLORATION +tanto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +transaminasas I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +alfafetoproteína. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diabético B-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II. I-PAST_MEDICAL_HISTORY +Bebedor I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pancreatitis I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +es I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible, I-EXPLORATION +no I-EXPLORATION +presenta I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +ni I-EXPLORATION +alteraciones I-EXPLORATION +analíticas. I-EXPLORATION + I-EXPLORATION +Ingresa I-EXPLORATION +en I-EXPLORATION +observación I-EXPLORATION +practicándose I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +pancreatitis I-EXPLORATION +crónica I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +calcificaciones. I-EXPLORATION +Existen I-EXPLORATION +dos I-EXPLORATION +formaciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +páncreas: I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cola I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +pseudoquiste I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +sólido I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +que I-EXPLORATION +corresponde I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +pseudoaneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +gastroduodenal. I-EXPLORATION +Evoluciona B-EVOLUTION +favorablemente I-EVOLUTION +mejorando I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +presentando I-EVOLUTION +una I-EVOLUTION +ligera I-EVOLUTION +anemización. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +presenta I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +muy I-EVOLUTION +intenso I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +hematemesis I-EVOLUTION +y I-EVOLUTION +rectorragia I-EVOLUTION +masiva. I-EVOLUTION +Se I-EVOLUTION +produce I-EVOLUTION +un I-EVOLUTION +shock I-EVOLUTION +hemodinámico I-EVOLUTION +mejorando I-EVOLUTION +posteriormente I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +persistiendo I-EVOLUTION +el I-EVOLUTION +sangrado. I-EVOLUTION +Una B-EXPLORATION +nueva I-EXPLORATION +TC I-EXPLORATION +muestra I-EXPLORATION +la I-EXPLORATION +desaparición I-EXPLORATION +del I-EXPLORATION +pseudoquiste I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cola I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +pancreática I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +arterial I-EXPLORATION +activo I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION +El I-EXPLORATION +cuadro I-EXPLORATION +es I-EXPLORATION +interpretado I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +drenaje I-EXPLORATION +espontáneo I-EXPLORATION +del I-EXPLORATION +pseudoquiste I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +gástrica I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +sangrado I-EXPLORATION +digestivo I-EXPLORATION +ocasionado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +pseudoaneurisma I-EXPLORATION +en I-EXPLORATION +comunicación I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +del I-EXPLORATION +pseudoquiste I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +tubo I-EXPLORATION +digestivo. I-EXPLORATION +Ante B-TREATMENT +tal I-TREATMENT +situación I-TREATMENT +se I-TREATMENT +desaconseja I-TREATMENT +el I-TREATMENT +traslado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +interveniene I-TREATMENT +quirúrgicamente. I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +aprecia I-TREATMENT +una I-TREATMENT +masa I-TREATMENT +del I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +un I-TREATMENT +puño I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cabeza I-TREATMENT +pancreática. I-TREATMENT +Se I-TREATMENT +aborda I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +gastroduodenal I-TREATMENT +que I-TREATMENT +se I-TREATMENT +liga I-TREATMENT +en I-TREATMENT +el I-TREATMENT +origen I-TREATMENT +para I-TREATMENT +detener I-TREATMENT +la I-TREATMENT +principal I-TREATMENT +fuente I-TREATMENT +de I-TREATMENT +sangre I-TREATMENT +que I-TREATMENT +alimenta I-TREATMENT +el I-TREATMENT +aneurisma. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +gastrotomía I-TREATMENT +comprobando I-TREATMENT +la I-TREATMENT +comunicación I-TREATMENT +del I-TREATMENT +pseudoquiste I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cola I-TREATMENT +con I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +gástrica I-TREATMENT +posterior I-TREATMENT +y I-TREATMENT +comprobando I-TREATMENT +que I-TREATMENT +no I-TREATMENT +existe I-TREATMENT +sangrado. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +es I-EVOLUTION +favorable. I-EVOLUTION +A B-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +pocos I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +intervención, I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +haber I-DERIVED_FROM/TO +repuesto I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +primeras I-DERIVED_FROM/TO +horas I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +hematocrito, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +aprecia I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +disminución I-DERIVED_FROM/TO +progresiva I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +valores I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hemoglobina, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +remite I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +enfermo I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +radiología I-DERIVED_FROM/TO +intervencionista. I-DERIVED_FROM/TO +Se B-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +arteriografía I-EXPLORATION +selectiva I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +acceder I-EXPLORATION +al I-EXPLORATION +pseudoaneurisma I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +principal I-EXPLORATION +que I-EXPLORATION +lo I-EXPLORATION +nutre, I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +gastroduodenal, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +accede I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +ramas I-EXPLORATION +arteriales I-EXPLORATION +secundarias I-EXPLORATION +que I-EXPLORATION +proceden I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pancreático-yeyunal. I-EXPLORATION +Se B-TREATMENT +consigue I-TREATMENT +excluir I-TREATMENT +por I-TREATMENT +completo I-TREATMENT +el I-TREATMENT +pseudoaneurisma. I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +siguientes I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +estable I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +evidencian I-EVOLUTION +nuevos I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +sangrado. I-EVOLUTION +Tras I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +histerectomía, I-PAST_MEDICAL_HISTORY +cólicos I-PAST_MEDICAL_HISTORY +renales, I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +B, I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +megaloblástica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cólicos I-PAST_MEDICAL_HISTORY +biliares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +hemiabdomen I-EXPLORATION +superior, I-EXPLORATION +especialmente I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho. I-EXPLORATION +Analítica I-EXPLORATION +al I-EXPLORATION +ingreso: I-EXPLORATION +17 I-EXPLORATION +x I-EXPLORATION +109/l I-EXPLORATION +leucocitos I-EXPLORATION +con I-EXPLORATION +86% I-EXPLORATION +de I-EXPLORATION +neutrofilia; I-EXPLORATION +amilasemia I-EXPLORATION +5.203 I-EXPLORATION +U/l; I-EXPLORATION +amilasuria I-EXPLORATION +43.703 I-EXPLORATION +U/l; I-EXPLORATION +LDH I-EXPLORATION +675 I-EXPLORATION +U/l; I-EXPLORATION +bilirubina I-EXPLORATION +total I-EXPLORATION +1, I-EXPLORATION +55 I-EXPLORATION +mg/dl; I-EXPLORATION +GOT I-EXPLORATION +111 I-EXPLORATION +U/L; I-EXPLORATION +GPT I-EXPLORATION +152 I-EXPLORATION +U/l; I-EXPLORATION +GGT I-EXPLORATION +203 I-EXPLORATION +U/l; I-EXPLORATION +PH I-EXPLORATION +7.222, I-EXPLORATION +PCO2 I-EXPLORATION +28, I-EXPLORATION +8 I-EXPLORATION +mmHg; I-EXPLORATION +PO2 I-EXPLORATION +80 I-EXPLORATION +mmHg; I-EXPLORATION +bicarbonato I-EXPLORATION +13, I-EXPLORATION +7 I-EXPLORATION +mmol/l; I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +normales. I-EXPLORATION +A I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +horas I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +mantiene I-EXPLORATION +cifras I-EXPLORATION +similares I-EXPLORATION +de I-EXPLORATION +amilasemia I-EXPLORATION +y I-EXPLORATION +amilasuria I-EXPLORATION +con I-EXPLORATION +alteraciones I-EXPLORATION +graves I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +coagulación: I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +50%; I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +cefalina I-EXPLORATION +48, I-EXPLORATION +2 I-EXPLORATION +s. I-EXPLORATION +Por I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +del I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +aprecia: I-EXPLORATION +colecistitis I-EXPLORATION +aguda I-EXPLORATION +litiásica, I-EXPLORATION +coledocolitiasis, I-EXPLORATION +aumento I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +del I-EXPLORATION +páncreas I-EXPLORATION +y I-EXPLORATION +ascitis, I-EXPLORATION +apreciándose I-EXPLORATION +en I-EXPLORATION +bazo I-EXPLORATION +múltiples I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +infarto. I-EXPLORATION +A B-TREATMENT +los I-TREATMENT +tres I-TREATMENT +días I-TREATMENT +del I-TREATMENT +ingreso I-TREATMENT +se I-TREATMENT +practica I-TREATMENT +esfinterotomía I-TREATMENT +endoscópica. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +tórpida, I-EVOLUTION +falleciendo I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +17 I-EVOLUTION +días I-EVOLUTION +por I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +shock I-EVOLUTION +hemorrágico I-EVOLUTION +de I-EVOLUTION +origen I-EVOLUTION +digestivo. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +quistes I-PAST_MEDICAL_HISTORY +renales I-PAST_MEDICAL_HISTORY +bilaterales, I-PAST_MEDICAL_HISTORY +hemorragia I-PAST_MEDICAL_HISTORY +digestiva I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +úlcera I-PAST_MEDICAL_HISTORY +duodenal, I-PAST_MEDICAL_HISTORY +dislipemia, I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +I I-PAST_MEDICAL_HISTORY +(índice I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +masa I-PAST_MEDICAL_HISTORY +corporal I-PAST_MEDICAL_HISTORY +33, I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +kg/m2) I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +prolactinoma. I-PAST_MEDICAL_HISTORY +Presenta B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +suprarrenal I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +funcionante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +tamaño, I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +TC I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +Se B-TREATMENT +efectuó I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +laparoscópico, I-TREATMENT +con I-TREATMENT +liberación I-TREATMENT +del I-TREATMENT +ángulo I-TREATMENT +esplénico I-TREATMENT +del I-TREATMENT +colon I-TREATMENT +y I-TREATMENT +movilización I-TREATMENT +medial I-TREATMENT +espleno-pancreática; I-TREATMENT +sección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +principal I-TREATMENT +adrenal I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +de I-TREATMENT +los I-TREATMENT +vasos I-TREATMENT +accesorios I-TREATMENT +venosos I-TREATMENT +y I-TREATMENT +arteriales; I-TREATMENT +exéresis I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +glándula I-TREATMENT +adrenal I-TREATMENT +tumoral, I-TREATMENT +revisión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hemostasia I-TREATMENT +y I-TREATMENT +extracci��n I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +en I-TREATMENT +una I-TREATMENT +bolsa I-TREATMENT +preformada I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +minilaparotomía I-TREATMENT +transversa. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +heterogéneo, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +hemorrágicas, I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +parduzcas, I-EXPLORATION +áreas I-EXPLORATION +amarillentas I-EXPLORATION +y I-EXPLORATION +extensas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +hemorrágicas; I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +septos I-EXPLORATION +con I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +calcificación. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +cortical I-EXPLORATION +suprarrenal I-EXPLORATION +(14 I-EXPLORATION +x I-EXPLORATION +12 I-EXPLORATION +x I-EXPLORATION +11, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro). I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +hospitalizada I-PRESENT_ILLNESS +doce I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuidado I-PRESENT_ILLNESS +intensivo, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +epigastralgia I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +irradiada, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cede I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +administración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ranitidina, I-PRESENT_ILLNESS +valorada I-PRESENT_ILLNESS +inicialmente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias, I-PRESENT_ILLNESS +donde B-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +hiperamilasemia I-EXPLORATION +e I-EXPLORATION +hipertrigliceridemia I-EXPLORATION +(5.080 I-EXPLORATION +mg/dl) I-EXPLORATION +con I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +hígado I-EXPLORATION +y I-EXPLORATION +vías I-EXPLORATION +biliares I-EXPLORATION +más I-EXPLORATION +colangiorresonancia I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +Por I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +deshidratación I-EXPLORATION +grado I-EXPLORATION +III, I-EXPLORATION +SIRS I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +severo, I-EXPLORATION +se I-EXPLORATION +manejó I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +unidad I-EXPLORATION +de I-EXPLORATION +cuidado I-EXPLORATION +intensivo. I-EXPLORATION +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dislipidemia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +manejo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lovastatina I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +gemfibrozilo I-PAST_MEDICAL_HISTORY +irregularmente, I-PAST_MEDICAL_HISTORY +adicionalmente I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +productos I-PAST_MEDICAL_HISTORY +homeopáticos I-PAST_MEDICAL_HISTORY +(espirulina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +vinagre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +manzana), I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +G2P1C1 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +planifica I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anticonceptivos I-PAST_MEDICAL_HISTORY +orales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +ingreso, I-EXPLORATION +como I-EXPLORATION +hallazgos I-EXPLORATION +relevantes I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +paciente I-EXPLORATION +somnolienta, I-EXPLORATION +taquicárdica, I-EXPLORATION +taquipneica, I-EXPLORATION +deshidratada; I-EXPLORATION +signos I-EXPLORATION +vitales: I-EXPLORATION +TA I-EXPLORATION +114/70; I-EXPLORATION +FC: I-EXPLORATION +105 I-EXPLORATION +por I-EXPLORATION +minuto; I-EXPLORATION +FR: I-EXPLORATION +28 I-EXPLORATION +por I-EXPLORATION +min: I-EXPLORATION +SaO2: I-EXPLORATION +90% I-EXPLORATION +con I-EXPLORATION +FIO2 I-EXPLORATION +28%; I-EXPLORATION +IMC I-EXPLORATION +32, I-EXPLORATION +5, I-EXPLORATION +abdomen I-EXPLORATION +blando I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +epigastrio I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal, I-EXPLORATION +sin I-EXPLORATION +otro I-EXPLORATION +hallazgo I-EXPLORATION +anormal I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico. I-EXPLORATION +Se I-EXPLORATION +hace I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +aguda I-EXPLORATION +severa I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +hipertrigliceridemia, I-EXPLORATION +con I-EXPLORATION +puntuación I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +en I-EXPLORATION +APACHE I-EXPLORATION +inicial I-EXPLORATION +y I-EXPLORATION +5 I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +horas, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +TAC I-EXPLORATION +contrastada I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +Baltazar I-EXPLORATION +E I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +menos I-EXPLORATION +del I-EXPLORATION +30%. I-EXPLORATION +Se B-TREATMENT +manejó I-TREATMENT +multidisciplinariamente I-TREATMENT +con I-TREATMENT +los I-TREATMENT +servicios I-TREATMENT +de I-TREATMENT +gastroenterología I-TREATMENT +y I-TREATMENT +soporte I-TREATMENT +nutricional, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +insulina I-TREATMENT +con I-TREATMENT +descenso I-TREATMENT +significativo I-TREATMENT +de I-TREATMENT +triglicéridos I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +horas I-TREATMENT +(valor I-TREATMENT +inicial I-TREATMENT +5.080, I-TREATMENT +control I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +h: I-TREATMENT +369), I-TREATMENT +al I-TREATMENT +séptimo I-TREATMENT +día I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +leucocitos, I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +taquicardia I-TREATMENT +y I-TREATMENT +PCR I-TREATMENT +mayor I-TREATMENT +a I-TREATMENT +16 I-TREATMENT +mg/dl, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +iniciar I-TREATMENT +cubrimiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +meropenem. I-TREATMENT +Al B-EVOLUTION +noveno I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +mostraba I-EVOLUTION +una I-EVOLUTION +apariencia I-EVOLUTION +clínica I-EVOLUTION +normal I-EVOLUTION +sin I-EVOLUTION +dolor, I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +leucocitosis I-EVOLUTION +y I-EVOLUTION +bandemia; I-EVOLUTION +dada I-EVOLUTION +su I-EVOLUTION +evolución, I-EVOLUTION +se I-EVOLUTION +decide I-EVOLUTION +traslado I-EVOLUTION +a I-EVOLUTION +planta. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +constitucional I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tenesmo I-PRESENT_ILLNESS +rectal. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +molestias I-EXPLORATION +abdominales I-EXPLORATION +difusas I-EXPLORATION +y, I-EXPLORATION +al I-EXPLORATION +tacto, I-EXPLORATION +un I-EXPLORATION +recto I-EXPLORATION +rígido I-EXPLORATION +a I-EXPLORATION +punta I-EXPLORATION +de I-EXPLORATION +dedo. I-EXPLORATION +Se I-EXPLORATION +descartaron I-EXPLORATION +metástasis I-EXPLORATION +pulmonares I-EXPLORATION +y I-EXPLORATION +hepáticas. I-EXPLORATION +La I-EXPLORATION +rectocolonoscopia I-EXPLORATION +mostró I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pliegues I-EXPLORATION +mucosos I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +pseudopolipoide I-EXPLORATION +y I-EXPLORATION +duro I-EXPLORATION +del I-EXPLORATION +7º I-EXPLORATION +al I-EXPLORATION +15º I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +margen I-EXPLORATION +anal I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +intacta. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +carcinomatosa I-EXPLORATION +rectal I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +mamario I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +lobulillar, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +siguiente I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico: I-EXPLORATION +citoqueratina I-EXPLORATION +7 I-EXPLORATION ++, I-EXPLORATION +citoqueratina I-EXPLORATION +20 I-EXPLORATION +-, I-EXPLORATION +e-cadherina I-EXPLORATION +- I-EXPLORATION +y I-EXPLORATION +receptores I-EXPLORATION +estrogénicos I-EXPLORATION ++. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +mamográfico I-EXPLORATION +dirigido I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +espiculación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mama I-EXPLORATION +izquierda, I-EXPLORATION +cuya I-EXPLORATION +biopsia I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +gruesa I-EXPLORATION +(BAG) I-EXPLORATION +remedó I-EXPLORATION +la I-EXPLORATION +rectal. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +(TAC) I-EXPLORATION +abdominopélvica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +rectal I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +el I-EXPLORATION +saco I-EXPLORATION +de I-EXPLORATION +Douglas I-EXPLORATION +y I-EXPLORATION +destruía I-EXPLORATION +los I-EXPLORATION +planos I-EXPLORATION +"de I-EXPLORATION +clivaje" I-EXPLORATION +rectouterinos. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +al I-EXPLORATION +alta I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +lobulillar I-EXPLORATION +mamario I-EXPLORATION +izquierdo I-EXPLORATION +en I-EXPLORATION +estadio I-EXPLORATION +IV, I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +rectales. I-EXPLORATION +En B-TREATMENT +la I-TREATMENT +actualidad I-TREATMENT +sigue I-TREATMENT +régimen I-TREATMENT +quimioterápico I-TREATMENT +ambulatorio I-TREATMENT +con I-TREATMENT +pobre I-TREATMENT +respuesta I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +mal I-TREATMENT +tolerado. I-TREATMENT +En B-EVOLUTION +5 I-EVOLUTION +meses I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +sufrido I-EVOLUTION +complicación I-EVOLUTION +alguna I-EVOLUTION +que I-EVOLUTION +haya I-EVOLUTION +requerido I-EVOLUTION +cirugía I-EVOLUTION +paliativa. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +penicilina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +características I-PAST_MEDICAL_HISTORY +similares I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +actual. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +periumbilical I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +irradió I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +FID, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carácter I-PRESENT_ILLNESS +continuo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +deambulación. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +previos. I-PRESENT_ILLNESS +Ausencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +mareo. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hábito I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +miccional. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +afebril, I-EXPLORATION +normotenso I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +Presentaba I-EXPLORATION +abdomen I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible, I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +ni I-EXPLORATION +megalias, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +FID I-EXPLORATION +e I-EXPLORATION +hipogastrio, I-EXPLORATION +con I-EXPLORATION +defensa I-EXPLORATION +y I-EXPLORATION +peritonismo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destacaba I-EXPLORATION +leucocitosis I-EXPLORATION +(13.390 I-EXPLORATION +x I-EXPLORATION +103/mcl) I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(66,7%). I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +apendicitis I-TREATMENT +aguda I-TREATMENT +se I-TREATMENT +intervino I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +urgente I-TREATMENT +encontrando I-TREATMENT +divertículo I-TREATMENT +en I-TREATMENT +cara I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +ciego I-TREATMENT +inflamado I-TREATMENT +y I-TREATMENT +necrótico I-TREATMENT +por I-TREATMENT +fecalito I-TREATMENT +impactado I-TREATMENT +en I-TREATMENT +su I-TREATMENT +interior I-TREATMENT +y I-TREATMENT +apéndice I-TREATMENT +ileocecal I-TREATMENT +hiperémico. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +apendicectomía I-TREATMENT +reglada I-TREATMENT +y I-TREATMENT +diverticulectomía I-TREATMENT +con I-TREATMENT +sutura I-TREATMENT +manual I-TREATMENT +transversal I-TREATMENT +con I-TREATMENT +Byosin® I-TREATMENT +2-0, I-TREATMENT +dejando I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +Penrose. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +12º I-EVOLUTION +día I-EVOLUTION +postoperatorio I-EVOLUTION +completamente I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +reveló I-EXPLORATION +apéndice I-EXPLORATION +ileocecal, I-EXPLORATION +periapendicitis, I-EXPLORATION +fecalito I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +grueso I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +con I-EXPLORATION +severa I-EXPLORATION +inflamación I-EXPLORATION +aguda. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +naturales B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Perú, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acuden I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +doce I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +epigástrico, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +irradiado, I-PRESENT_ILLNESS +continuo, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +referían I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +noche I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +ingesta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +comida I-PAST_MEDICAL_HISTORY +típica I-PAST_MEDICAL_HISTORY +peruana, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pescado I-PAST_MEDICAL_HISTORY +crudo. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +abdomen I-EXPLORATION +era I-EXPLORATION +blando, I-EXPLORATION +depresible I-EXPLORATION +pero I-EXPLORATION +doloroso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +epigastrio. I-EXPLORATION +No I-EXPLORATION +había I-EXPLORATION +masas, I-EXPLORATION +organomegalias I-EXPLORATION +abdominales I-EXPLORATION +ni I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal. I-EXPLORATION +Se I-EXPLORATION +observó I-EXPLORATION +leucocitosis I-EXPLORATION +importante I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(16.000 I-EXPLORATION +L), I-EXPLORATION +sin I-EXPLORATION +eosinofilia. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +endoscópico I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +pacientes I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +incontables I-EXPLORATION +AS I-EXPLORATION +adheridos I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +gástrica I-EXPLORATION +y I-EXPLORATION +duodenal, I-EXPLORATION +la I-EXPLORATION +mayoría I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +agrupados I-EXPLORATION +en I-EXPLORATION +nidos I-EXPLORATION +con I-EXPLORATION +más I-EXPLORATION +de I-EXPLORATION +diez I-EXPLORATION +parásitos. I-EXPLORATION +También I-EXPLORATION +los I-EXPLORATION +había I-EXPLORATION +aislados I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +pliegues I-EXPLORATION +mucosos, I-EXPLORATION +donde I-EXPLORATION +producían I-EXPLORATION +intenso I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +erosiones I-EXPLORATION +por I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +gástrica I-EXPLORATION +y I-EXPLORATION +duodenal. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +los I-TREATMENT +mismos I-TREATMENT +mediante I-TREATMENT +pinza I-TREATMENT +de I-TREATMENT +biopsia. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticada B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hiato I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +intolerancia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +lactosa. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +porque I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +diarreico, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +veces I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +rectorragia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +estudio I-EXPLORATION +bioquímico I-EXPLORATION +y I-EXPLORATION +hematológico I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +normal, I-EXPLORATION +incluyendo I-EXPLORATION +hormonas I-EXPLORATION +tiroideas I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +hepático. I-EXPLORATION +Los I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +CEA, I-EXPLORATION +CA. I-EXPLORATION +125 I-EXPLORATION +y I-EXPLORATION +CA I-EXPLORATION +19.9 I-EXPLORATION +fueron I-EXPLORATION +también I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +izquierda, I-EXPLORATION +existe I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +redondeada, I-EXPLORATION +ligeramente I-EXPLORATION +hiperecogénica, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +45 I-EXPLORATION +mm, I-EXPLORATION +que I-EXPLORATION +pudiera I-EXPLORATION +corresponder I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +intraluminal I-EXPLORATION +o I-EXPLORATION +un I-EXPLORATION +artefacto I-EXPLORATION +por I-EXPLORATION +heces. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +fibrocolonoscopia I-EXPLORATION +para I-EXPLORATION +observar I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +del I-EXPLORATION +sigma, I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +polipoide, I-EXPLORATION +lisa I-EXPLORATION +y I-EXPLORATION +nacarada I-EXPLORATION +en I-EXPLORATION +superficie I-EXPLORATION +y I-EXPLORATION +azulada I-EXPLORATION +en I-EXPLORATION +profundidad, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +dura, I-EXPLORATION +desplazable, I-EXPLORATION +no I-EXPLORATION +apreciándose I-EXPLORATION +pedículo I-EXPLORATION +tras I-EXPLORATION +inyectar I-EXPLORATION +contraste. I-EXPLORATION +Dada B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +naturaleza I-DERIVED_FROM/TO +inespecífica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +lesión I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +obstrucción I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +luz I-DERIVED_FROM/TO +colónica I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +procede I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +colocación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +stent I-DERIVED_FROM/TO +colónico I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +remitir I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valorar I-DERIVED_FROM/TO +intervención I-DERIVED_FROM/TO +quirúrgica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +lesión. I-DERIVED_FROM/TO +Previo B-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +quirúrgica I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +hace I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +tumoración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +descendente I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +sigma I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +y I-EXPLORATION +reducción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +intestinal. I-EXPLORATION +A B-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +finalmente I-TREATMENT +se I-TREATMENT +le I-TREATMENT +practicó I-TREATMENT +una I-TREATMENT +hemicolectomía I-TREATMENT +izquierda. I-TREATMENT +A I-TREATMENT +la I-TREATMENT +apertura I-TREATMENT +se I-TREATMENT +identifica I-TREATMENT +una I-TREATMENT +neoformación I-TREATMENT +excrecente, I-TREATMENT +polipoidea; I-TREATMENT +externamente I-TREATMENT +es I-TREATMENT +de I-TREATMENT +superficie I-TREATMENT +lisa, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +pedículo I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +diámetro I-TREATMENT +máximo I-TREATMENT +y I-TREATMENT +ocupa I-TREATMENT +la I-TREATMENT +luz I-TREATMENT +intestinal I-TREATMENT +casi I-TREATMENT +por I-TREATMENT +completo. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +cortes, I-TREATMENT +dicha I-TREATMENT +neoformación I-TREATMENT +es I-TREATMENT +blanquecina, I-TREATMENT +amarillenta I-TREATMENT +de I-TREATMENT +consistencia I-TREATMENT +elástica, I-TREATMENT +aspecto I-TREATMENT +homogéneo I-TREATMENT +y I-TREATMENT +parece I-TREATMENT +estar I-TREATMENT +rodeado I-TREATMENT +por I-TREATMENT +una I-TREATMENT +pared I-TREATMENT +que I-TREATMENT +lo I-TREATMENT +delimita I-TREATMENT +en I-TREATMENT +su I-TREATMENT +mayor I-TREATMENT +parte. I-TREATMENT +Fue I-TREATMENT +informada I-TREATMENT +como I-TREATMENT +un I-TREATMENT +lipoma I-TREATMENT +submucoso I-TREATMENT +infartado I-TREATMENT +con I-TREATMENT +ulceración I-TREATMENT +epitelial I-TREATMENT +y I-TREATMENT +necrosis I-TREATMENT +grasa. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alcoholismo I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pseudoquiste I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cabeza I-PRESENT_ILLNESS +pancreática I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +pancreatitis I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +alcohólica. I-PRESENT_ILLNESS +Amilasemia B-EXPLORATION +normal. I-EXPLORATION +Tras B-TREATMENT +tratamiento I-TREATMENT +sintomático, I-TREATMENT +el B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +disnea I-EVOLUTION +progresiva I-EVOLUTION +y I-EVOLUTION +derrame I-EVOLUTION +pleural I-EVOLUTION +derecho I-EVOLUTION +que B-TREATMENT +mejora I-TREATMENT +tras I-TREATMENT +drenaje I-TREATMENT +pleural. I-TREATMENT +Una B-EXPLORATION +colangio-RM I-EXPLORATION +verifica I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +y I-EXPLORATION +revela I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +volumen I-EXPLORATION +del I-EXPLORATION +pseudoquiste I-EXPLORATION +con I-EXPLORATION +probable I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +comunicación I-EXPLORATION +entre I-EXPLORATION +ducto I-EXPLORATION +pancreático I-EXPLORATION +y I-EXPLORATION +pseudoquiste. I-EXPLORATION +Posteriormente, B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +disnea, I-EVOLUTION +consecuencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +rotura I-EVOLUTION +del I-EVOLUTION +pseudoquiste I-EVOLUTION +y I-EVOLUTION +difusión I-EVOLUTION +a I-EVOLUTION +cavidad I-EVOLUTION +pleural I-EVOLUTION +izquierda I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +hiato I-EVOLUTION +esofágico. I-EVOLUTION +Se B-TREATMENT +realizó I-TREATMENT +drenaje I-TREATMENT +pleural, I-TREATMENT +evidenciándose I-TREATMENT +líquido I-TREATMENT +pleural I-TREATMENT +de I-TREATMENT +características I-TREATMENT +hemorrágicas, I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +comunicación I-TREATMENT +pancreático-pleural. I-TREATMENT +Tras B-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +inicial, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +disnea I-EVOLUTION +y I-EVOLUTION +recurrencia I-EVOLUTION +del I-EVOLUTION +derrame, I-EVOLUTION +realizándose B-TREATMENT +un I-TREATMENT +tercer I-TREATMENT +drenaje I-TREATMENT +pleural I-TREATMENT +y I-TREATMENT +pleurodesis. I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +se B-TREATMENT +decide I-TREATMENT +tratamiento I-TREATMENT +quirúgico I-TREATMENT +definitivo I-TREATMENT +del I-TREATMENT +pseudoquiste. I-TREATMENT + I-TREATMENT +A I-TREATMENT +los I-TREATMENT +25 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +intervenido, I-TREATMENT +realizándosele I-TREATMENT +una I-TREATMENT +cistogastrostomía I-TREATMENT +a I-TREATMENT +cara I-TREATMENT +posterior I-TREATMENT +gástrica I-TREATMENT +con B-EVOLUTION +mejoría I-EVOLUTION +definitiva I-EVOLUTION +y I-EVOLUTION +reducción I-EVOLUTION +del I-EVOLUTION +pseudoquiste. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con B-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +que I-EXPLORATION +evidenciaba I-EXPLORATION +anemia, I-EXPLORATION +trombopenia I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bilirrubina I-EXPLORATION +y I-EXPLORATION +enzimas I-EXPLORATION +de I-EXPLORATION +colestasis. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +13 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +segmentos I-EXPLORATION +IV, I-EXPLORATION +V I-EXPLORATION +y I-EXPLORATION +VIII. I-EXPLORATION +Al B-EVOLUTION +mes I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +falleció I-EVOLUTION +por I-EVOLUTION +shock I-EVOLUTION +hipovolémico I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +autopsia I-EVOLUTION +compatible I-EVOLUTION +con I-EVOLUTION +ASH. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +C, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +constitucional I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +presentaba I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bilirrubina I-EXPLORATION +y I-EXPLORATION +enzimas I-EXPLORATION +de I-EXPLORATION +colestasis. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +mostró I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +hepáticos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +versus I-EXPLORATION +hepatocarcinoma I-EXPLORATION +multicéntrico I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +en I-EXPLORATION +bazo. I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +falleció I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +hepática I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +autopsia I-EVOLUTION +compatible I-EVOLUTION +con I-EVOLUTION +ASH I-EVOLUTION +con I-EVOLUTION +metástasis I-EVOLUTION +esplénicas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +analítica I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +evidenciaba I-PRESENT_ILLNESS +trombopenia, I-PRESENT_ILLNESS +elevación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +bilirrubina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +enzimas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +colestasis. I-PRESENT_ILLNESS +La B-EXPLORATION +TC I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +nódulos I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +bazo. I-EXPLORATION +Al B-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +falleció I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +shock I-EVOLUTION +hipovolémico I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +autopsia I-EVOLUTION +compatible I-EVOLUTION +con I-EVOLUTION +ASH I-EVOLUTION +con I-EVOLUTION +metástasis I-EVOLUTION +esplénicas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +con B-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +inespecífica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +incremento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +perímetro I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +constitucional. I-PRESENT_ILLNESS +Intervenido B-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +urgencia I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +apendicitis, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +diagnosticó I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +pseudomixoma, I-DERIVED_FROM/TO +practicándole I-DERIVED_FROM/TO +exclusivamente I-DERIVED_FROM/TO +toma I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +biopsias, I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +remitiéndolo I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +atención. I-DERIVED_FROM/TO +A B-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +que I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +comprometía I-TREATMENT +todas I-TREATMENT +las I-TREATMENT +regiones I-TREATMENT +abdominales I-TREATMENT +y I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +presentaba I-TREATMENT +un I-TREATMENT +índice I-TREATMENT +de I-TREATMENT +carcinomatosis I-TREATMENT +peritoneal I-TREATMENT +de I-TREATMENT +32, I-TREATMENT +acorde I-TREATMENT +con I-TREATMENT +la I-TREATMENT +clasificación I-TREATMENT +de I-TREATMENT +Sugarbaker I-TREATMENT +(4), I-TREATMENT +se I-TREATMENT +consiguió I-TREATMENT +realizar I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +intención I-TREATMENT +curativa I-TREATMENT +mediante I-TREATMENT +citorreducción I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +macroscópica I-TREATMENT +tipo I-TREATMENT +CC0, I-TREATMENT +precisando I-TREATMENT +las I-TREATMENT +6 I-TREATMENT +peritonectomías I-TREATMENT +parietales I-TREATMENT +con I-TREATMENT +omentectomía I-TREATMENT +mayor I-TREATMENT +y I-TREATMENT +menor, I-TREATMENT +colecistectomía I-TREATMENT +y I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +tumor I-TREATMENT +primario I-TREATMENT +mediante I-TREATMENT +apendicectomía I-TREATMENT +con I-TREATMENT +cequectomía. I-TREATMENT +Se I-TREATMENT +completó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +posible I-TREATMENT +enfermedad I-TREATMENT +microscópica I-TREATMENT +residual I-TREATMENT +con I-TREATMENT +QIIH I-TREATMENT +con I-TREATMENT +mitomicina I-TREATMENT +C I-TREATMENT +a I-TREATMENT +12 I-TREATMENT +mg/m2 I-TREATMENT +disueltos I-TREATMENT +en I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +l I-TREATMENT +de I-TREATMENT +solución I-TREATMENT +de I-TREATMENT +diálisis I-TREATMENT +peritoneal I-TREATMENT +de I-TREATMENT +dianeal I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +33% I-TREATMENT +a I-TREATMENT +42 I-TREATMENT +ºC I-TREATMENT +durante I-TREATMENT +60 I-TREATMENT +min, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +flujo I-TREATMENT +de I-TREATMENT +perfusión I-TREATMENT +continua I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +l/min, I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +abierta I-TREATMENT +o I-TREATMENT +"técnica I-TREATMENT +de I-TREATMENT +coliseo". I-TREATMENT +Durante I-TREATMENT +su I-TREATMENT +estancia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +de I-TREATMENT +cuidados I-TREATMENT +intensivos, I-TREATMENT +recibió I-TREATMENT +QIPP I-TREATMENT +los I-TREATMENT +días I-TREATMENT +1º I-TREATMENT +a I-TREATMENT +5º I-TREATMENT +del I-TREATMENT +postoperatorio I-TREATMENT +inmediato I-TREATMENT +con I-TREATMENT +5-fluorouracilo I-TREATMENT +750 I-TREATMENT +mg/m2 I-TREATMENT +en I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +l I-TREATMENT +de I-TREATMENT +glucosado I-TREATMENT +al I-TREATMENT +5% I-TREATMENT +durante I-TREATMENT +23 I-TREATMENT +horas. I-TREATMENT +Su B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +satisfactoria I-EVOLUTION +con I-EVOLUTION +estancia I-EVOLUTION +de I-EVOLUTION +19 I-EVOLUTION +días I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +vivo I-EVOLUTION +y I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +más I-EVOLUTION +de I-EVOLUTION +10 I-EVOLUTION +años I-EVOLUTION +después, I-EVOLUTION +habiendo I-EVOLUTION +sufrido I-EVOLUTION +un I-EVOLUTION +AVC I-EVOLUTION +por I-EVOLUTION +HTA, I-EVOLUTION +con I-EVOLUTION +hemiplejía I-EVOLUTION +residual. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +entre B-PAST_MEDICAL_HISTORY +cuyos I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +únicamente I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +amigdalectomizado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +neumonía I-PAST_MEDICAL_HISTORY +adquirida I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +comunidad. I-PAST_MEDICAL_HISTORY +Es I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +seguía I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +crónico. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Presentaba I-PAST_MEDICAL_HISTORY +dolores I-PAST_MEDICAL_HISTORY +abdominales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición, I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +supuesto I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +hospitalarios I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cifras I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +amilasa I-PAST_MEDICAL_HISTORY +elevadas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pancreatitis I-PAST_MEDICAL_HISTORY +aguda, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +pudiera I-PAST_MEDICAL_HISTORY +alcanzar I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +etiológico. I-PAST_MEDICAL_HISTORY +Por I-PAST_MEDICAL_HISTORY +ello I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +realizando I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +consultas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gastroenterología. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizaron I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +analíticas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +cifras I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +plasmático I-PAST_MEDICAL_HISTORY +rondaban I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +límites I-PAST_MEDICAL_HISTORY +superiores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +normalidad I-PAST_MEDICAL_HISTORY +(considerando I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +rangos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +normalidad I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +sérico I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +8, I-PAST_MEDICAL_HISTORY +4-10, I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +mg/dl), I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +llegar I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +francamente I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +caso. I-PAST_MEDICAL_HISTORY +Es I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +destacar I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +pancreatitis I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +cifras I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +nuevamente I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +epigastrio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +irradiación I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +hipocondrios. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +continuo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +limitaba I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta. I-PRESENT_ILLNESS +Analíticamente B-EXPLORATION +destacaba I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +recepción: I-EXPLORATION + I-EXPLORATION +-Hb: I-EXPLORATION +13, I-EXPLORATION +8 I-EXPLORATION +g/dl; I-EXPLORATION +Hcto: I-EXPLORATION +40%; I-EXPLORATION +leucocitos: I-EXPLORATION +13400 I-EXPLORATION +(81% I-EXPLORATION +neutrófilos). I-EXPLORATION + I-EXPLORATION +-Glucosa: I-EXPLORATION +99 I-EXPLORATION +mg/dl; I-EXPLORATION +urea: I-EXPLORATION +33 I-EXPLORATION +mg/dl; I-EXPLORATION +creatinina: I-EXPLORATION +1, I-EXPLORATION +03 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +-Amilasa I-EXPLORATION +plasmática: I-EXPLORATION +1980 I-EXPLORATION +U/l; I-EXPLORATION +lipasa: I-EXPLORATION +630 I-EXPLORATION +U/l. I-EXPLORATION + I-EXPLORATION +-Colesterol: I-EXPLORATION +210 I-EXPLORATION +mg/dl; I-EXPLORATION +triglicéridos: I-EXPLORATION +98 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +-Proteínas: I-EXPLORATION +7, I-EXPLORATION +1 I-EXPLORATION +g/dl; I-EXPLORATION +albúmina: I-EXPLORATION +4, I-EXPLORATION +5 I-EXPLORATION +g/dl. I-EXPLORATION + I-EXPLORATION +-Calcio: I-EXPLORATION +11, I-EXPLORATION +7 I-EXPLORATION +mg I-EXPLORATION +mg/dl; I-EXPLORATION +ácido I-EXPLORATION +úrico: I-EXPLORATION +6, I-EXPLORATION +9 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +aguda I-EXPLORATION +se I-EXPLORATION +realizan I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +primero, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecoendoscopia I-EXPLORATION +posteriormente, I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +litiasis, I-EXPLORATION +microlitiasis I-EXPLORATION +ni I-EXPLORATION +barro I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar. I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +un I-EXPLORATION +páncreas I-EXPLORATION +edematoso I-EXPLORATION +y I-EXPLORATION +desestructurado, I-EXPLORATION +sin I-EXPLORATION +más I-EXPLORATION +hallazgos. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +negatividad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +exploraciones I-EXPLORATION +en I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +etiología I-EXPLORATION +del I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +pancreatitis, I-EXPLORATION +se I-EXPLORATION +postuló I-EXPLORATION +una I-EXPLORATION +posible I-EXPLORATION +relación I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +hipercalcemia I-EXPLORATION +objetivada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +rutinaria I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +ingreso. I-EXPLORATION +Así, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +calcio I-EXPLORATION +plasmático I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +paratohormona I-EXPLORATION +intacta I-EXPLORATION +(PTHi), I-EXPLORATION +cuyos I-EXPLORATION +valores I-EXPLORATION +fueron I-EXPLORATION +respectivamente I-EXPLORATION +de I-EXPLORATION +11, I-EXPLORATION +9 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +451 I-EXPLORATION +pg/ml I-EXPLORATION +(valores I-EXPLORATION +normales I-EXPLORATION +por I-EXPLORATION +debajo I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +pg/ml), I-EXPLORATION +confirmándose I-EXPLORATION +la I-EXPLORATION +hipercalcemia I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +hiperparatiroidismo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +pancreatitis I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +ulteriores, I-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +amilasa I-EVOLUTION +y I-EVOLUTION +lipasa, I-EVOLUTION +obtención I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +correcta I-EVOLUTION +tolerancia I-EVOLUTION +oral I-EVOLUTION +y I-EVOLUTION +desaparición I-EVOLUTION +del I-EVOLUTION +dolor. I-EVOLUTION +Cuando B-EXPLORATION +se I-EXPLORATION +hubo I-EXPLORATION +resuelto I-EXPLORATION +por I-EXPLORATION +completo I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +gammagrafía I-EXPLORATION +con I-EXPLORATION +Tc99-Sestamibi, I-EXPLORATION +que I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +captación I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +adenoma I-EXPLORATION +paratiroideo I-EXPLORATION +inferior I-EXPLORATION +derecho. I-EXPLORATION +Días B-TREATMENT +más I-TREATMENT +tarde I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +intervino I-TREATMENT +quirúrgicamente, I-TREATMENT +hallándose I-TREATMENT +dicha I-TREATMENT +lesión I-TREATMENT +y I-TREATMENT +procediéndose I-TREATMENT +a I-TREATMENT +su I-TREATMENT +extirpación. I-TREATMENT +Se B-EXPLORATION +comprobó I-EXPLORATION +intraoperatoriamente I-EXPLORATION +el I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +PTHi. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +confirmó I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +adenoma I-EXPLORATION +paratiroideo. I-EXPLORATION + I-EXPLORATION +Tras B-EVOLUTION +este I-EVOLUTION +episodio I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +referir I-EVOLUTION +más I-EVOLUTION +cuadros I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +revisiones I-EVOLUTION +posteriores. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +73 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diabético B-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertenso I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +sigue I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +farmacológico. I-PAST_MEDICAL_HISTORY +Dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +tóxica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +amoxicilina-clavulánico. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +especialista I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Aparato I-PAST_MEDICAL_HISTORY +Digestivo. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +cifras I-PAST_MEDICAL_HISTORY +discretamente I-PAST_MEDICAL_HISTORY +elevadas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +plasmático, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +hubiera I-PAST_MEDICAL_HISTORY +llegado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +filiar I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dicha I-PAST_MEDICAL_HISTORY +alteración I-PAST_MEDICAL_HISTORY +analítica. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +seguía I-PAST_MEDICAL_HISTORY +tratamientos I-PAST_MEDICAL_HISTORY +crónicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pancreatitis I-PRESENT_ILLNESS +aguda, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico, I-PRESENT_ILLNESS +intolerancia I-PRESENT_ILLNESS +oral, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +elevación I-PRESENT_ILLNESS +significativa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +cifras I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +amilasa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lipasa, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +resto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +datos I-PRESENT_ILLNESS +analíticos I-PRESENT_ILLNESS +anodinos. I-PRESENT_ILLNESS +La B-EVOLUTION +evolución I-EVOLUTION +es I-EVOLUTION +favorable I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +días, I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +reinstauración I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +dieta I-EVOLUTION +oral. I-EVOLUTION +No I-EVOLUTION +obstante, I-EVOLUTION +sufre I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +súbita I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +situación I-EVOLUTION +clínica, I-EVOLUTION +con I-EVOLUTION +aparición I-EVOLUTION +nuevamente I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +deterioro I-EVOLUTION +progresivo I-EVOLUTION +del I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +conciencia, I-EVOLUTION +con I-EVOLUTION +episodios I-EVOLUTION +fluctuantes I-EVOLUTION +de I-EVOLUTION +desconexión I-EVOLUTION +del I-EVOLUTION +medio, I-EVOLUTION +objetivándose I-EVOLUTION +además, I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +analíticos I-EVOLUTION +llevados I-EVOLUTION +a I-EVOLUTION +cabo I-EVOLUTION +esos I-EVOLUTION +días, I-EVOLUTION +elevación I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +calcio I-EVOLUTION +total, I-EVOLUTION +alcanzándose I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +15, I-EVOLUTION +5 I-EVOLUTION +mg/dl I-EVOLUTION +(rangos I-EVOLUTION +de I-EVOLUTION +normalidad I-EVOLUTION +del I-EVOLUTION +calcio I-EVOLUTION +sérico I-EVOLUTION +entre I-EVOLUTION +8, I-EVOLUTION +4-10, I-EVOLUTION +4 I-EVOLUTION +mg/dl). I-EVOLUTION +Se B-EXPLORATION +determinaron I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +paratohormona I-EXPLORATION +intacta I-EXPLORATION +(PTHi): I-EXPLORATION +311, I-EXPLORATION +2 I-EXPLORATION +pg/ml I-EXPLORATION +(valores I-EXPLORATION +de I-EXPLORATION +normalidad I-EXPLORATION +< I-EXPLORATION +9 I-EXPLORATION +pg/ml) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +cervical I-EXPLORATION +que I-EXPLORATION +informaba I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +quístico I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +lóbulo I-EXPLORATION +tiroideo I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +requirió I-EVOLUTION +ingreso I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cuidados I-EVOLUTION +Intensivos, I-EVOLUTION +con I-EVOLUTION +mala I-EVOLUTION +evolución I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posteriores. I-EVOLUTION +No I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +corregir I-EVOLUTION +la I-EVOLUTION +hipercalcemia I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +médico I-EVOLUTION +intensivo I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +PTHi I-EVOLUTION +alcanzó I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +1.900 I-EVOLUTION +pg/ml. I-EVOLUTION +Se B-TREATMENT +intervino I-TREATMENT +quirúrgicamente, I-TREATMENT +extirpándose I-TREATMENT +un I-TREATMENT +nódulo I-TREATMENT +paratiroideo I-TREATMENT +dependiente I-TREATMENT +de I-TREATMENT +la I-TREATMENT +glándula I-TREATMENT +superior I-TREATMENT +izquierda, I-TREATMENT +tras I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +la I-TREATMENT +PTHi I-TREATMENT +descendió I-TREATMENT +a I-TREATMENT +324, I-TREATMENT +7 I-TREATMENT +pg/ml, I-TREATMENT +llegando I-TREATMENT +a I-TREATMENT +normalizarse I-TREATMENT +en I-TREATMENT +las I-TREATMENT +horas I-TREATMENT +siguientes. I-TREATMENT +El B-EVOLUTION +calcio I-EVOLUTION +plasmático I-EVOLUTION +ionizado I-EVOLUTION +disminuyó I-EVOLUTION +igualmente, I-EVOLUTION +consiguiéndose I-EVOLUTION +valores I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +límite I-EVOLUTION +alto I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad. I-EVOLUTION +No I-EVOLUTION +obstante, I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +de I-EVOLUTION +soporte, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +pudo I-EVOLUTION +superar I-EVOLUTION +un I-EVOLUTION +shock I-EVOLUTION +refractario I-EVOLUTION +con I-EVOLUTION +intensa I-EVOLUTION +acidosis I-EVOLUTION +metabólica I-EVOLUTION +láctica, I-EVOLUTION +falleciendo I-EVOLUTION +por I-EVOLUTION +asistolia I-EVOLUTION +sin I-EVOLUTION +respuesta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +maniobras I-EVOLUTION +de I-EVOLUTION +reanimación. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fallo I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +nutrición I-PRESENT_ILLNESS +parenteral I-PRESENT_ILLNESS +domiciliaria I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Presentaba B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +mórbida, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +quirúrgicamente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2002. I-PAST_MEDICAL_HISTORY +Tras B-TREATMENT +cuatro I-TREATMENT +años I-TREATMENT +de I-TREATMENT +buen I-TREATMENT +estado I-TREATMENT +general I-TREATMENT +y I-TREATMENT +una I-TREATMENT +reducción I-TREATMENT +importante I-TREATMENT +de I-TREATMENT +peso I-TREATMENT +presentó I-TREATMENT +un I-TREATMENT +vólvulo I-TREATMENT +intestinal, I-TREATMENT +que I-TREATMENT +obligó I-TREATMENT +a I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +totalidad I-TREATMENT +del I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +y I-TREATMENT +colon I-TREATMENT +derecho. I-TREATMENT +El B-EVOLUTION +tracto I-EVOLUTION +digestivo I-EVOLUTION +quedó I-EVOLUTION +cerrado I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cuarta I-EVOLUTION +porción I-EVOLUTION +duodenal I-EVOLUTION +sin I-EVOLUTION +continuidad I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +colon I-EVOLUTION +transverso, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +era I-EVOLUTION +portador I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +gastrostomía I-EVOLUTION +de I-EVOLUTION +descarga. I-EVOLUTION +Debido I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +totalidad I-EVOLUTION +del I-EVOLUTION +intestino I-EVOLUTION +delgado, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +con I-EVOLUTION +nutrición I-EVOLUTION +parenteral I-EVOLUTION +domiciliaria, I-EVOLUTION +sin I-EVOLUTION +la I-EVOLUTION +posibilidad I-EVOLUTION +de I-EVOLUTION +ningún I-EVOLUTION +tipo I-EVOLUTION +de I-EVOLUTION +rehabilitación I-EVOLUTION +intestinal. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +remitido I-EVOLUTION +a I-EVOLUTION +nuestro I-EVOLUTION +centro I-EVOLUTION +para I-EVOLUTION +valorar I-EVOLUTION +la I-EVOLUTION +posibilidad I-EVOLUTION +de I-EVOLUTION +trasplante I-EVOLUTION +intestinal. I-EVOLUTION +Dadas I-EVOLUTION +las I-EVOLUTION +circunstancias I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +y I-EVOLUTION +teniendo I-EVOLUTION +en I-EVOLUTION +cuenta I-EVOLUTION +que I-EVOLUTION +había I-EVOLUTION +presentado I-EVOLUTION +repetidos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +sepsis I-EVOLUTION +por I-EVOLUTION +catéter I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +último I-EVOLUTION +año, I-EVOLUTION +se I-EVOLUTION +indicó I-EVOLUTION +el I-EVOLUTION +trasplante I-EVOLUTION +intestinal I-EVOLUTION +aislado. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +incluido I-EVOLUTION +en I-EVOLUTION +lista I-EVOLUTION +de I-EVOLUTION +espera I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +peso I-EVOLUTION +de I-EVOLUTION +60 I-EVOLUTION +kg, I-EVOLUTION +180 I-EVOLUTION +cm I-EVOLUTION +de I-EVOLUTION +altura I-EVOLUTION +y I-EVOLUTION +18, I-EVOLUTION +3 I-EVOLUTION +de I-EVOLUTION +índice I-EVOLUTION +de I-EVOLUTION +masa I-EVOLUTION +corporal. I-EVOLUTION + I-EVOLUTION +A B-TREATMENT +los I-TREATMENT +2 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +su I-TREATMENT +inclusión I-TREATMENT +en I-TREATMENT +lista I-TREATMENT +de I-TREATMENT +espera I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +el I-TREATMENT +trasplante I-TREATMENT +intestinal I-TREATMENT +con I-TREATMENT +un I-TREATMENT +donante I-TREATMENT +isogrupo. I-TREATMENT +Al I-TREATMENT +donante I-TREATMENT +se I-TREATMENT +le I-TREATMENT +administró I-TREATMENT +timoglobulina I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +mg/kg I-TREATMENT +con I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +deplecionar I-TREATMENT +al I-TREATMENT +máximo I-TREATMENT +el I-TREATMENT +número I-TREATMENT +de I-TREATMENT +linfocitos I-TREATMENT +y I-TREATMENT +así I-TREATMENT +disminuir I-TREATMENT +la I-TREATMENT +probabilidad I-TREATMENT +de I-TREATMENT +rechazo I-TREATMENT +y I-TREATMENT +de I-TREATMENT +enfermedad I-TREATMENT +de I-TREATMENT +injerto I-TREATMENT +contra I-TREATMENT +huésped. I-TREATMENT +El I-TREATMENT +receptor I-TREATMENT +presentaba I-TREATMENT +una I-TREATMENT +trasposición I-TREATMENT +de I-TREATMENT +los I-TREATMENT +grandes I-TREATMENT +vasos I-TREATMENT +con I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +situada I-TREATMENT +a I-TREATMENT +la I-TREATMENT +izquierda I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +aorta. I-TREATMENT +Este I-TREATMENT +problema I-TREATMENT +se I-TREATMENT +solucionó I-TREATMENT +con I-TREATMENT +una I-TREATMENT +rotación I-TREATMENT +del I-TREATMENT +injerto I-TREATMENT +de I-TREATMENT +180º I-TREATMENT +sobre I-TREATMENT +su I-TREATMENT +eje I-TREATMENT +mesentérico, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +que I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +y I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +mesentérica I-TREATMENT +superior I-TREATMENT +del I-TREATMENT +injerto I-TREATMENT +coincidieran I-TREATMENT +con I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +y I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +aorta I-TREATMENT +del I-TREATMENT +receptor. I-TREATMENT +La I-TREATMENT +primera I-TREATMENT +asa I-TREATMENT +yeyunal I-TREATMENT +del I-TREATMENT +injerto I-TREATMENT +se I-TREATMENT +anastomosó I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +latero-lateral I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cuarta I-TREATMENT +porción I-TREATMENT +duodenal I-TREATMENT +y I-TREATMENT +el I-TREATMENT +íleon I-TREATMENT +terminal I-TREATMENT +del I-TREATMENT +injerto I-TREATMENT +al I-TREATMENT +colon I-TREATMENT +transverso I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +latero-terminal I-TREATMENT +dejando I-TREATMENT +una I-TREATMENT +ileostomía I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +de I-TREATMENT +"chimenea" I-TREATMENT +para I-TREATMENT +poder I-TREATMENT +acceder I-TREATMENT +con I-TREATMENT +facilidad I-TREATMENT +a I-TREATMENT +la I-TREATMENT +mucosa I-TREATMENT +intestinal I-TREATMENT +y I-TREATMENT +realizar I-TREATMENT +las I-TREATMENT +biopsias I-TREATMENT +de I-TREATMENT +protocolo. I-TREATMENT +Al I-TREATMENT +girar I-TREATMENT +el I-TREATMENT +injerto I-TREATMENT +180º, I-TREATMENT +la I-TREATMENT +ileostomía I-TREATMENT +quedó I-TREATMENT +fijada I-TREATMENT +en I-TREATMENT +el I-TREATMENT +flanco I-TREATMENT +derecho I-TREATMENT +del I-TREATMENT +abdomen I-TREATMENT +en I-TREATMENT +lugar I-TREATMENT +del I-TREATMENT +izquierdo. I-TREATMENT +Además, I-TREATMENT +se I-TREATMENT +dejó I-TREATMENT +una I-TREATMENT +yeyunostomía I-TREATMENT +de I-TREATMENT +alimentación I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +colecistectomía I-TREATMENT +por I-TREATMENT +barro I-TREATMENT +biliar, I-TREATMENT +muy I-TREATMENT +frecuente I-TREATMENT +en I-TREATMENT +este I-TREATMENT +tipo I-TREATMENT +de I-TREATMENT +pacientes. I-TREATMENT + I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +inducción I-TREATMENT +con I-TREATMENT +timoglobulina I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +mg/kg I-TREATMENT +y I-TREATMENT +profilaxis I-TREATMENT +antibiótica I-TREATMENT +con I-TREATMENT +vancomicina, I-TREATMENT +aztreonam I-TREATMENT +y I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +lioposomal. I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +postoperatorio I-TREATMENT +inmediato I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +siguió I-TREATMENT +tratamiento I-TREATMENT +inmunosupresor I-TREATMENT +con I-TREATMENT +triple I-TREATMENT +terapia: I-TREATMENT +timoglobulina I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +mg/kg/día I-TREATMENT +(durante I-TREATMENT +5 I-TREATMENT +días), I-TREATMENT +tacrolimus I-TREATMENT +0, I-TREATMENT +15 I-TREATMENT +mg/kg/día I-TREATMENT +(administrado I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +dosis) I-TREATMENT +por I-TREATMENT +sonda I-TREATMENT +nasogástrica, I-TREATMENT +modificando I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +hasta I-TREATMENT +alcanzar I-TREATMENT +niveles I-TREATMENT +sanguíneos I-TREATMENT +entre I-TREATMENT +15-20 I-TREATMENT +ng/dl, I-TREATMENT +y I-TREATMENT +prednisolona I-TREATMENT +200 I-TREATMENT +mg/día I-TREATMENT +en I-TREATMENT +pauta I-TREATMENT +descendente I-TREATMENT +hasta I-TREATMENT +llegar I-TREATMENT +a I-TREATMENT +20 I-TREATMENT +mg I-TREATMENT +el I-TREATMENT +6º I-TREATMENT +día. I-TREATMENT +Al I-TREATMENT +no I-TREATMENT +alcanzar I-TREATMENT +niveles I-TREATMENT +sanguíneos I-TREATMENT +de I-TREATMENT +tacrolimus I-TREATMENT +adecuados I-TREATMENT +al I-TREATMENT +3er I-TREATMENT +día I-TREATMENT +postoperatorio, I-TREATMENT +se I-TREATMENT +pasó I-TREATMENT +a I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +intravenosa I-TREATMENT +durante I-TREATMENT +4 I-TREATMENT +días I-TREATMENT +hasta I-TREATMENT +que I-TREATMENT +los I-TREATMENT +niveles I-TREATMENT +fueron I-TREATMENT +correctos, I-TREATMENT +volviendo I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +enteral. I-TREATMENT +Además I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +PGE1 I-TREATMENT +(Alprostadil®) I-TREATMENT +en I-TREATMENT +el I-TREATMENT +postoperatorio I-TREATMENT +inmediato I-TREATMENT +con I-TREATMENT +el I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +mejorar I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +de I-TREATMENT +reperfusión I-TREATMENT +(4). I-TREATMENT + I-TREATMENT +A I-TREATMENT +las I-TREATMENT +72 I-TREATMENT +horas I-TREATMENT +del I-TREATMENT +trasplante I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +presentó I-TREATMENT +una I-TREATMENT +hemorragia I-TREATMENT +digestiva I-TREATMENT +secundaria I-TREATMENT +a I-TREATMENT +una I-TREATMENT +úlcera I-TREATMENT +cardial I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +mediante I-TREATMENT +"clip" I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endoscópica. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +y I-EVOLUTION +trasladado I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +planta I-EVOLUTION +de I-EVOLUTION +hospitalización. I-EVOLUTION +Dentro I-EVOLUTION +del I-EVOLUTION +protocolo I-EVOLUTION +para I-EVOLUTION +el I-EVOLUTION +control I-EVOLUTION +del I-EVOLUTION +rechazo, I-EVOLUTION +se I-EVOLUTION +realizaron I-EVOLUTION +biopsias I-EVOLUTION +2 I-EVOLUTION +veces I-EVOLUTION +por I-EVOLUTION +semana I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ileostomía I-EVOLUTION +durante I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +mes, I-EVOLUTION +y I-EVOLUTION +1 I-EVOLUTION +vez I-EVOLUTION +por I-EVOLUTION +semana I-EVOLUTION +durante I-EVOLUTION +el I-EVOLUTION +segundo I-EVOLUTION +mes. I-EVOLUTION +Durante I-EVOLUTION +las I-EVOLUTION +seis I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +sólo I-EVOLUTION +una I-EVOLUTION +biopsia I-EVOLUTION +mostró I-EVOLUTION +rechazo I-EVOLUTION +indeterminado I-EVOLUTION +y I-EVOLUTION +otra I-EVOLUTION +rechazo I-EVOLUTION +leve, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +trató I-EVOLUTION +con I-EVOLUTION +3 I-EVOLUTION +bolus I-EVOLUTION +de I-EVOLUTION +500 I-EVOLUTION +mg I-EVOLUTION +de I-EVOLUTION +metil-prednisolona. I-EVOLUTION + I-EVOLUTION +Desde I-EVOLUTION +el I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +nutricional, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +post-trasplante I-EVOLUTION +se I-EVOLUTION +inició I-EVOLUTION +la I-EVOLUTION +administración I-EVOLUTION +de I-EVOLUTION +agua I-EVOLUTION +y I-EVOLUTION +posteriormente I-EVOLUTION +de I-EVOLUTION +nutrición I-EVOLUTION +enteral I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +sonda I-EVOLUTION +de I-EVOLUTION +yeyunostomía. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +tres I-EVOLUTION +semanas I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +inició I-EVOLUTION +la I-EVOLUTION +ingesta I-EVOLUTION +oral I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +progresiva I-EVOLUTION +hasta I-EVOLUTION +ingerir I-EVOLUTION +2.100 I-EVOLUTION +kcal I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +permitió I-EVOLUTION +suspender I-EVOLUTION +la I-EVOLUTION +nutrición I-EVOLUTION +parenteral. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +aumentó I-EVOLUTION +10 I-EVOLUTION +kg I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +6 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +séptima I-EVOLUTION +semana I-EVOLUTION +del I-EVOLUTION +trasplante, I-EVOLUTION +sin I-EVOLUTION +requerir I-EVOLUTION +nutrición I-EVOLUTION +parenteral. I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +excelente I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +aumento I-EVOLUTION +ponderal, I-EVOLUTION +que I-EVOLUTION +indica I-EVOLUTION +la I-EVOLUTION +viabilidad I-EVOLUTION +y I-EVOLUTION +buena I-EVOLUTION +función I-EVOLUTION +del I-EVOLUTION +injerto I-EVOLUTION +intestinal. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +insulindependiente, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +apnea I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +sueño I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +gastritis I-PAST_MEDICAL_HISTORY +atrófica I-PAST_MEDICAL_HISTORY +autoinmune I-PAST_MEDICAL_HISTORY +(con I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anticélulas I-PAST_MEDICAL_HISTORY +parietales I-PAST_MEDICAL_HISTORY +positivos I-PAST_MEDICAL_HISTORY +1/160, I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +agosto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2007), I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +colecistectomía I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +colelitiasis I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +septiembre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2007. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +enero I-EXPLORATION +de I-EXPLORATION +2008 I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +por I-EXPLORATION +presentar I-EXPLORATION +molestias I-EXPLORATION +epigástricas I-EXPLORATION +irradiadas I-EXPLORATION +en I-EXPLORATION +cinturón I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +kg I-EXPLORATION +de I-EXPLORATION +peso, I-EXPLORATION +objetivándose I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +concéntrico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +gástricas, I-EXPLORATION +motivo I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +completa I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +gastroscopia, I-EXPLORATION +ecoendoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta, I-EXPLORATION +analítica I-EXPLORATION +y I-EXPLORATION +marcadores I-EXPLORATION +tumorales. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +tan I-EXPLORATION +sólo I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +colestasis I-EXPLORATION +disociada I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +y I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +gastroscopia I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +un I-EXPLORATION +pólipo I-EXPLORATION +sesil I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +fundus, I-EXPLORATION +sobre I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +atrófico, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extirpó I-EXPLORATION +y I-EXPLORATION +cuyo I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +resultó I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +gástrico I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +difuso. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecoendoscopia I-EXPLORATION +alta I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +adenopatías I-EXPLORATION +locorregionales. I-EXPLORATION +Dados B-TREATMENT +los I-TREATMENT +hallazgos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +anatomía I-TREATMENT +patológica, I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +para I-TREATMENT +gastrectomía I-TREATMENT +total, I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +macroscópicamente I-TREATMENT +no I-TREATMENT +se I-TREATMENT +evidenció I-TREATMENT +aparentemente I-TREATMENT +tumoración I-TREATMENT +gástrica I-TREATMENT +macroscópica, I-TREATMENT +ni I-TREATMENT +afectación I-TREATMENT +ganglionar I-TREATMENT +ni I-TREATMENT +peritoneal. I-TREATMENT +La B-EXPLORATION +histopatología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +mostró I-EXPLORATION +múltiples I-EXPLORATION +tumores I-EXPLORATION +neuroendocrinos I-EXPLORATION +bien I-EXPLORATION +diferenciados I-EXPLORATION +tipo I-EXPLORATION +I I-EXPLORATION +(tumores I-EXPLORATION +carcinoides) I-EXPLORATION +en I-EXPLORATION +cuerpo I-EXPLORATION +y I-EXPLORATION +fundus, I-EXPLORATION +de I-EXPLORATION +1-5 I-EXPLORATION +mm, I-EXPLORATION +asociados I-EXPLORATION +a I-EXPLORATION +hiperplasia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +neuroendocrinas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +oxíntica I-EXPLORATION +y I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +atrófica I-EXPLORATION +de I-EXPLORATION +cuerpo I-EXPLORATION +y I-EXPLORATION +fundus I-EXPLORATION +con I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +displasia I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +y I-EXPLORATION +márgenes I-EXPLORATION +quirúrgicos I-EXPLORATION +no I-EXPLORATION +afectados. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +apendicectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +neurinoma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1986. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +reciente I-PRESENT_ILLNESS +comienzo, I-PRESENT_ILLNESS +sin B-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +ni I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destacaba I-EXPLORATION +FA I-EXPLORATION +1499 I-EXPLORATION +UI/l, I-EXPLORATION +GGT I-EXPLORATION +1163 I-EXPLORATION +UI/l, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +1, I-EXPLORATION +62 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +CA-19.9 I-EXPLORATION +533 I-EXPLORATION +UI/ml I-EXPLORATION +(normal I-EXPLORATION +< I-EXPLORATION +37 I-EXPLORATION +UI/ml). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +ecografía-doppler I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostraban I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +situada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +del I-EXPLORATION +páncreas, I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intra- I-EXPLORATION +y I-EXPLORATION +extrahepática. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +presentaba I-EXPLORATION +zonas I-EXPLORATION +quísticas, I-EXPLORATION +con I-EXPLORATION +septos I-EXPLORATION +y I-EXPLORATION +mamelones I-EXPLORATION +sólidos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +alguno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +captaba I-EXPLORATION +contraste I-EXPLORATION +intensamente I-EXPLORATION +; I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +invasión I-EXPLORATION +vascular I-EXPLORATION +ni I-EXPLORATION +adenopatías. I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +impresión I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +neoplasia I-TREATMENT +quística I-TREATMENT +del I-TREATMENT +páncreas I-TREATMENT +sin I-TREATMENT +contraindicación I-TREATMENT +quirúrgica I-TREATMENT +y I-TREATMENT +resecable, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +duodeno-pancreatectomía I-TREATMENT +cefálica. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +blanquecina I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +elástica, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +del I-EXPLORATION +páncreas, I-EXPLORATION +no I-EXPLORATION +encapsulada I-EXPLORATION +pero I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +bien I-EXPLORATION +delimitados, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +separaba I-EXPLORATION +con I-EXPLORATION +facilidad I-EXPLORATION +del I-EXPLORATION +páncreas I-EXPLORATION +adyacente. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +inmunohistoquímica I-EXPLORATION +mostró I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +marcador I-EXPLORATION +vimentina, I-EXPLORATION +y I-EXPLORATION +negatividad I-EXPLORATION +para I-EXPLORATION +citoqueratinas I-EXPLORATION +(AE1-AE3), I-EXPLORATION +S-100, I-EXPLORATION +cromogranina, I-EXPLORATION +CD I-EXPLORATION +34, I-EXPLORATION +C-KIT I-EXPLORATION +y I-EXPLORATION +actina, I-EXPLORATION +presentando I-EXPLORATION +además I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +celular I-EXPLORATION +(MIB-I) I-EXPLORATION +muy I-EXPLORATION +bajo I-EXPLORATION +; I-EXPLORATION +siendo I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +sarcoma I-EXPLORATION +fusocelular I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +malignidad. I-EXPLORATION +Tras B-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +recidiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +Analítica: B-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +17.500/mm3, I-EXPLORATION +PMN I-EXPLORATION +75%, I-EXPLORATION +amilasa I-EXPLORATION +1.956 I-EXPLORATION +U/L, I-EXPLORATION +AST: I-EXPLORATION +89U/L, I-EXPLORATION +ALT I-EXPLORATION +120U/L. I-EXPLORATION +Ecografía I-EXPLORATION +abdominal: I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extrahepática I-EXPLORATION +con I-EXPLORATION +defectos I-EXPLORATION +de I-EXPLORATION +repleción. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +CPRE: I-EXPLORATION +colédoco I-EXPLORATION +dilatado I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +defecto I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +filiforme, I-EXPLORATION +plegada I-EXPLORATION +sobre I-EXPLORATION +sí I-EXPLORATION +misma I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extrahepática. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +limpieza I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +biliar I-TREATMENT +con I-TREATMENT +balón I-TREATMENT +Fogarty, I-TREATMENT +extrayéndose I-TREATMENT +un I-TREATMENT +gusano I-TREATMENT +cilíndrico I-TREATMENT +de I-TREATMENT +23 I-TREATMENT +cm, I-TREATMENT +barro I-TREATMENT +biliar I-TREATMENT +y I-TREATMENT +dos I-TREATMENT +cálculos I-TREATMENT +menores I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +mm. I-TREATMENT +Se I-TREATMENT +lavó I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +biliar I-TREATMENT +con I-TREATMENT +suero I-TREATMENT +fisiológico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +pautó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +albendazol I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +durante I-TREATMENT +4 I-TREATMENT +días. I-TREATMENT +Fue B-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta, I-EVOLUTION +asintomática, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +ingreso. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +deterioro I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +perímetro I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +trabaja I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +auxiliar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +despacho I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +notario I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +seguido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +intermitente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +consultas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Digestivo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alteración I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +perfil I-PAST_MEDICAL_HISTORY +hepático I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +predominio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colestasis I-PAST_MEDICAL_HISTORY +leve. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +resto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +y B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +carecían I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Durante B-PAST_MEDICAL_HISTORY +esos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizaron I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +analíticas, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +únicamente I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consabido I-PAST_MEDICAL_HISTORY +patrón I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colestasis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +trombocitopenia I-PAST_MEDICAL_HISTORY +leve I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +algunos I-PAST_MEDICAL_HISTORY +controles. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +largo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +periodo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tiempo I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +cifras I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +GOT I-PAST_MEDICAL_HISTORY +oscilaron I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +31-56 I-PAST_MEDICAL_HISTORY +UI/l; I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +GPT, I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +27-75 I-PAST_MEDICAL_HISTORY +UI/l; I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +GGT, I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +150-185 I-PAST_MEDICAL_HISTORY +UI/l; I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +FA, I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +213-456 I-PAST_MEDICAL_HISTORY +UI/l. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +bilirrubina I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +movió I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +2-2, I-PAST_MEDICAL_HISTORY +56 I-PAST_MEDICAL_HISTORY +mg/dl. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +autoinmunidad, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +negativo. I-PAST_MEDICAL_HISTORY +Igual I-PAST_MEDICAL_HISTORY +resultado I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +obtuvo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +serologías I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +virus I-PAST_MEDICAL_HISTORY +hepatotropos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +VIH, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +marcadores I-PAST_MEDICAL_HISTORY +tumorales I-PAST_MEDICAL_HISTORY +(CEA, I-PAST_MEDICAL_HISTORY +Ca I-PAST_MEDICAL_HISTORY +19.9 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +α-fetoproteína). I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +resto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +datos I-PAST_MEDICAL_HISTORY +analíticos, I-PAST_MEDICAL_HISTORY +incluyendo I-PAST_MEDICAL_HISTORY +hemograma, I-PAST_MEDICAL_HISTORY +bioquímica I-PAST_MEDICAL_HISTORY +completa, I-PAST_MEDICAL_HISTORY +coagulación, I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ferrocinética, I-PAST_MEDICAL_HISTORY +proteinograma, I-PAST_MEDICAL_HISTORY +hormonas I-PAST_MEDICAL_HISTORY +tiroideas, I-PAST_MEDICAL_HISTORY +... I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +También I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +sometió I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +diversas I-PAST_MEDICAL_HISTORY +pruebas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +imagen. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +esos I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +llevaron I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +cabo I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +ecografías I-PAST_MEDICAL_HISTORY +abdominales, I-PAST_MEDICAL_HISTORY +todas I-PAST_MEDICAL_HISTORY +ellas I-PAST_MEDICAL_HISTORY +normales I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +excepción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +realizada I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +ingreso, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +informaba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +discreta I-PAST_MEDICAL_HISTORY +esplenomegalia. I-PAST_MEDICAL_HISTORY +Dos I-PAST_MEDICAL_HISTORY +estudios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +TAC, I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +abdominal, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +abdómino-pélvico I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +siete I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +centro, I-PAST_MEDICAL_HISTORY +habían I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +igualmente I-PAST_MEDICAL_HISTORY +informados I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +su I-EXPLORATION +recepción I-EXPLORATION +en I-EXPLORATION +nuestra I-EXPLORATION +planta I-EXPLORATION +de I-EXPLORATION +hospitalización I-EXPLORATION +se I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +ictericia I-EXPLORATION +mucocutánea I-EXPLORATION +franca I-EXPLORATION +y I-EXPLORATION +ascitis I-EXPLORATION +no I-EXPLORATION +a I-EXPLORATION +tensión, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +deterioro I-EXPLORATION +del I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +conciencia I-EXPLORATION +del I-EXPLORATION +paciente. I-EXPLORATION +Analíticamente I-EXPLORATION +destaca: I-EXPLORATION +Hb: I-EXPLORATION +9, I-EXPLORATION +6 I-EXPLORATION +g/dl; I-EXPLORATION +Hcto: I-EXPLORATION +26, I-EXPLORATION +9%; I-EXPLORATION +plaquetas: I-EXPLORATION +37000; I-EXPLORATION +leucocitos: I-EXPLORATION +3800; I-EXPLORATION +bilirrubina I-EXPLORATION +total: I-EXPLORATION +27, I-EXPLORATION +5 I-EXPLORATION +mg/dl; I-EXPLORATION +GOT: I-EXPLORATION +88; I-EXPLORATION +GPT: I-EXPLORATION +73; I-EXPLORATION +GGT: I-EXPLORATION +243; I-EXPLORATION +FA: I-EXPLORATION +305; I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +protrombina: I-EXPLORATION +33%; I-EXPLORATION +INR: I-EXPLORATION +2, I-EXPLORATION +1; I-EXPLORATION +creatinina: I-EXPLORATION +2, I-EXPLORATION +09 I-EXPLORATION +mg/dl; I-EXPLORATION +urea: I-EXPLORATION +172 I-EXPLORATION +mg/dl; I-EXPLORATION +α-fetoproteína: I-EXPLORATION +1 I-EXPLORATION +ng/ml; I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +de I-EXPLORATION +VHB, I-EXPLORATION +VHC, I-EXPLORATION +VIH, I-EXPLORATION +CMV I-EXPLORATION +y I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein I-EXPLORATION +Barr I-EXPLORATION +son I-EXPLORATION +nuevamente I-EXPLORATION +negativas. I-EXPLORATION +Se I-EXPLORATION +lleva I-EXPLORATION +a I-EXPLORATION +cabo I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +que I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +hígado I-EXPLORATION +con I-EXPLORATION +estigmas I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +crónica, I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +nódulos I-EXPLORATION +de I-EXPLORATION +regeneración I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior; I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear, I-EXPLORATION +con I-EXPLORATION +imágenes I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +cirrosis I-EXPLORATION +hepática I-EXPLORATION +macronodular I-EXPLORATION +y I-EXPLORATION +ascitis I-EXPLORATION +perihepática I-EXPLORATION +y I-EXPLORATION +periesplénica I-EXPLORATION +en I-EXPLORATION +escasa I-EXPLORATION +cantidad. I-EXPLORATION +Con I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +transyugular. I-EXPLORATION + I-EXPLORATION +No B-EVOLUTION +obstante, I-EVOLUTION +y I-EVOLUTION +mientras I-EVOLUTION +se I-EVOLUTION +espera I-EVOLUTION +el I-EVOLUTION +resultado I-EVOLUTION +histológico I-EVOLUTION +de I-EVOLUTION +dicha I-EVOLUTION +biopsia, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +sufre I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +brusco I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +situación I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +función I-EVOLUTION +respiratoria, I-EVOLUTION +requiriendo B-TREATMENT +ventilación I-TREATMENT +mecánica, I-TREATMENT +intubación I-TREATMENT +orotraqueal I-TREATMENT +e I-TREATMENT +ingreso I-TREATMENT +en I-TREATMENT +UCI I-TREATMENT +por I-TREATMENT +cuadro I-TREATMENT +de I-TREATMENT +distrés I-TREATMENT +respiratorio. I-TREATMENT +Fallece B-EVOLUTION +36 I-EVOLUTION +horas I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +biopsia I-EXPLORATION +hepática, I-EXPLORATION +cuyo I-EXPLORATION +resultado I-EXPLORATION +se I-EXPLORATION +recibió I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +fallecimiento I-EXPLORATION +del I-EXPLORATION +enfermo, I-EXPLORATION +es I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +dilatación I-EXPLORATION +irregular I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +sinusoides I-EXPLORATION +(peliosis) I-EXPLORATION +y I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +endoteliales, I-EXPLORATION +sin I-EXPLORATION +que I-EXPLORATION +estas I-EXPLORATION +presenten I-EXPLORATION +mitosis. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +necropsia, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +macroscópicamente I-EXPLORATION +hígado I-EXPLORATION +con I-EXPLORATION +superficie I-EXPLORATION +externa I-EXPLORATION +macronodular, I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +al I-EXPLORATION +corte I-EXPLORATION +áreas I-EXPLORATION +peliótico-esponjosas, I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +sitúan I-EXPLORATION +zonas I-EXPLORATION +con I-EXPLORATION +parénquima I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +sano I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +macroscópicos I-EXPLORATION +de I-EXPLORATION +colestasis. I-EXPLORATION +Al I-EXPLORATION +microscopio I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +proliferación I-EXPLORATION +neoplásica I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +sinusoidal, I-EXPLORATION +configurando I-EXPLORATION +espacios I-EXPLORATION +cavernosos I-EXPLORATION +tapizados I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +atípicas. I-EXPLORATION +La I-EXPLORATION +afectación I-EXPLORATION +hepática I-EXPLORATION +es I-EXPLORATION +difusa I-EXPLORATION +y I-EXPLORATION +parcheada, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +algunas I-EXPLORATION +zonas I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +crecimiento I-EXPLORATION +intravascular I-EXPLORATION +neoplásico, I-EXPLORATION +a I-EXPLORATION +veces I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +mitosis, I-EXPLORATION +algunas I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +atípicas. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +intensamente I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +marcadores I-EXPLORATION +endoteliales I-EXPLORATION +CD-31 I-EXPLORATION +y I-EXPLORATION +CD-34. I-EXPLORATION +Todo I-EXPLORATION +ello I-EXPLORATION +es I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +angiosarcoma I-EXPLORATION +hepático I-EXPLORATION +primario. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +73 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +entre B-PAST_MEDICAL_HISTORY +cuyos I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +únicamente I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +tuberculosis I-PAST_MEDICAL_HISTORY +pasada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +juventud, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +dejó I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +secuela I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +importante I-PAST_MEDICAL_HISTORY +fibrosis I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +lóbulo I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +superior I-PAST_MEDICAL_HISTORY +izquierdo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Sufre B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +accidental, I-PRESENT_ILLNESS +produciéndose I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +herida I-PRESENT_ILLNESS +incisocontusa I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pierna I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +sangra I-PRESENT_ILLNESS +profusamente, I-PRESENT_ILLNESS +llamando I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +atención I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +personal I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +atiende I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +dificultoso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hemostasia. I-PRESENT_ILLNESS +Por B-EXPLORATION +ello I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +analítica, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto: I-EXPLORATION +Hb: I-EXPLORATION +10, I-EXPLORATION +6 I-EXPLORATION +g/dl; I-EXPLORATION +plaquetas: I-EXPLORATION +115.000; I-EXPLORATION +leucocitos: I-EXPLORATION +3.450; I-EXPLORATION +bilirrubina I-EXPLORATION +total: I-EXPLORATION +7, I-EXPLORATION +1 I-EXPLORATION +mg/dl; I-EXPLORATION +GOT: I-EXPLORATION +45; I-EXPLORATION +GPT: I-EXPLORATION +53; I-EXPLORATION +GGT: I-EXPLORATION +293; I-EXPLORATION +FA: I-EXPLORATION +286; I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +protrombina: I-EXPLORATION +61%. I-EXPLORATION +Tras I-EXPLORATION +esto I-EXPLORATION +se I-EXPLORATION +inicia I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +hepatopatía, I-EXPLORATION +realizándose I-EXPLORATION +serologías I-EXPLORATION +virales, I-EXPLORATION +proteinograma, I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +autoinmunidad I-EXPLORATION +y I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +tumorales, I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +todos I-EXPLORATION +negativos. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +hacen I-EXPLORATION +varias I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen, I-EXPLORATION +que I-EXPLORATION +arrojan I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +datos: I-EXPLORATION +TAC I-EXPLORATION +abdominal: I-EXPLORATION +hígado I-EXPLORATION +aumentado I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +imágenes I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +hepáticas, I-EXPLORATION +algunas I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño, I-EXPLORATION +y I-EXPLORATION +repartidas I-EXPLORATION +por I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +del I-EXPLORATION +hígado. I-EXPLORATION +Escasa I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +ascitis I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +atípica I-EXPLORATION +; I-EXPLORATION +colangio-RMN: I-EXPLORATION +cirrosis I-EXPLORATION +hepática I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +nódulos I-EXPLORATION +de I-EXPLORATION +regeneración I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +descartarse I-EXPLORATION +otra I-EXPLORATION +etiología I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +metastásica. I-EXPLORATION +Ascitis; I-EXPLORATION +PET-TAC: I-EXPLORATION +captación I-EXPLORATION +patológica I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +hepáticos I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +más I-EXPLORATION +captación I-EXPLORATION +patológica I-EXPLORATION +extrahepática; I-EXPLORATION +ecografía I-EXPLORATION +abdominal: I-EXPLORATION +varias I-EXPLORATION +lesiones I-EXPLORATION +ocupantes I-EXPLORATION +de I-EXPLORATION +espacio I-EXPLORATION +(LOE) I-EXPLORATION +hepáticas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +metastático. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos, I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +patología I-EXPLORATION +neoplásica, I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +PAAF I-EXPLORATION +guiada I-EXPLORATION +por I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +estas I-EXPLORATION +lesiones, I-EXPLORATION +cuyo I-EXPLORATION +informe I-EXPLORATION +reza: I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +estirpe I-EXPLORATION +mesenquimal, I-EXPLORATION +con I-EXPLORATION +células I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +hipercromáticos, I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +diferentes I-EXPLORATION +marcadores I-EXPLORATION +endoteliales, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +angiosarcoma I-EXPLORATION +hepático. I-EXPLORATION + I-EXPLORATION +Cuarenta B-EVOLUTION +y I-EVOLUTION +ocho I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +punción I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +precisa I-EVOLUTION +ingreso I-EVOLUTION +hospitalario I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +hemoperitoneo I-EVOLUTION +secundario, I-EVOLUTION +con I-EVOLUTION +distensión I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +peritonismo. I-EVOLUTION +El I-EVOLUTION +sangrado I-EVOLUTION +cede I-EVOLUTION +espontáneamente I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +requiere I-EVOLUTION +intervencionismo, I-EVOLUTION +siendo I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +domicilio I-EVOLUTION +varios I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +sin I-EVOLUTION +más I-EVOLUTION +complicaciones. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +semanas I-EVOLUTION +siguientes I-EVOLUTION +sufre I-EVOLUTION +un I-EVOLUTION +deterioro I-EVOLUTION +progresivo I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +estado, I-EVOLUTION +llegando I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +mixto I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +hepática, I-EVOLUTION +encefalopatía, I-EVOLUTION +e I-EVOLUTION +insuficiencia I-EVOLUTION +respiratoria, I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +responde I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +médico, I-EVOLUTION +falleciendo I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +final I-EVOLUTION +de I-EVOLUTION +fracaso I-EVOLUTION +multiorgánico. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +adicto I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +drogas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +parenteral, I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +VIH I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +dejado I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +antirretroviral I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +Ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +odinofagia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dudosa I-PRESENT_ILLNESS +disfagia, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +deposiciones/día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +heces I-PRESENT_ILLNESS +líquidas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +desnutrición I-EXPLORATION +con I-EXPLORATION +muguet I-EXPLORATION +orofaríngeo. I-EXPLORATION +Hepatomegalia I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +derecho I-EXPLORATION +sin I-EXPLORATION +esplenomegalia. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +presentaba I-EXPLORATION +6.830 I-EXPLORATION +leucocitos I-EXPLORATION +con I-EXPLORATION +7, I-EXPLORATION +2% I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +86, I-EXPLORATION +7% I-EXPLORATION +neutrófilos. I-EXPLORATION +CD4 I-EXPLORATION +10 I-EXPLORATION +cel/µl. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +esofagogastrocopia I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +de I-EXPLORATION +duodeno I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +velloso, I-EXPLORATION +blanquecino, I-EXPLORATION +irregular I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +biopsias. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +oral I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +alteraciones. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +Leishmania I-EXPLORATION +amastigotes I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +histiocitos. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amfotericina I-TREATMENT +B I-TREATMENT +mejorando B-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +acudió I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +sucesivas I-EVOLUTION +revisiones. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +trasplantado B-PAST_MEDICAL_HISTORY +hepático I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +VHC I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +inmunosupresor I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +esteroides, I-PAST_MEDICAL_HISTORY +tacrolimus I-PAST_MEDICAL_HISTORY +(FK) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +mofetil-micofenolato I-PAST_MEDICAL_HISTORY +(MMF). I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +primeros I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +postrasplante I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +produjo I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +deterioro I-PAST_MEDICAL_HISTORY +progresivo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +función I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aparición I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +relacionada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +tacrolimus, I-PAST_MEDICAL_HISTORY +planteándose I-PAST_MEDICAL_HISTORY +sustituir I-PAST_MEDICAL_HISTORY +FK I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +MMF I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +rapamicina I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +mg/día. I-PAST_MEDICAL_HISTORY +Transcurridos B-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +seca I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +febrícula. I-PRESENT_ILLNESS +En B-EXPLORATION +ese I-EXPLORATION +momento I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +plasmáticos I-EXPLORATION +de I-EXPLORATION +rapamicina I-EXPLORATION +eran I-EXPLORATION +25 I-EXPLORATION +ng/ml I-EXPLORATION +(normal: I-EXPLORATION +9-19). I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +varios I-EXPLORATION +infiltrados I-EXPLORATION +alveolares I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +medio I-EXPLORATION +y I-EXPLORATION +segmento I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +pulmón I-EXPLORATION +derecho I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +ipsilateral. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +empíricamente I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +levofloxacino I-TREATMENT +por I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +bronconeumonía I-TREATMENT +y I-TREATMENT +se I-TREATMENT +redujo I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +1 I-TREATMENT +mg/día, I-TREATMENT +presentando B-EVOLUTION +evolución I-EVOLUTION +desfavorable I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +costal I-EVOLUTION +mecánico, I-EVOLUTION +tos I-EVOLUTION +irritativa, I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +febrícula I-EVOLUTION +y I-EVOLUTION +apareciendo I-EVOLUTION +disnea. I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +cambiar I-TREATMENT +a I-TREATMENT +piperacilina-tazobactam, I-TREATMENT +persistiendo I-TREATMENT +la I-TREATMENT +fiebre. I-TREATMENT +La B-EXPLORATION +gasometría I-EXPLORATION +arterial I-EXPLORATION +basal I-EXPLORATION +mostró I-EXPLORATION +hipoxia I-EXPLORATION +leve. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +torácica I-EXPLORATION +reveló I-EXPLORATION +opacidades I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +basal I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +hemotórax, I-EXPLORATION +cavitación I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +segmentos I-EXPLORATION +anteriores I-EXPLORATION +de I-EXPLORATION +lóbulos I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +áreas I-EXPLORATION +nodulares I-EXPLORATION +múltiples, I-EXPLORATION +realizándose I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF) I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +condensaciones. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +PAAF I-EXPLORATION +mostraron I-EXPLORATION +Ziehl I-EXPLORATION +negativo, I-EXPLORATION +anticuerpos I-EXPLORATION +monoclonales I-EXPLORATION +para I-EXPLORATION +Pneumocystis I-EXPLORATION +carinii I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +aerobios I-EXPLORATION +estéril. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +con I-EXPLORATION +lavado I-EXPLORATION +bronquioloalveolar I-EXPLORATION +(LAB) I-EXPLORATION +cuya I-EXPLORATION +baciloscopia I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +fueron I-EXPLORATION +estériles I-EXPLORATION +para I-EXPLORATION +bacterias, I-EXPLORATION +virus, I-EXPLORATION +hongos, I-EXPLORATION +micobacterias I-EXPLORATION +o I-EXPLORATION +parásitos, I-EXPLORATION +incluyendo I-EXPLORATION +nocardia. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +micobacterias I-EXPLORATION +en I-EXPLORATION +esputo I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +micoplasma, I-EXPLORATION +fiebre I-EXPLORATION +Q, I-EXPLORATION +clamidia I-EXPLORATION +y I-EXPLORATION +legionela I-EXPLORATION +fueron I-EXPLORATION +negativas, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +galactomanano, I-EXPLORATION +la I-EXPLORATION +antigenemia I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +citomegalovirus. I-EXPLORATION +Debido B-TREATMENT +a I-TREATMENT +la I-TREATMENT +inapropiada I-TREATMENT +respuesta I-TREATMENT +antibiótica, I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +aislarse I-TREATMENT +ningún I-TREATMENT +microorganismo, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +suspender I-TREATMENT +la I-TREATMENT +rapamicina. I-TREATMENT +El B-EVOLUTION +cuadro I-EVOLUTION +clínico I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +encontrándose I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +asintomático I-EVOLUTION +en I-EVOLUTION +posteriores I-EVOLUTION +revisiones, I-EVOLUTION +aunque I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +radiológicas I-EVOLUTION +persistieron I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +12 I-EVOLUTION +semanas, I-EVOLUTION +normalizándose I-EVOLUTION +transcurridos I-EVOLUTION +6 I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +ingresada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +anémico I-PRESENT_ILLNESS +(Hb I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +g/dl, I-PRESENT_ILLNESS +Hto I-PRESENT_ILLNESS +30%) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +constitucional. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presentaba I-EXPLORATION +manchas I-EXPLORATION +"café I-EXPLORATION +con I-EXPLORATION +leche" I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +espalda I-EXPLORATION +y I-EXPLORATION +cuello, I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +neurofibromas. I-EXPLORATION +El I-EXPLORATION +abdomen I-EXPLORATION +era I-EXPLORATION +blando, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipogastrio I-EXPLORATION +y I-EXPLORATION +zona I-EXPLORATION +periumbilical, I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +palpables I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +peristalsis I-EXPLORATION +conservada. I-EXPLORATION +El I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +refería I-EXPLORATION +presentar I-EXPLORATION +un I-EXPLORATION +fenotipo I-EXPLORATION +similar I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +padre. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +asa I-EXPLORATION +intestinal I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm, I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +abdominal, I-EXPLORATION +objetivándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +intraluminal I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +ascendente. I-EXPLORATION +Se B-TREATMENT +intervino I-TREATMENT +quirúrgicamente, I-TREATMENT +hallándose I-TREATMENT +3 I-TREATMENT +tumoraciones, I-TREATMENT +la I-TREATMENT +mayor I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +cm, I-TREATMENT +que I-TREATMENT +englobaba I-TREATMENT +íleon I-TREATMENT +terminal I-TREATMENT +y I-TREATMENT +ciego, I-TREATMENT +y I-TREATMENT +otras I-TREATMENT +dos I-TREATMENT +de I-TREATMENT +3, I-TREATMENT +5 I-TREATMENT +y I-TREATMENT +1, I-TREATMENT +2 I-TREATMENT +cm, I-TREATMENT +proximales I-TREATMENT +a I-TREATMENT +la I-TREATMENT +primera. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +GIST, I-EXPLORATION +describía I-EXPLORATION +formación I-EXPLORATION +nodular I-EXPLORATION +fusiforme, I-EXPLORATION +con I-EXPLORATION +marcada I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +CD I-EXPLORATION +117, I-EXPLORATION +CD I-EXPLORATION +34, I-EXPLORATION +y I-EXPLORATION +negatividad I-EXPLORATION +para I-EXPLORATION +S-100. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +meningitis I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +gestacional I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +colestasis I-PAST_MEDICAL_HISTORY +gravídica. I-PAST_MEDICAL_HISTORY +Diagnosticada B-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +pancreatitis I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +idiopática, I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +localización I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +obstructiva. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizada I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +helicoidal I-EXPLORATION +con I-EXPLORATION +contraste, I-EXPLORATION +identificándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +calcificaciones I-EXPLORATION +pancreáticas, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +del I-EXPLORATION +páncreas I-EXPLORATION +(alcanza I-EXPLORATION +los I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor), I-EXPLORATION +con I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +planos I-EXPLORATION +grasos I-EXPLORATION +con I-EXPLORATION +duodeno. I-EXPLORATION +Existe I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +pancreático I-EXPLORATION +principal, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +gran I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +periaorticocavas I-EXPLORATION +y I-EXPLORATION +mesentéricas. I-EXPLORATION +Se I-EXPLORATION +establece I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +inflamatoria I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +pancreatitis I-EXPLORATION +crónica, I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +descartar I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +páncreas. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +USE, I-EXPLORATION +confirmándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +cabeza I-EXPLORATION +pancreática, I-EXPLORATION +heteroecogénica, I-EXPLORATION +irregular, I-EXPLORATION +mal I-EXPLORATION +delimitada, I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +calcificaciones I-EXPLORATION +dispersas, I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +parénquima I-EXPLORATION +pancreático, I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +lobular, I-EXPLORATION +con I-EXPLORATION +puntos I-EXPLORATION +y I-EXPLORATION +bandas I-EXPLORATION +hiperecogénicas I-EXPLORATION +(característico I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +crónica). I-EXPLORATION +El I-EXPLORATION +conducto I-EXPLORATION +pancreático I-EXPLORATION +principal I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +dilatado, I-EXPLORATION +con I-EXPLORATION +pared I-EXPLORATION +hiperecogénica, I-EXPLORATION +patrón I-EXPLORATION +irregular I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +colaterales. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +pancreática I-EXPLORATION +afecta I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +principal, I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +secundaria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION +Durante I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +USE I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +elastográfico. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +basal I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +heterogéneo I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +verde, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +elastográfico I-EXPLORATION +de I-EXPLORATION +segunda I-EXPLORATION +generación I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +coeficiente I-EXPLORATION +de I-EXPLORATION +elasticidad I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +35 I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +A I-EXPLORATION +(lesión I-EXPLORATION +a I-EXPLORATION +estudio) I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +12%. I-EXPLORATION +Finalmente I-EXPLORATION +se I-EXPLORATION +rea-liza I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +de I-EXPLORATION +22G, I-EXPLORATION +apreciándose I-EXPLORATION +hallazgos I-EXPLORATION +característicos I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +inflamatoria I-EXPLORATION +en I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +pancreatitis I-EXPLORATION +crónica I-EXPLORATION +(18). I-EXPLORATION +Finalmente B-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +colangiopancreatografía I-TREATMENT +retrógrada I-TREATMENT +endoscópica I-TREATMENT +con I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +de I-TREATMENT +polietileno. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +satisfactoria, I-EVOLUTION +encontrándose I-EVOLUTION +tras I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +estable I-EVOLUTION +y I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pancreatitis I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +alcohólica, I-PAST_MEDICAL_HISTORY +ingresado B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +respiratoria. I-PRESENT_ILLNESS +Tras B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +y I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +un I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +derecho. I-EXPLORATION +Tras B-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +toracocentesis I-TREATMENT +diagnóstica I-TREATMENT +y I-TREATMENT +evacuadora, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +experimentó I-TREATMENT +disnea I-TREATMENT +y I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +superior. I-TREATMENT +En B-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +ensanchamiento I-EXPLORATION +mediastínico. I-EXPLORATION +En I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +torácica I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +abdomen, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +drenó I-EXPLORATION +mediante I-EXPLORATION +un I-EXPLORATION +tubo I-EXPLORATION +torácico. I-EXPLORATION +Este I-EXPLORATION +líquido I-EXPLORATION +contenía I-EXPLORATION +una I-EXPLORATION +elevada I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +amilasa I-EXPLORATION +(104.000 I-EXPLORATION +U/ml). I-EXPLORATION +Además B-EVOLUTION +apareció I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +cervical I-EVOLUTION +lateral I-EVOLUTION +derecha I-EVOLUTION +un I-EVOLUTION +área I-EVOLUTION +de I-EVOLUTION +abultamiento I-EVOLUTION +con I-EVOLUTION +signos I-EVOLUTION +inflamatorios, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +drenó, I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cual I-EVOLUTION +se I-EVOLUTION +obtuvo I-EVOLUTION +también I-EVOLUTION +una I-EVOLUTION +elevada I-EVOLUTION +concentración I-EVOLUTION +de I-EVOLUTION +amilasa I-EVOLUTION +(90.000 I-EVOLUTION +U/ml). I-EVOLUTION +Tras I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +colecciones I-EVOLUTION +cervical I-EVOLUTION +y I-EVOLUTION +torácica, I-EVOLUTION +mejoró I-EVOLUTION +la I-EVOLUTION +disnea I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +estabilizó. I-EVOLUTION +A B-EXPLORATION +fin I-EXPLORATION +de I-EXPLORATION +investigar I-EXPLORATION +el I-EXPLORATION +sospechado I-EXPLORATION +origen I-EXPLORATION +pancreático I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +colecciones, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +CPRE I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +conducto I-EXPLORATION +de I-EXPLORATION +Wirsung I-EXPLORATION +era I-EXPLORATION +irregular I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +dilataciones I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +comunicaba I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +pleura. I-EXPLORATION +Se B-TREATMENT +colocó I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +plástica, I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +se I-TREATMENT +cerró. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +mejoró I-EVOLUTION +sin I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +cirugía. I-EVOLUTION +La I-EVOLUTION +prótesis I-EVOLUTION +se I-EVOLUTION +retiró I-EVOLUTION +endoscópicamente I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +bien, I-EVOLUTION +sin I-EVOLUTION +recidiva I-EVOLUTION +del I-EVOLUTION +pseudoquiste I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +años. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +intermitentes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +advirtió I-PRESENT_ILLNESS +rectorragia. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +analítico I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +alteraciones. I-EXPLORATION +La I-EXPLORATION +colonoscopia I-EXPLORATION +evidenció I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +colon I-EXPLORATION +transverso I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +polipoide I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +casi I-EXPLORATION +por I-EXPLORATION +completo I-EXPLORATION +la I-EXPLORATION +luz, I-EXPLORATION +y I-EXPLORATION +mostraba I-EXPLORATION +ulceraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza. I-EXPLORATION +El I-EXPLORATION +lugar I-EXPLORATION +se I-EXPLORATION +marcó I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +clip I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +mejor I-EXPLORATION +la I-EXPLORATION +localización I-EXPLORATION +del I-EXPLORATION +pólipo I-EXPLORATION +mediante I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +simple. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +informadas I-EXPLORATION +como: I-EXPLORATION +mucosa I-EXPLORATION +colónica I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +ulceración I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +granulación I-EXPLORATION +y I-EXPLORATION +tejido I-EXPLORATION +conectivo I-EXPLORATION +fibroso, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +malignidad. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +endoscópicos. I-EXPLORATION +Tres B-TREATMENT +semanas I-TREATMENT +más I-TREATMENT +tarde I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +tuvo I-TREATMENT +que I-TREATMENT +ser I-TREATMENT +operada I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +urgente I-TREATMENT +al I-TREATMENT +presentar I-TREATMENT +un I-TREATMENT +cuadro I-TREATMENT +suboclusivo. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +objetivó I-TREATMENT +una I-TREATMENT +invaginación I-TREATMENT +colónica I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +un I-TREATMENT +lipoma I-TREATMENT +de I-TREATMENT +5, I-TREATMENT +5 I-TREATMENT +cm, I-TREATMENT +con I-TREATMENT +origen I-TREATMENT +en I-TREATMENT +la I-TREATMENT +submucosa. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +hemicolectomía I-TREATMENT +derecha. I-TREATMENT +Se I-TREATMENT +aislaron I-TREATMENT +varios I-TREATMENT +ganglios I-TREATMENT +reactivos. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +69 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +exfumador, B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +aneurisma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aorta I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +infrarrenal I-PAST_MEDICAL_HISTORY +7, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anticoagulación I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +tromboembolismo I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +previo, I-PAST_MEDICAL_HISTORY +recibió B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pulmón I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +microcítico I-PRESENT_ILLNESS +CPNM I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +epidermoide I-PRESENT_ILLNESS +T3aN2M0 I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +lóbulo I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +Considerado B-TREATMENT +irresecable, I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +4 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +cisplatino-vinorelbina I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +radioterapia I-TREATMENT +torácica; I-TREATMENT +con I-TREATMENT +moderada I-TREATMENT +respuesta. I-TREATMENT +Seis B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +diagnóstico, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +ingresó I-EVOLUTION +por I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +difuso I-EVOLUTION +de I-EVOLUTION +seis I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +vómitos I-EVOLUTION +esporádicos. I-EVOLUTION +Presentaba B-EXPLORATION +hipoalbuminemia I-EXPLORATION +leve I-EXPLORATION +y I-EXPLORATION +anemia I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +g/dl I-EXPLORATION +-precisando I-EXPLORATION +concentrados I-EXPLORATION +de I-EXPLORATION +hematíes-. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +abdómino-pélvica I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +procedente I-EXPLORATION +de I-EXPLORATION +mesenterio I-EXPLORATION +que I-EXPLORATION +englobaba I-EXPLORATION +varias I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino. I-EXPLORATION +La I-EXPLORATION +ultrasonografía I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +fistuloso I-EXPLORATION +entre I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +flemonosa I-EXPLORATION +con I-EXPLORATION +pequeñas I-EXPLORATION +burbujas I-EXPLORATION +de I-EXPLORATION +gas I-EXPLORATION +extraluminal, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +instauró I-EXPLORATION +tratamiento I-EXPLORATION +antibiótico. I-EXPLORATION +Al B-EVOLUTION +5o I-EVOLUTION +día I-EVOLUTION +desarrolló I-EVOLUTION +un I-EVOLUTION +franco I-EVOLUTION +cuadro I-EVOLUTION +obstructivo; I-EVOLUTION +siendo B-TREATMENT +entonces I-TREATMENT +intervenido I-TREATMENT +con I-TREATMENT +carácter I-TREATMENT +urgente. I-TREATMENT +Se B-EXPLORATION +halló I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mesenterio I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +promontorio I-EXPLORATION +y I-EXPLORATION +cercana I-EXPLORATION +al I-EXPLORATION +aneurisma. I-EXPLORATION +Esta I-EXPLORATION +englobaba I-EXPLORATION +al I-EXPLORATION +intestino I-EXPLORATION +delgado, I-EXPLORATION +dos I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +yeyuno, I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +íleon I-EXPLORATION +-a I-EXPLORATION +30 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +cecal- I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +colon I-EXPLORATION +sigmoideo I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +segmentaria I-TREATMENT +de I-TREATMENT +sigma I-TREATMENT +y I-TREATMENT +asas I-TREATMENT +englobadas I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tumor I-TREATMENT +mesentérico, I-TREATMENT +reconstruyendo I-TREATMENT +mediante I-TREATMENT +tres I-TREATMENT +anastomosis I-TREATMENT +de I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +con I-TREATMENT +autosutura I-TREATMENT +mecánica I-TREATMENT +latero-lateral, I-TREATMENT +y I-TREATMENT +una I-TREATMENT +de I-TREATMENT +sigma I-TREATMENT +término-terminal. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +mesentérica I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +extensión I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +asas I-EXPLORATION +intestinales I-EXPLORATION +-alcanzando I-EXPLORATION +la I-EXPLORATION +mucosa-, I-EXPLORATION +englobándolas, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +abscesificación I-EXPLORATION +y I-EXPLORATION +fistulización. I-EXPLORATION +El B-EVOLUTION +postoperatorio I-EVOLUTION +transcurrió I-EVOLUTION +sin I-EVOLUTION +incidencias I-EVOLUTION +-recuperó I-EVOLUTION +la I-EVOLUTION +ingesta I-EVOLUTION +oral I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +tránsito I-EVOLUTION +intestinal- I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +8o I-EVOLUTION +día, I-EVOLUTION +cuando I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +pico I-EVOLUTION +febril. I-EVOLUTION +La B-EXPLORATION +TC I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +-por I-EXPLORATION +mínima I-EXPLORATION +dehiscencia I-EXPLORATION +de I-EXPLORATION +sigma- I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +drenó I-EXPLORATION +y I-EXPLORATION +resolvió I-EXPLORATION +radiológicamente. I-EXPLORATION +Con B-EVOLUTION +función I-EVOLUTION +intestinal I-EVOLUTION +normal, I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION +En I-EVOLUTION +las I-EVOLUTION +semanas I-EVOLUTION +posteriores, I-EVOLUTION +experimentó I-EVOLUTION +rápido I-EVOLUTION +deterioro I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +y I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +tumoral I-EVOLUTION +(linfangitis I-EVOLUTION +carcinomatosa I-EVOLUTION +pulmonar, I-EVOLUTION +crecimiento I-EVOLUTION +de I-EVOLUTION +metástasis I-EVOLUTION +subcutánea I-EVOLUTION +en I-EVOLUTION +pared I-EVOLUTION +torácica, I-EVOLUTION +hipercalcemia I-EVOLUTION +tumoral). I-EVOLUTION +No I-EVOLUTION +estando I-EVOLUTION +en I-EVOLUTION +condiciones I-EVOLUTION +de I-EVOLUTION +iniciar I-EVOLUTION +una I-EVOLUTION +segunda I-EVOLUTION +línea I-EVOLUTION +de I-EVOLUTION +quimioterapia, I-EVOLUTION +falleció I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +exéresis I-EVOLUTION +quirúrgica I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +metástasis I-EVOLUTION +abdominal. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +44 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +diagnosticado B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +colitis I-PRESENT_ILLNESS +ulcerosa I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +intervenido, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +colectomía I-PRESENT_ILLNESS +total I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +ileostomía I-PRESENT_ILLNESS +terminal, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +megacolon I-PRESENT_ILLNESS +tóxico. I-PRESENT_ILLNESS +Acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +líquidas I-PRESENT_ILLNESS +inicialmente, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cierre I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +horas. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +abdomen I-EXPLORATION +distendido I-EXPLORATION +y I-EXPLORATION +doloroso, I-EXPLORATION +con I-EXPLORATION +ruidos I-EXPLORATION +hidroaéreos I-EXPLORATION +ausentes. I-EXPLORATION +Ileostomía I-EXPLORATION +terminal I-EXPLORATION +iliaca I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +escaso I-EXPLORATION +débito I-EXPLORATION +y I-EXPLORATION +hernia I-EXPLORATION +paraileostómica I-EXPLORATION +no I-EXPLORATION +reductible. I-EXPLORATION +Analíticamente, I-EXPLORATION +presentaba I-EXPLORATION +hemograma I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +bioquímica I-EXPLORATION +con I-EXPLORATION +glucosa I-EXPLORATION +388 I-EXPLORATION +mg/dl, I-EXPLORATION +urea I-EXPLORATION +98 I-EXPLORATION +mg/dl, I-EXPLORATION +GOT I-EXPLORATION +50 I-EXPLORATION +U/l, I-EXPLORATION +GPT I-EXPLORATION +52 I-EXPLORATION +U/l, I-EXPLORATION +LDH I-EXPLORATION +556 I-EXPLORATION +U/l, I-EXPLORATION +GGT I-EXPLORATION +159 I-EXPLORATION +U/l, I-EXPLORATION +CK I-EXPLORATION +41 I-EXPLORATION +U/l, I-EXPLORATION +TG I-EXPLORATION +358 I-EXPLORATION +mg/dl, I-EXPLORATION +PT I-EXPLORATION +5, I-EXPLORATION +2 I-EXPLORATION +g/l I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +63 I-EXPLORATION +mg/l. I-EXPLORATION +La I-EXPLORATION +gasometría I-EXPLORATION +venosa, I-EXPLORATION +ionograma I-EXPLORATION +y I-EXPLORATION +coagulación I-EXPLORATION +eran I-EXPLORATION +normales I-EXPLORATION +con I-EXPLORATION +fibrinógeno I-EXPLORATION +de I-EXPLORATION +891 I-EXPLORATION +mg/dl. I-EXPLORATION +La I-EXPLORATION +radiología I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +eran I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +oclusión I-EXPLORATION +intestinal. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +falta I-TREATMENT +de I-TREATMENT +respuesta I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +médico, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hernia I-TREATMENT +paraileostómica I-TREATMENT +presentando B-EVOLUTION +posteriormente I-EVOLUTION +empeoramiento I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +sepsis I-EVOLUTION +y I-EVOLUTION +celulitis I-EVOLUTION +de I-EVOLUTION +piel I-EVOLUTION +y I-EVOLUTION +tejido I-EVOLUTION +celular I-EVOLUTION +subcutáneo I-EVOLUTION +abdominal I-EVOLUTION +circundante I-EVOLUTION +al I-EVOLUTION +ostoma, I-EVOLUTION +reinterviniéndose B-TREATMENT +en I-TREATMENT +otras I-TREATMENT +2 I-TREATMENT +ocasiones, I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +50 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +cada I-TREATMENT +una, I-TREATMENT +presentando I-TREATMENT +ulceraciones I-TREATMENT +profundas, I-TREATMENT +perforaciones I-TREATMENT +y I-TREATMENT +pequeños I-TREATMENT +abscesos I-TREATMENT +adyacentes I-TREATMENT +al I-TREATMENT +ostoma. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +postoperatorio, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +comienza I-EVOLUTION +con I-EVOLUTION +sangrado I-EVOLUTION +difuso I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +orificio I-EVOLUTION +de I-EVOLUTION +ileostomía I-EVOLUTION +y I-EVOLUTION +necrosis I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +centímetros I-EVOLUTION +de I-EVOLUTION +esta. I-EVOLUTION +La B-EXPLORATION +endoscopia I-EXPLORATION +alta, I-EXPLORATION +hasta I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +duodenal I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos, I-EXPLORATION +se I-EXPLORATION +procede I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +reapertura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +herida I-EXPLORATION +quirúrgica, I-EXPLORATION +apreciándose I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +últimos I-EXPLORATION +centímetros I-EXPLORATION +del I-EXPLORATION +asa I-EXPLORATION +de I-EXPLORATION +ileostomía, I-EXPLORATION +sangrado I-EXPLORATION +activo I-EXPLORATION +de I-EXPLORATION +ulceraciones I-EXPLORATION +profundas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +y I-EXPLORATION +perforaciones I-EXPLORATION +cubiertas I-EXPLORATION +con I-EXPLORATION +coágulos I-EXPLORATION +intraluminales, I-EXPLORATION +resecándose I-EXPLORATION +nuevamente I-EXPLORATION +50 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +afectado. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +resulta I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +continuó I-EVOLUTION +con I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +persistente I-EVOLUTION +y I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +inestabilidad I-EVOLUTION +hemodinámica, I-EVOLUTION +requiriendo B-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +de I-TREATMENT +fibrinógeno, I-TREATMENT +sin I-TREATMENT +respuesta I-TREATMENT +a I-TREATMENT +corticoterapia I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +plenas, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +infliximab I-TREATMENT +previa I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +placa I-TREATMENT +de I-TREATMENT +tórax, I-TREATMENT +mantoux I-TREATMENT +negativo I-TREATMENT +y I-TREATMENT +TAC I-TREATMENT +toracoabdominal I-TREATMENT +que I-TREATMENT +descartó I-TREATMENT +procesos I-TREATMENT +infecciosos. I-TREATMENT +Cinco B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +infliximab, I-EVOLUTION +el I-EVOLUTION +sangrado I-EVOLUTION +remite I-EVOLUTION +y I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático, I-EVOLUTION +con I-EVOLUTION +terapia I-EVOLUTION +de I-EVOLUTION +mantenimiento I-EVOLUTION +con I-EVOLUTION +infliximab I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +enteroscopia I-EVOLUTION +de I-EVOLUTION +control, I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +mucosa I-EVOLUTION +intestinal I-EVOLUTION +sin I-EVOLUTION +ulceraciones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colecistectomía I-PAST_MEDICAL_HISTORY +abierta I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +intermitente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +epigastrio I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +biliosos, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +consultado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +diversas I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +atención I-PRESENT_ILLNESS +primaria I-PRESENT_ILLNESS +realizándose I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +sintomático I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +omeprazol. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +afebril, I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +no I-EXPLORATION +mostraba I-EXPLORATION +alteraciones. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +y, I-EXPLORATION +posteriormente, I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +revelaba I-EXPLORATION +una I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +hepática I-EXPLORATION +propia I-EXPLORATION +próxima I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +bifurcación I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +pseudoaneurisma, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +componente I-EXPLORATION +mural I-EXPLORATION +trombosado I-EXPLORATION +de I-EXPLORATION +4, I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +condicionaba I-EXPLORATION +una I-EXPLORATION +compresión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +secundaria. I-EXPLORATION +Al I-EXPLORATION +día I-EXPLORATION +siguiente I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +por I-EXPLORATION +vía I-EXPLORATION +femoral I-EXPLORATION +derecha I-EXPLORATION +una I-EXPLORATION +arteriografía I-EXPLORATION +selectiva I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +celiaco, I-EXPLORATION +arteria I-EXPLORATION +hepática I-EXPLORATION +común I-EXPLORATION +y I-EXPLORATION +mesentérica I-EXPLORATION +superior I-EXPLORATION +objetivando I-EXPLORATION +un I-EXPLORATION +aneurisma I-EXPLORATION +sacular I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bifurcación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +hepática I-EXPLORATION +propia, I-EXPLORATION +con I-EXPLORATION +vascularización I-EXPLORATION +distal I-EXPLORATION +intrahepática I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +relleno I-EXPLORATION +retrógrado I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arcada I-EXPLORATION +pancreatoduodenal. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +metálica I-TREATMENT +autoexpandible I-TREATMENT +y I-TREATMENT +embolización I-TREATMENT +del I-TREATMENT +pseudoaneurisma I-TREATMENT +mediante I-TREATMENT +coils I-TREATMENT +con I-TREATMENT +una I-TREATMENT +oclusión I-TREATMENT +efectiva I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +en I-TREATMENT +el I-TREATMENT +control. I-TREATMENT +Al B-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Reanimación, I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +e I-EVOLUTION +hipotensión I-EVOLUTION +brusca I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +rotura I-EVOLUTION +del I-EVOLUTION +aneurisma I-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +cavidad I-EVOLUTION +peritoneal I-EVOLUTION +falleciendo I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +constitucional. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hiperuricemia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +metformina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alopurinol. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +apetito I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipercalcemia. I-PRESENT_ILLNESS +En B-EXPLORATION +analítica I-EXPLORATION +destaca: I-EXPLORATION +Hb I-EXPLORATION +9, I-EXPLORATION +9 I-EXPLORATION +mg/dl, I-EXPLORATION +eosinófilos I-EXPLORATION +7, I-EXPLORATION +5%, I-EXPLORATION +GGT I-EXPLORATION +225 I-EXPLORATION +U/l, I-EXPLORATION +calcio I-EXPLORATION +11, I-EXPLORATION +8 I-EXPLORATION +mg/dl, I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +7, I-EXPLORATION +2 I-EXPLORATION +g/dl, I-EXPLORATION +creatinina I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +mg/dl. I-EXPLORATION +ECA I-EXPLORATION +134.8. I-EXPLORATION +Resto I-EXPLORATION +normal. I-EXPLORATION +Anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +negativos. I-EXPLORATION +Serología I-EXPLORATION +hepatitis, I-EXPLORATION +CMV, I-EXPLORATION +VEB, I-EXPLORATION +toxoplasma, I-EXPLORATION +Aspergillus I-EXPLORATION +fumigatus, I-EXPLORATION +Brucella, I-EXPLORATION +Candida I-EXPLORATION +negativos; I-EXPLORATION +VEB I-EXPLORATION +Ig I-EXPLORATION +G I-EXPLORATION +positivo, I-EXPLORATION +Coxiella I-EXPLORATION +Ig I-EXPLORATION +G I-EXPLORATION +positivo I-EXPLORATION +1/80, I-EXPLORATION +Ig I-EXPLORATION +M I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Endoscopia I-EXPLORATION +alta, I-EXPLORATION +colonoscopia, I-EXPLORATION +broncoscopia, I-EXPLORATION +gammagrafía, I-EXPLORATION +proteinograma I-EXPLORATION +y I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +toraco-abdominal I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +hepatopatía I-EXPLORATION +difusa I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hipertensión I-EXPLORATION +portal. I-EXPLORATION +Tras B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +furosemida I-TREATMENT +y I-TREATMENT +sueroterapia I-TREATMENT +presenta I-TREATMENT +inicialmente I-TREATMENT +empeoramiento I-TREATMENT +de I-TREATMENT +las I-TREATMENT +cifras I-TREATMENT +de I-TREATMENT +calcemia I-TREATMENT +hasta I-TREATMENT +14, I-TREATMENT +7 I-TREATMENT +mg/dl. I-TREATMENT +Se B-EXPLORATION +realiza I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +objetivándose I-EXPLORATION +granulomas I-EXPLORATION +no I-EXPLORATION +necrotizantes I-EXPLORATION +con I-EXPLORATION +células I-EXPLORATION +epiteliodes I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +acompaña I-EXPLORATION +de I-EXPLORATION +fibrosis. I-EXPLORATION +Está I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +epiteliodes, I-EXPLORATION +gigantes I-EXPLORATION +multinucleadas I-EXPLORATION +(algunas I-EXPLORATION +microvacuoladas) I-EXPLORATION +con I-EXPLORATION +componente I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +plasmáticas, I-EXPLORATION +mononucleares I-EXPLORATION +y I-EXPLORATION +polimorfonucleares. I-EXPLORATION +La I-EXPLORATION +inflamación I-EXPLORATION +sobrepasa I-EXPLORATION +la I-EXPLORATION +limitante I-EXPLORATION +portal, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +esteatosis I-EXPLORATION +macrovesicular, I-EXPLORATION +neutrófilos I-EXPLORATION +y I-EXPLORATION +eosinófilos. I-EXPLORATION +Tinciones I-EXPLORATION +para I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +Ziehl I-EXPLORATION +negativa. I-EXPLORATION +Dado B-TREATMENT +que I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +clínico I-TREATMENT +era I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +granulomas I-TREATMENT +secundarios I-TREATMENT +a I-TREATMENT +fármacos, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +retirada I-TREATMENT +del I-TREATMENT +alopurinol I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +furosemida. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +3 I-EVOLUTION +semanas I-EVOLUTION +persistía I-EVOLUTION +hipercalcemia I-EVOLUTION +leve I-EVOLUTION +(10, I-EVOLUTION +7 I-EVOLUTION +mg/dl) I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +pauta I-TREATMENT +corta I-TREATMENT +de I-TREATMENT +corticoides, I-TREATMENT +normalizándose I-TREATMENT +la I-TREATMENT +calcemia I-TREATMENT +y I-TREATMENT +las I-TREATMENT +enzimas I-TREATMENT +hepáticas I-TREATMENT +a I-TREATMENT +los I-TREATMENT +2 I-TREATMENT +meses. I-TREATMENT +La B-EVOLUTION +ecografía I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +fue I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Antecedentes B-FAMILY_HISTORY +familiares: I-FAMILY_HISTORY +padres I-FAMILY_HISTORY +y I-FAMILY_HISTORY +ocho I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +fallecidos I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +patología I-FAMILY_HISTORY +digestiva I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés. I-FAMILY_HISTORY +Antecedentes B-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +alergias, I-PAST_MEDICAL_HISTORY +hábito I-PAST_MEDICAL_HISTORY +tabáquico I-PAST_MEDICAL_HISTORY +(60 I-PAST_MEDICAL_HISTORY +cigarrillos/día) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +etílico I-PAST_MEDICAL_HISTORY +(80 I-PAST_MEDICAL_HISTORY +g/día) I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +apendicectomizado, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +enfisematosa, I-PAST_MEDICAL_HISTORY +hipertrofia I-PAST_MEDICAL_HISTORY +benigna I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +próstata I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +artrosis I-PAST_MEDICAL_HISTORY +generalizada. I-PAST_MEDICAL_HISTORY +Diagnosticado I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +diverticular I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colon I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +enema I-PAST_MEDICAL_HISTORY +opaco, I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +referir I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +hipogástrico. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +practicó I-PAST_MEDICAL_HISTORY +colonoscopia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +analítica I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +detectaron I-PAST_MEDICAL_HISTORY +alteraciones I-PAST_MEDICAL_HISTORY +significativas, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +normal I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cifra I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +proteínas I-PAST_MEDICAL_HISTORY +totales. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +con: I-PAST_MEDICAL_HISTORY +tamsulosina, I-PAST_MEDICAL_HISTORY +tartrato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +zolpidem, I-PAST_MEDICAL_HISTORY +biotina, I-PAST_MEDICAL_HISTORY +candesartán, I-PAST_MEDICAL_HISTORY +fumarato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +formoterol, I-PAST_MEDICAL_HISTORY +bromuro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ipratropio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +budesonida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +inhalatoria. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +ingesta I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antiinflamatorios I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +esteroideos I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +antibióticos. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +mes, I-PAST_MEDICAL_HISTORY +dada I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diarrea, I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +loperamida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ciprofloxacino, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +observarse I-PAST_MEDICAL_HISTORY +mejoría. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +- I-PAST_MEDICAL_HISTORY +Enfermedad B-PRESENT_ILLNESS +actual: I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +progresiva: I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +(10 I-PRESENT_ILLNESS +kg), I-PRESENT_ILLNESS +numerosas I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +precedidas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +hipogástrico, I-PRESENT_ILLNESS +diurnas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +nocturnas, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +consistencia I-PRESENT_ILLNESS +blanda I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +líquida, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +contenido I-PRESENT_ILLNESS +hemático I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +abundante I-PRESENT_ILLNESS +mucosidad. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +interés. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +- B-EXPLORATION +Exploración I-EXPLORATION +física: I-EXPLORATION +deterioro I-EXPLORATION +físico I-EXPLORATION +atribuible I-EXPLORATION +a I-EXPLORATION +edad I-EXPLORATION +avanzada I-EXPLORATION +y I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +muscular. I-EXPLORATION +Talla I-EXPLORATION +164 I-EXPLORATION +cm. I-EXPLORATION +Peso I-EXPLORATION +67 I-EXPLORATION +kg. I-EXPLORATION +Necesitaba I-EXPLORATION +ayuda I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +deambulación. I-EXPLORATION +Ausencia I-EXPLORATION +de I-EXPLORATION +ictericia I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +palidez I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas. I-EXPLORATION +Presencia I-EXPLORATION +de I-EXPLORATION +máculas I-EXPLORATION +hiperpigmentadas I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +superiores. I-EXPLORATION +Escaso I-EXPLORATION +vello I-EXPLORATION +corporal. I-EXPLORATION +No I-EXPLORATION +adenopatías I-EXPLORATION +periféricas. I-EXPLORATION +Auscultación I-EXPLORATION +cardiaca I-EXPLORATION +normal. I-EXPLORATION +Frecuencia I-EXPLORATION +cardiaca: I-EXPLORATION +80 I-EXPLORATION +sístoles/minuto. I-EXPLORATION +Tensión I-EXPLORATION +arterial: I-EXPLORATION +150/90 I-EXPLORATION +mmHg. I-EXPLORATION +Auscultación I-EXPLORATION +respiratoria: I-EXPLORATION +disminución I-EXPLORATION +difusa I-EXPLORATION +del I-EXPLORATION +murmullo I-EXPLORATION +vesicular I-EXPLORATION +con I-EXPLORATION +escasos I-EXPLORATION +roncus I-EXPLORATION +y I-EXPLORATION +sibilantes. I-EXPLORATION +Abdomen I-EXPLORATION +con I-EXPLORATION +auscultación I-EXPLORATION +normal, I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipogastrio I-EXPLORATION +y I-EXPLORATION +ambas I-EXPLORATION +fosas I-EXPLORATION +iliacas, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +masas I-EXPLORATION +o I-EXPLORATION +visceromegalias. I-EXPLORATION +Atrofia I-EXPLORATION +muscular I-EXPLORATION +en I-EXPLORATION +extremidades, I-EXPLORATION +pulsos I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +edemas. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Analítica: I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +hematocrito, I-EXPLORATION +hemoglobina, I-EXPLORATION +volumen I-EXPLORATION +corpuscular I-EXPLORATION +medio, I-EXPLORATION +plaquetas, I-EXPLORATION +glucosa, I-EXPLORATION +urea, I-EXPLORATION +sodio, I-EXPLORATION +creatinina, I-EXPLORATION +bilirrubina, I-EXPLORATION +transaminasas, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina, I-EXPLORATION +colesterol, I-EXPLORATION +triglicéridos, I-EXPLORATION +ácido I-EXPLORATION +fólico, I-EXPLORATION +ferritina I-EXPLORATION +y I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +se I-EXPLORATION +mantuvieron I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +rango I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +Elevación I-EXPLORATION +progresiva I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +(13.900- I-EXPLORATION +30.900, I-EXPLORATION +normal I-EXPLORATION +4.600-10.200/mm3), I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(70-90%), I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(16, I-EXPLORATION +9-93, I-EXPLORATION +4, I-EXPLORATION +normal I-EXPLORATION +0-5 I-EXPLORATION +mg/l); I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +(4, I-EXPLORATION +4-5, I-EXPLORATION +3, I-EXPLORATION +normal I-EXPLORATION +6, I-EXPLORATION +6-8, I-EXPLORATION +7 I-EXPLORATION +g/dl), I-EXPLORATION +calcio I-EXPLORATION +(4, I-EXPLORATION +7-7, I-EXPLORATION +0, I-EXPLORATION +normal I-EXPLORATION +8, I-EXPLORATION +5-10, I-EXPLORATION +5 I-EXPLORATION +mg/dl) I-EXPLORATION +y I-EXPLORATION +colinesterasa I-EXPLORATION +(1.557-2.591, I-EXPLORATION +normal I-EXPLORATION +5.300-12.900 I-EXPLORATION +U/l). I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +normal. I-EXPLORATION +Proteinograma: I-EXPLORATION +hipoalbuminemia I-EXPLORATION +(2, I-EXPLORATION +49, I-EXPLORATION +normal I-EXPLORATION +4, I-EXPLORATION +0-4, I-EXPLORATION +7 I-EXPLORATION +g/dl) I-EXPLORATION +e I-EXPLORATION +hipogammaglobulinemia I-EXPLORATION +(0, I-EXPLORATION +39, I-EXPLORATION +normal I-EXPLORATION +0, I-EXPLORATION +80-1, I-EXPLORATION +35 I-EXPLORATION +g/dl), I-EXPLORATION +con I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +4, I-EXPLORATION +7 I-EXPLORATION +g/dl. I-EXPLORATION +Las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +potasio, I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +anodinas I-EXPLORATION +durante I-EXPLORATION +las I-EXPLORATION +primeras I-EXPLORATION +semanas I-EXPLORATION +del I-EXPLORATION +ingreso, I-EXPLORATION +alcanzaron I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +3-1, I-EXPLORATION +9, I-EXPLORATION +normal I-EXPLORATION +3, I-EXPLORATION +5-5 I-EXPLORATION +mEq/l). I-EXPLORATION +Elevación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +gastrina I-EXPLORATION +(263, I-EXPLORATION +normal I-EXPLORATION +13-115 I-EXPLORATION +pg/ml) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +tirotropina I-EXPLORATION +(TSH) I-EXPLORATION +(33, I-EXPLORATION +9-17, I-EXPLORATION +3, I-EXPLORATION +normal I-EXPLORATION +0, I-EXPLORATION +12-5 I-EXPLORATION +uU/ml), I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tiroxina I-EXPLORATION +(T4) I-EXPLORATION +(0, I-EXPLORATION +56-0, I-EXPLORATION +27, I-EXPLORATION +normal I-EXPLORATION +0, I-EXPLORATION +8-1, I-EXPLORATION +8 I-EXPLORATION +ng/dl) I-EXPLORATION +y I-EXPLORATION +normalidad I-EXPLORATION +de I-EXPLORATION +cortisol I-EXPLORATION +sérico. I-EXPLORATION +Las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +TSH I-EXPLORATION +y I-EXPLORATION +T4 I-EXPLORATION +eran I-EXPLORATION +normales I-EXPLORATION +al I-EXPLORATION +ingreso. I-EXPLORATION +Anticuerpos I-EXPLORATION +anti-peroxidasa I-EXPLORATION +tiroidea, I-EXPLORATION +anti-tiroglobulina, I-EXPLORATION +antinucleares I-EXPLORATION +y I-EXPLORATION +anti-transglutaminasa I-EXPLORATION +negativos. I-EXPLORATION +Sedimento I-EXPLORATION +urinario I-EXPLORATION +normal. I-EXPLORATION +Elevación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario I-EXPLORATION +(28, I-EXPLORATION +5-88, I-EXPLORATION +1, I-EXPLORATION +normal I-EXPLORATION +0-5 I-EXPLORATION +ng/ml) I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +antígeno I-EXPLORATION +CA I-EXPLORATION +19., I-EXPLORATION +9 I-EXPLORATION +(57, I-EXPLORATION +8, I-EXPLORATION +normal I-EXPLORATION +0-37 I-EXPLORATION +U/ml); I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +antígeno I-EXPLORATION +específico I-EXPLORATION +prostático, I-EXPLORATION +alfa-fetoproteína I-EXPLORATION +y I-EXPLORATION +antígeno I-EXPLORATION +CA I-EXPLORATION +125 I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +Cuantificación I-EXPLORATION +de I-EXPLORATION +grasas I-EXPLORATION +en I-EXPLORATION +heces I-EXPLORATION +no I-EXPLORATION +valorable. I-EXPLORATION +Microbiología: I-EXPLORATION +negatividad I-EXPLORATION +de I-EXPLORATION +coprocultivos, I-EXPLORATION +urocultivos, I-EXPLORATION +parásitos I-EXPLORATION +en I-EXPLORATION +heces, I-EXPLORATION +toxina I-EXPLORATION +de I-EXPLORATION +Clostridium I-EXPLORATION +difficile, I-EXPLORATION +Mantoux I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +a I-EXPLORATION +Helicobacter I-EXPLORATION +pylori, I-EXPLORATION +VIH, I-EXPLORATION +citomegalovirus, I-EXPLORATION +Salmonella I-EXPLORATION +y I-EXPLORATION +Yersinia I-EXPLORATION +enterocolítica. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Exploraciones I-EXPLORATION +complementarias: I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Colonoscopia I-EXPLORATION +(practicada I-EXPLORATION +en I-EXPLORATION +dos I-EXPLORATION +ocasiones): I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa, I-EXPLORATION +principalmente I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +rectosigmoidea I-EXPLORATION +y I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +ileocecal, I-EXPLORATION +numerosas I-EXPLORATION +lesiones I-EXPLORATION +nodulares I-EXPLORATION +o I-EXPLORATION +polipoides I-EXPLORATION +sésiles, I-EXPLORATION +de I-EXPLORATION +variable I-EXPLORATION +tamaño, I-EXPLORATION +llegando I-EXPLORATION +en I-EXPLORATION +algunos I-EXPLORATION +tramos I-EXPLORATION +a I-EXPLORATION +ocupar I-EXPLORATION +casi I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +del I-EXPLORATION +colon, I-EXPLORATION +dificultando I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio. I-EXPLORATION +Las I-EXPLORATION +lesiones I-EXPLORATION +muestran I-EXPLORATION +una I-EXPLORATION +superficie I-EXPLORATION +enrojecida I-EXPLORATION +con I-EXPLORATION +lesiones I-EXPLORATION +petequiales I-EXPLORATION +y I-EXPLORATION +equimóticas. I-EXPLORATION +Se I-EXPLORATION +obtuvieron I-EXPLORATION +biopsias I-EXPLORATION +a I-EXPLORATION +distintos I-EXPLORATION +niveles I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +exploración, I-EXPLORATION +una I-EXPLORATION +macrobiopsia I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +rectal I-EXPLORATION +con I-EXPLORATION +asa I-EXPLORATION +de I-EXPLORATION +polipectomía. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Gastroscopia: I-EXPLORATION +esófago, I-EXPLORATION +fundus I-EXPLORATION +y I-EXPLORATION +cuerpo I-EXPLORATION +gástrico I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +antro I-EXPLORATION +gástrico, I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +prepilórico, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +duodenal I-EXPLORATION +mostraban, I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa, I-EXPLORATION +nódulos I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Radiología I-EXPLORATION +del I-EXPLORATION +tórax: I-EXPLORATION +bullas I-EXPLORATION +enfisematosas I-EXPLORATION +en I-EXPLORATION +base I-EXPLORATION +pulmonar I-EXPLORATION +derecha. I-EXPLORATION +No I-EXPLORATION +derrame I-EXPLORATION +pleural. I-EXPLORATION +Sospecha I-EXPLORATION +de I-EXPLORATION +leve I-EXPLORATION +derrame I-EXPLORATION +pericárdico. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Radiología I-EXPLORATION +baritada I-EXPLORATION +de I-EXPLORATION +esófago, I-EXPLORATION +estómago I-EXPLORATION +e I-EXPLORATION +intestino I-EXPLORATION +delgado: I-EXPLORATION +pliegues I-EXPLORATION +gástricos I-EXPLORATION +antrales I-EXPLORATION +engrosados, I-EXPLORATION +irregulares I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +defectos I-EXPLORATION +de I-EXPLORATION +repleción. I-EXPLORATION +Engrosamiento I-EXPLORATION +de I-EXPLORATION +pliegues I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado, I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +nodular, I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +en I-EXPLORATION +yeyuno, I-EXPLORATION +y I-EXPLORATION +dilución I-EXPLORATION +del I-EXPLORATION +contraste. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Enema I-EXPLORATION +opaco: I-EXPLORATION +divertículos I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +sigmoideo I-EXPLORATION +y I-EXPLORATION +descendente. I-EXPLORATION +Múltiples I-EXPLORATION +defectos I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +en I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +del I-EXPLORATION +colon. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Tomografía I-EXPLORATION +computarizada I-EXPLORATION +abdominal: I-EXPLORATION +quistes I-EXPLORATION +en I-EXPLORATION +riñón I-EXPLORATION +izquierdo. I-EXPLORATION +Probable I-EXPLORATION +adenoma I-EXPLORATION +suprarrenal I-EXPLORATION +derecho. I-EXPLORATION +Divertículos I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +descendente I-EXPLORATION +y I-EXPLORATION +sigmoides. I-EXPLORATION +Engrosamiento I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +del I-EXPLORATION +colon. I-EXPLORATION +Hipertrofia I-EXPLORATION +prostática. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Ecografía I-EXPLORATION +tiroidea: I-EXPLORATION +tiroides I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +normal. I-EXPLORATION +Pequeños I-EXPLORATION +quistes I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +derecho. I-EXPLORATION +Lóbulo I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +ecogenicidad I-EXPLORATION +homogénea I-EXPLORATION +y I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Ecocardiograma I-EXPLORATION +transtorácico: I-EXPLORATION +no I-EXPLORATION +derrame I-EXPLORATION +pericárdico, I-EXPLORATION +función I-EXPLORATION +sistólica I-EXPLORATION +conservada, I-EXPLORATION +insuficiencia I-EXPLORATION +valvular I-EXPLORATION +mitral I-EXPLORATION +y I-EXPLORATION +aórtica. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Histología I-EXPLORATION +de I-EXPLORATION +biopsias I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +y I-EXPLORATION +macrobiopsia I-EXPLORATION +rectal: I-EXPLORATION +mucosa I-EXPLORATION +con I-EXPLORATION +distorsión I-EXPLORATION +intensa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arquitectura I-EXPLORATION +glandular, I-EXPLORATION +dilataciones I-EXPLORATION +glandulares I-EXPLORATION +microquísticas I-EXPLORATION +y I-EXPLORATION +colecciones I-EXPLORATION +de I-EXPLORATION +mucina, I-EXPLORATION +lámina I-EXPLORATION +propia I-EXPLORATION +edematosa I-EXPLORATION +con I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +moderado I-EXPLORATION +a I-EXPLORATION +severo I-EXPLORATION +con I-EXPLORATION +abundantes I-EXPLORATION +células I-EXPLORATION +plasmáticas, I-EXPLORATION +neutrófilos I-EXPLORATION +y I-EXPLORATION +eosinófilos. I-EXPLORATION +Las I-EXPLORATION +alteraciones I-EXPLORATION +detectadas I-EXPLORATION +son I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +hamartomas I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +y I-EXPLORATION +recto. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Histología I-EXPLORATION +de I-EXPLORATION +biopsias I-EXPLORATION +gástricas I-EXPLORATION +y I-EXPLORATION +duodenales: I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +dilataciones I-EXPLORATION +glandulares I-EXPLORATION +e I-EXPLORATION +intenso I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +mixto, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +hamartomas I-EXPLORATION +de I-EXPLORATION +estómago I-EXPLORATION +y I-EXPLORATION +duodeno. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Evolución B-EVOLUTION +clínica: I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +diagnosticado I-EVOLUTION +de I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +Cronkhite-Canadá, I-EVOLUTION +falleciendo I-EVOLUTION +tras I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +hospitalario I-EVOLUTION +sin I-EVOLUTION +detectarse I-EVOLUTION +en I-EVOLUTION +ningún I-EVOLUTION +momento I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +evidente I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +clínico I-EVOLUTION +inicial. I-EVOLUTION +Mantuvo I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +de I-EVOLUTION +astenia I-EVOLUTION +y I-EVOLUTION +anorexia, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +número I-EVOLUTION +variable I-EVOLUTION +de I-EVOLUTION +deposiciones I-EVOLUTION +con I-EVOLUTION +abundante I-EVOLUTION +contenido I-EVOLUTION +mucoso, I-EVOLUTION +mayor I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +y I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +hipoproteinemia I-EVOLUTION +con I-EVOLUTION +edemas I-EVOLUTION +en I-EVOLUTION +miembros I-EVOLUTION +inferiores. I-EVOLUTION +Presencia I-EVOLUTION +de I-EVOLUTION +fiebre I-EVOLUTION +(38 I-EVOLUTION +oC) I-EVOLUTION +en I-EVOLUTION +días I-EVOLUTION +aislados I-EVOLUTION +con I-EVOLUTION +hemocultivos I-EVOLUTION +positivos I-EVOLUTION +a I-EVOLUTION +E. I-EVOLUTION +coli I-EVOLUTION +atribuible I-EVOLUTION +a I-EVOLUTION +flebitis I-EVOLUTION +e I-EVOLUTION +infecciones I-EVOLUTION +urinarias, I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +tetania I-EVOLUTION +hipocalcémica, I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +miembros I-EVOLUTION +inferiores I-EVOLUTION +de I-EVOLUTION +probable I-EVOLUTION +origen I-EVOLUTION +neuropático I-EVOLUTION +y I-EVOLUTION +lesiones I-EVOLUTION +ungueales I-EVOLUTION +con I-EVOLUTION +onicólisis I-EVOLUTION +muy I-EVOLUTION +evidente. I-EVOLUTION +Es I-EVOLUTION +destacable I-EVOLUTION +el I-EVOLUTION +desarrollo I-EVOLUTION +de I-EVOLUTION +hipotiroidismo I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +elevación I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +antígeno I-EVOLUTION +carcinoembrionario. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +fallece I-EVOLUTION +tras I-EVOLUTION +presentar, I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +últimas I-EVOLUTION +24 I-EVOLUTION +horas, I-EVOLUTION +fiebre, I-EVOLUTION +tos I-EVOLUTION +con I-EVOLUTION +expectoración I-EVOLUTION +hemoptoica, I-EVOLUTION +disnea, I-EVOLUTION +datos I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +respiratoria I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +gasometría I-EVOLUTION +arterial I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +neumonía I-EVOLUTION +de I-EVOLUTION +base I-EVOLUTION +izquierda I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +radiología I-EVOLUTION +de I-EVOLUTION +tórax. I-EVOLUTION +Se B-EXPLORATION +practicó I-EXPLORATION +necropsia. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Tratamientos: B-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +durante I-TREATMENT +su I-TREATMENT +prolongada I-TREATMENT +estancia I-TREATMENT +hospitalaria I-TREATMENT +recibió I-TREATMENT +tratamiento, I-TREATMENT +no I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +simultánea, I-TREATMENT +con: I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +por I-TREATMENT +sonda, I-TREATMENT +sueroterapia I-TREATMENT +con I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +cloruro I-TREATMENT +potásico, I-TREATMENT +calcio I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +sistémico, I-TREATMENT +albúmina I-TREATMENT +intravenosa, I-TREATMENT +omeprazol I-TREATMENT +20 I-TREATMENT +mg/día, I-TREATMENT +mesalazina, I-TREATMENT +complejos I-TREATMENT +vitamínicos, I-TREATMENT +loratadina I-TREATMENT +10 I-TREATMENT +mg/día, I-TREATMENT +corticoides I-TREATMENT +orales I-TREATMENT +y I-TREATMENT +sistémicos, I-TREATMENT +loperamida, I-TREATMENT +octeótrida I-TREATMENT +subcutánea I-TREATMENT +50 I-TREATMENT +mcg/8 I-TREATMENT +h, I-TREATMENT +gabapentina I-TREATMENT +300 I-TREATMENT +mg/8 I-TREATMENT +h, I-TREATMENT +antibióticos I-TREATMENT +(piperacilina-tazobactam, I-TREATMENT +amoxicilina-clavulámico, I-TREATMENT +metronidazol I-TREATMENT +y I-TREATMENT +ciprofloxacino), I-TREATMENT +levotiroxina I-TREATMENT +y I-TREATMENT +medicación I-TREATMENT +para I-TREATMENT +su I-TREATMENT +patología I-TREATMENT +previas: I-TREATMENT +hipertensión I-TREATMENT +arterial, I-TREATMENT +broncopatía I-TREATMENT +crónica I-TREATMENT +e I-TREATMENT +hipertrofia I-TREATMENT +prostática. I-TREATMENT + I-TREATMENT +- B-EXPLORATION +Informe I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +necropsia: I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +autópsicos I-EXPLORATION +resultan I-EXPLORATION +concordantes I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Cronkhite-Canadá. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Examen I-EXPLORATION +externo: I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +vello I-EXPLORATION +corporal I-EXPLORATION +y I-EXPLORATION +máculas I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +pardo-oscuras I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +superiores, I-EXPLORATION +especialmente I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +dorsal I-EXPLORATION +de I-EXPLORATION +mano I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +antebrazo I-EXPLORATION +izquierdo. I-EXPLORATION +Los I-EXPLORATION +dedos I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +manos I-EXPLORATION +presentan I-EXPLORATION +onicólisis I-EXPLORATION +con I-EXPLORATION +coloración I-EXPLORATION +ungueal I-EXPLORATION +blanquecino-amarillenta. I-EXPLORATION +Hidrocele I-EXPLORATION +bilateral. I-EXPLORATION +Edemas I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores. I-EXPLORATION + I-EXPLORATION +-Examen I-EXPLORATION +interno: I-EXPLORATION +derrame I-EXPLORATION +pericárdico, I-EXPLORATION +pleural I-EXPLORATION +y I-EXPLORATION +peritoneal. I-EXPLORATION +Hipotrofia I-EXPLORATION +tiroides. I-EXPLORATION +Enfisema I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +neumonía I-EXPLORATION +pulmón I-EXPLORATION +izquierdo. I-EXPLORATION +Hiperplasia I-EXPLORATION +nodular I-EXPLORATION +suprarrenal I-EXPLORATION +bilateral. I-EXPLORATION +Arterioesclerosis I-EXPLORATION +moderada. I-EXPLORATION +Adenocarcinoma I-EXPLORATION +de I-EXPLORATION +próstata I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +extracapsular I-EXPLORATION +ni I-EXPLORATION +metástasica. I-EXPLORATION +Atrofia I-EXPLORATION +testicular. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectan I-EXPLORATION +alteraciones I-EXPLORATION +destacables I-EXPLORATION +en I-EXPLORATION +hígado, I-EXPLORATION +vías I-EXPLORATION +biliares I-EXPLORATION +o I-EXPLORATION +páncreas. I-EXPLORATION +Estudio I-EXPLORATION +del I-EXPLORATION +tubo I-EXPLORATION +digestivo: I-EXPLORATION +esófago I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION +El I-EXPLORATION +cuerpo I-EXPLORATION +gástrico I-EXPLORATION +muestra I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +pliegues. I-EXPLORATION +El I-EXPLORATION +antro I-EXPLORATION +gástrico I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +superficie I-EXPLORATION +rugosa, I-EXPLORATION +"en I-EXPLORATION +empedrado", I-EXPLORATION +con I-EXPLORATION +engrosamienro I-EXPLORATION +nodular I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pliegues I-EXPLORATION +y I-EXPLORATION +equimosis I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie, I-EXPLORATION +persistiendo I-EXPLORATION +estas I-EXPLORATION +alteraciones I-EXPLORATION +hasta I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +duodenal, I-EXPLORATION +donde I-EXPLORATION +es I-EXPLORATION +más I-EXPLORATION +evidente I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +pólipos I-EXPLORATION +sésiles. I-EXPLORATION +En I-EXPLORATION +yeyuno I-EXPLORATION +e I-EXPLORATION +íleon I-EXPLORATION +no I-EXPLORATION +aparecen I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION +La I-EXPLORATION +mucosa I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +muestra, I-EXPLORATION +en I-EXPLORATION +toda I-EXPLORATION +su I-EXPLORATION +extensión, I-EXPLORATION +una I-EXPLORATION +morfología I-EXPLORATION +polipoidea, I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +prominencias I-EXPLORATION +sésiles, I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +equimótica I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +friable. I-EXPLORATION +Las I-EXPLORATION +alteraciones I-EXPLORATION +son I-EXPLORATION +menos I-EXPLORATION +evidentes I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +colon I-EXPLORATION +derecho. I-EXPLORATION +Divertículos I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +Microscópicamente I-EXPLORATION +lo I-EXPLORATION +más I-EXPLORATION +llamativo I-EXPLORATION +era I-EXPLORATION +la I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +antro, I-EXPLORATION +duodeno, I-EXPLORATION +colon I-EXPLORATION +y I-EXPLORATION +recto I-EXPLORATION +(en I-EXPLORATION +su I-EXPLORATION +totalidad), I-EXPLORATION +que I-EXPLORATION +mostraban I-EXPLORATION +una I-EXPLORATION +histopatología I-EXPLORATION +similar, I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +formaciones I-EXPLORATION +polipoides, I-EXPLORATION +algunos I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +hamartomatoso, I-EXPLORATION +con I-EXPLORATION +criptas I-EXPLORATION +dilatadas I-EXPLORATION +y I-EXPLORATION +quísticas I-EXPLORATION +que I-EXPLORATION +disminuyen I-EXPLORATION +en I-EXPLORATION +número I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +presentan I-EXPLORATION +hipersecreción I-EXPLORATION +de I-EXPLORATION +moco. I-EXPLORATION +En I-EXPLORATION +lámina I-EXPLORATION +propia I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +edema I-EXPLORATION +con I-EXPLORATION +hiperplasia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +fibras I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muscularis I-EXPLORATION +mucosa, I-EXPLORATION +e I-EXPLORATION +inflamación I-EXPLORATION +crónica I-EXPLORATION +leve-moderada. I-EXPLORATION +Existe I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +vellosidades I-EXPLORATION +intestinales I-EXPLORATION +tanto I-EXPLORATION +de I-EXPLORATION +duodeno I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +colon, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pliegues I-EXPLORATION +gástricos I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +y I-EXPLORATION +cuerpo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +reconocen I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +displasia I-EXPLORATION +en I-EXPLORATION +ninguno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cortes I-EXPLORATION +examinados. I-EXPLORATION + I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +justificación I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario. I-EXPLORATION + I-EXPLORATION +Causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muerte: I-EXPLORATION +malnutrición I-EXPLORATION +grave I-EXPLORATION +secundaria I-EXPLORATION +al I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Cronkhite I-EXPLORATION +Canada. I-EXPLORATION +Neumonía I-EXPLORATION +en I-EXPLORATION +pulmón I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +perímetro I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Presentaba I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cantidad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +consistencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +frecuencia. I-PRESENT_ILLNESS +En B-FAMILY_HISTORY +sus I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +personales I-FAMILY_HISTORY +destacan: I-FAMILY_HISTORY +alergia I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +penicilina, I-FAMILY_HISTORY +hipertensa, I-FAMILY_HISTORY +dislipémica I-FAMILY_HISTORY +y I-FAMILY_HISTORY +asma I-FAMILY_HISTORY +intrínseco. I-FAMILY_HISTORY + I-FAMILY_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +gran I-EXPLORATION +tumoración I-EXPLORATION +abdominal I-EXPLORATION +palpable, I-EXPLORATION +dura I-EXPLORATION +y I-EXPLORATION +dolorosa. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +abdómino-pélvica I-EXPLORATION +mostraban I-EXPLORATION +anejos I-EXPLORATION +normales, I-EXPLORATION +endometrio I-EXPLORATION +lineal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +de I-EXPLORATION +17, I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +17, I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +11 I-EXPLORATION +cm I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +precisar I-EXPLORATION +origen. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +intervino I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +programada, I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Ginecología, I-TREATMENT +realizando I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +infraumbilical, I-TREATMENT +evidenciando I-TREATMENT +una I-TREATMENT +tumoración I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +20 I-TREATMENT +cm I-TREATMENT +dependiente I-TREATMENT +de I-TREATMENT +mesenterio I-TREATMENT +adherida I-TREATMENT +a I-TREATMENT +un I-TREATMENT +asa I-TREATMENT +de I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +y I-TREATMENT +a I-TREATMENT +colon I-TREATMENT +sigmoide. I-TREATMENT +Se I-TREATMENT +avisó I-TREATMENT +al I-TREATMENT +cirujano I-TREATMENT +de I-TREATMENT +guardia I-TREATMENT +que I-TREATMENT +realizó I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +intestinal I-TREATMENT +de I-TREATMENT +50 I-TREATMENT +cm I-TREATMENT +y I-TREATMENT +sutura I-TREATMENT +de I-TREATMENT +área I-TREATMENT +deserosada I-TREATMENT +de I-TREATMENT +colon I-TREATMENT +sigmoide. I-TREATMENT +Al I-TREATMENT +7o I-TREATMENT +día I-TREATMENT +postoperatorio I-TREATMENT +se I-TREATMENT +reintervino I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +por I-TREATMENT +presentar I-TREATMENT +abdomen I-TREATMENT +agudo I-TREATMENT +realizando I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +colon I-TREATMENT +sigmoide I-TREATMENT +perforado I-TREATMENT +y I-TREATMENT +anastomosis I-TREATMENT +T-T. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +posteriormente I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +favorable I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +17 I-EVOLUTION +día I-EVOLUTION +postoperatorio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +mostró I-EXPLORATION +proliferación I-EXPLORATION +fusocelular I-EXPLORATION +sin I-EXPLORATION +atipias I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +alguna I-EXPLORATION +mitosis I-EXPLORATION +ocasional. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +son I-EXPLORATION +positivas I-EXPLORATION +con I-EXPLORATION +vimentina I-EXPLORATION +y I-EXPLORATION +CD117 I-EXPLORATION +(C-Kit). I-EXPLORATION +Actualmente, B-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +y B-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +adyuvante I-TREATMENT +con I-TREATMENT +mesilato I-TREATMENT +de I-TREATMENT +imatinib. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemofilia I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +severa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Cuba I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +(su I-PAST_MEDICAL_HISTORY +país I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +residente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +España I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +años). I-PAST_MEDICAL_HISTORY +No B-FAMILY_HISTORY +refería I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +enfermedad. I-FAMILY_HISTORY +Durante B-PAST_MEDICAL_HISTORY +estos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemartros I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +rodilla I-PAST_MEDICAL_HISTORY +derecha, I-PAST_MEDICAL_HISTORY +tratados I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +conservadora, I-PAST_MEDICAL_HISTORY +precisando I-PAST_MEDICAL_HISTORY +crioprecipitados. I-PAST_MEDICAL_HISTORY +Previo I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +actual I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +asintomático I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +domiciliario. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipogastrio, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hematuria. I-PRESENT_ILLNESS +Tras B-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +analíticas I-EXPLORATION +y I-EXPLORATION +radiológicas I-EXPLORATION +fue I-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +cólico I-EXPLORATION +nefrítico, I-EXPLORATION +siendo I-EXPLORATION +alta I-EXPLORATION +con I-EXPLORATION +tratamiento I-EXPLORATION +analgésico. I-EXPLORATION + I-EXPLORATION +Cinco B-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +tarde, I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +micción, I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síncope I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conocimiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +escasos I-PRESENT_ILLNESS +segundos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +consciente I-EXPLORATION +y I-EXPLORATION +orientado, I-EXPLORATION +con I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +e I-EXPLORATION +intensa I-EXPLORATION +palidez I-EXPLORATION +mucocutánea. I-EXPLORATION +La I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +sistólica I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +70 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +diastólica I-EXPLORATION +de I-EXPLORATION +37 I-EXPLORATION +mmHg, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +61 I-EXPLORATION +latidos/min. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +abdominal I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +estaba I-EXPLORATION +distendido, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa, I-EXPLORATION +con I-EXPLORATION +defensa I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +generalizada. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +realizada I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +del I-EXPLORATION +20%, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +7 I-EXPLORATION +g/dl, I-EXPLORATION +leucocitos I-EXPLORATION +12.270/ul I-EXPLORATION +(84% I-EXPLORATION +neutrófilos) I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +358.000/ul. I-EXPLORATION +Actividad I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +100%, I-EXPLORATION +TTPA I-EXPLORATION +46%. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +que I-EXPLORATION +informaba I-EXPLORATION +de I-EXPLORATION +abundante I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +subdiafragmático I-EXPLORATION +izquierdo, I-EXPLORATION +subhepático I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +gotieras I-EXPLORATION +paracólicas. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +espacio I-EXPLORATION +vesicorrectal I-EXPLORATION +se I-EXPLORATION +visualizaba I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +ovalada, I-EXPLORATION +con I-EXPLORATION +líquido I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +imagen I-EXPLORATION +quística I-EXPLORATION +retro I-EXPLORATION +y I-EXPLORATION +supravesical, I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +que I-EXPLORATION +parece I-EXPLORATION +depender I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +vaso I-EXPLORATION +arterial I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +llegar I-EXPLORATION +a I-EXPLORATION +detectar I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +del I-EXPLORATION +mismo. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +sangrado I-TREATMENT +en I-TREATMENT +paciente I-TREATMENT +hemofílico I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +transfusión I-TREATMENT +inmediata I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes, I-TREATMENT +3 I-TREATMENT +viales I-TREATMENT +de I-TREATMENT +factor I-TREATMENT +VIII I-TREATMENT +además I-TREATMENT +de I-TREATMENT +otro I-TREATMENT +de I-TREATMENT +factor I-TREATMENT +VII I-TREATMENT +recombinante. I-TREATMENT +La B-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +factor I-EXPLORATION +VIII I-EXPLORATION +requirió I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +Ac I-EXPLORATION +antifactor I-EXPLORATION +VIII I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +positivos, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +requirió, I-TREATMENT +previa I-TREATMENT +a I-TREATMENT +su I-TREATMENT +administración, I-TREATMENT +la I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +inhibidores I-TREATMENT +de I-TREATMENT +Ac I-TREATMENT +antifactor I-TREATMENT +VIII I-TREATMENT +(4). I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +analítica I-EVOLUTION +y I-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +del I-EVOLUTION +mal I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +del I-EVOLUTION +paciente, I-EVOLUTION +se B-TREATMENT +decidió I-TREATMENT +intervenir I-TREATMENT +mediante I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +suprainfraumbilical I-TREATMENT +hallando I-TREATMENT +hemoperitoneo I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +3 I-TREATMENT +litros I-TREATMENT +de I-TREATMENT +coágulos I-TREATMENT +y I-TREATMENT +sangre I-TREATMENT +roja. I-TREATMENT +Se B-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +retrovesical, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +y I-EXPLORATION +superficie I-EXPLORATION +lisa, I-EXPLORATION +íntimamente I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +cara I-EXPLORATION +posterior I-EXPLORATION +vesical. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +disección I-TREATMENT +roma I-TREATMENT +y I-TREATMENT +exéreis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración. I-TREATMENT +Posteriormente B-EXPLORATION +se I-EXPLORATION +revisó I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +abdominal I-EXPLORATION +sin I-EXPLORATION +objetivar I-EXPLORATION +un I-EXPLORATION +punto I-EXPLORATION +sangrante I-EXPLORATION +activo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +satisfactoriamente I-EVOLUTION +en I-EVOLUTION +planta, I-EVOLUTION +manteniéndose I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +hematocritos I-EVOLUTION +mantenidos I-EVOLUTION +y I-EVOLUTION +débitos I-EVOLUTION +decrecientes I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +décimo I-EVOLUTION +día I-EVOLUTION +postoperatorio. I-EVOLUTION +El B-TREATMENT +paciente I-TREATMENT +precisó I-TREATMENT +controles I-TREATMENT +por I-TREATMENT +hematología I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +del I-TREATMENT +factor I-TREATMENT +VIII I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +en I-TREATMENT +los I-TREATMENT +cuatro I-TREATMENT +primeros I-TREATMENT +días. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +formación I-EXPLORATION +cupuliforme I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +La I-EXPLORATION +superficie I-EXPLORATION +externa I-EXPLORATION +era I-EXPLORATION +lisa I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +interna I-EXPLORATION +presentaba I-EXPLORATION +múltiples I-EXPLORATION +coágulos I-EXPLORATION +hemáticos I-EXPLORATION +adheridos. I-EXPLORATION +La I-EXPLORATION +cúpula I-EXPLORATION +fibrosa I-EXPLORATION +contenía I-EXPLORATION +moderada I-EXPLORATION +infiltración I-EXPLORATION +inflamatoria I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +crónico I-EXPLORATION +inespecífico I-EXPLORATION +con I-EXPLORATION +algunos I-EXPLORATION +hemosiderofagos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +interna I-EXPLORATION +presentaba, I-EXPLORATION +además I-EXPLORATION +del I-EXPLORATION +material I-EXPLORATION +hemático I-EXPLORATION +adherido, I-EXPLORATION +tejido I-EXPLORATION +graso I-EXPLORATION +maduro, I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +pseudotumor I-EXPLORATION +hemofílico. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +64 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +mareo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +profusa. I-PRESENT_ILLNESS +Unas I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +trabajando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +campo I-PRESENT_ILLNESS +fumigando I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +insecticida I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +contenía I-PRESENT_ILLNESS +polvo I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +espolvoreo. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +mostraba I-EXPLORATION +importante I-EXPLORATION +diaforesis I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +bradipsiquia I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +focalidad I-EXPLORATION +neurológica. I-EXPLORATION +Tras B-TREATMENT +estabilización I-TREATMENT +hemodinámica, I-TREATMENT +se B-EXPLORATION +realizó I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +hepático I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +distinta I-EXPLORATION +intensidad I-EXPLORATION +con I-EXPLORATION +gran I-EXPLORATION +colección I-EXPLORATION +subcapsular I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +probable I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +hemoperitoneo. I-EXPLORATION +La I-EXPLORATION +vesícula I-EXPLORATION +adyacente I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +nivel I-EXPLORATION +líquido-líquido I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +descartar I-EXPLORATION +contenido I-EXPLORATION +hemático. I-EXPLORATION +Así I-EXPLORATION +mismo I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +y I-EXPLORATION +realce I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +antro I-EXPLORATION +gástrico I-EXPLORATION +y I-EXPLORATION +duodeno I-EXPLORATION +con I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +periesplénico I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +gotieras, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +gastroscopia I-EXPLORATION +confirmando I-EXPLORATION +gastroduodenitis I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +los I-TREATMENT +resultados, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +urgente I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +evidenció I-TREATMENT +gran I-TREATMENT +hemoperitoneo I-TREATMENT +con I-TREATMENT +coágulos I-TREATMENT +suprahepáticos I-TREATMENT +y I-TREATMENT +brecha I-TREATMENT +en I-TREATMENT +lóbulo I-TREATMENT +hepático I-TREATMENT +derecho I-TREATMENT +de I-TREATMENT +unos I-TREATMENT +10 I-TREATMENT +cm, I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +necrótico I-TREATMENT +con I-TREATMENT +sangrado I-TREATMENT +activo I-TREATMENT +en I-TREATMENT +sábana. I-TREATMENT +Se I-TREATMENT +drenó I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +200 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +contenido I-TREATMENT +hemático I-TREATMENT +y I-TREATMENT +se I-TREATMENT +controló I-TREATMENT +el I-TREATMENT +sangrado I-TREATMENT +mediante I-TREATMENT +medidas I-TREATMENT +hemostáticas. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +postoperatorio. I-EVOLUTION +La B-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +colección I-EXPLORATION +aunque I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +tamaño I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +resolvió I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +práctica I-EXPLORATION +totalidad I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +drenaje I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ulcus I-PAST_MEDICAL_HISTORY +duodenal I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +(no I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +previamente I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +paquetes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cigarrillos/día). I-PAST_MEDICAL_HISTORY +Intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +papila I-PAST_MEDICAL_HISTORY +anal I-PAST_MEDICAL_HISTORY +hipertrófica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2007 I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fístula I-PAST_MEDICAL_HISTORY +perianal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +recidiva I-PAST_MEDICAL_HISTORY +precoz. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8-10 I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +diarias, I-PRESENT_ILLNESS +blandas-líquidas, I-PRESENT_ILLNESS +algunas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sangre, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carácter I-PRESENT_ILLNESS +diurno I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +nocturno I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cedieron I-PRESENT_ILLNESS +parcialmente I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ciprofloxacino I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +oral. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +aparece I-PRESENT_ILLNESS +empeoramiento I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mucorrea I-PRESENT_ILLNESS +sanguinolenta I-PRESENT_ILLNESS +(6-8 I-PRESENT_ILLNESS +deposiciones/día), I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +hipogástrico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +proctalgia I-PRESENT_ILLNESS +intensa. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +aqueja I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +creciente I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +picos I-PRESENT_ILLNESS +febriles I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +oC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +predominio I-PRESENT_ILLNESS +vespertino I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +última I-PRESENT_ILLNESS +semana. I-PRESENT_ILLNESS +No B-EXPLORATION +presentaba I-EXPLORATION +fístulas I-EXPLORATION +perianales I-EXPLORATION +activas I-EXPLORATION +ni I-EXPLORATION +supuración. I-EXPLORATION + I-EXPLORATION +Desde I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +evidencia I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +brusca I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +inflamatorias I-EXPLORATION +eritematosas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +pustuloso I-EXPLORATION +sobre I-EXPLORATION +placas, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +brazos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +manos, I-EXPLORATION +con I-EXPLORATION +centro I-EXPLORATION +umbilicado, I-EXPLORATION +dolorosas, I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +asimétrica. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +rectal I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +perianal I-EXPLORATION +complicada I-EXPLORATION +con I-EXPLORATION +dos I-EXPLORATION +orificios I-EXPLORATION +fistulosos I-EXPLORATION +inactivos, I-EXPLORATION +mariscas I-EXPLORATION +hemorroidales I-EXPLORATION +y I-EXPLORATION +fisura I-EXPLORATION +aguda I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +posterior. I-EXPLORATION + I-EXPLORATION +Analíticamente I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +anemia I-EXPLORATION +microcítica I-EXPLORATION +hipocroma I-EXPLORATION +ferropénica I-EXPLORATION +sin I-EXPLORATION +leucocitosis I-EXPLORATION +y I-EXPLORATION +coagulación I-EXPLORATION +normal, I-EXPLORATION +destacando I-EXPLORATION +GGT I-EXPLORATION +de I-EXPLORATION +203 I-EXPLORATION +mU/ml, I-EXPLORATION +PCR: I-EXPLORATION +248 I-EXPLORATION +mg/l I-EXPLORATION +y I-EXPLORATION +VSG: I-EXPLORATION +120 I-EXPLORATION +mm/h. I-EXPLORATION +Hemocultivos I-EXPLORATION +y I-EXPLORATION +coprocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +describe I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +del I-EXPLORATION +rectosigma, I-EXPLORATION +confirmada I-EXPLORATION +por I-EXPLORATION +TC I-EXPLORATION +abdominal, I-EXPLORATION +que I-EXPLORATION +también I-EXPLORATION +revela I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +transverso I-EXPLORATION +y I-EXPLORATION +ciego, I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +adenopatías I-EXPLORATION +en I-EXPLORATION +territorio I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +iliacos, I-EXPLORATION +sin I-EXPLORATION +líquido I-EXPLORATION +libre. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +rectal I-EXPLORATION +aparece I-EXPLORATION +edematosa I-EXPLORATION +y I-EXPLORATION +eritematosa I-EXPLORATION +con I-EXPLORATION +formaciones I-EXPLORATION +pseudopolipoideas I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extienden I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +mayor I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +colon, I-EXPLORATION +intercalando I-EXPLORATION +áreas I-EXPLORATION +con I-EXPLORATION +mucosa I-EXPLORATION +conservada. I-EXPLORATION +El I-EXPLORATION +íleon I-EXPLORATION +es I-EXPLORATION +macroscópicamente I-EXPLORATION +normal. I-EXPLORATION +Las I-EXPLORATION +biopsias I-EXPLORATION +colónicas I-EXPLORATION +confirman I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +ulceración I-EXPLORATION +e I-EXPLORATION +inflamación I-EXPLORATION +crónica, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +granulomas. I-EXPLORATION + I-EXPLORATION +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +valorado I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +Dermatología. I-DERIVED_FROM/TO +Una B-EXPLORATION +biopsia I-EXPLORATION +cutánea I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +eminencia I-EXPLORATION +hipotecar I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +infiltrado I-EXPLORATION +neutrofílico I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +dérmico I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +vasculitis, I-EXPLORATION +confirmándose I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +dermatosis I-EXPLORATION +neutrofílica I-EXPLORATION +(DN). I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +tanto I-EXPLORATION +se I-EXPLORATION +diagnostica I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +de: I-EXPLORATION +a) I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn I-EXPLORATION +colónica I-EXPLORATION +con I-EXPLORATION +brote I-EXPLORATION +de I-EXPLORATION +actividad I-EXPLORATION +moderada I-EXPLORATION +con I-EXPLORATION +CDAI: I-EXPLORATION +345 I-EXPLORATION +(debut I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad) I-EXPLORATION +y I-EXPLORATION +enfermedad I-EXPLORATION +perianal I-EXPLORATION +(EPA), I-EXPLORATION +clasificación I-EXPLORATION +de I-EXPLORATION +Montreal: I-EXPLORATION +A3 I-EXPLORATION +L2 I-EXPLORATION +B1p; I-EXPLORATION +y I-EXPLORATION +b) I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Sweet, I-EXPLORATION +cumpliendo I-EXPLORATION +los I-EXPLORATION +criterios I-EXPLORATION +aceptados. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +fluidoterapia, I-TREATMENT +metilprednisolona I-TREATMENT +(60 I-TREATMENT +mg/i.v./24 I-TREATMENT +h), I-TREATMENT +antibioterapia I-TREATMENT +(ciprofloxacino I-TREATMENT +400 I-TREATMENT +mg/i.v./12 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +metronidazol I-TREATMENT +1.500 I-TREATMENT +mg/i.v./24 I-TREATMENT +h), I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +y I-TREATMENT +mesalazina I-TREATMENT +(3 I-TREATMENT +g/v.o./24 I-TREATMENT +h), I-TREATMENT +con I-TREATMENT +muy I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínica. I-TREATMENT +La B-EVOLUTION +fiebre I-EVOLUTION +desapareció I-EVOLUTION +en I-EVOLUTION +48 I-EVOLUTION +h, I-EVOLUTION +mejorando I-EVOLUTION +en I-EVOLUTION +pocos I-EVOLUTION +días I-EVOLUTION +las I-EVOLUTION +molestias I-EVOLUTION +abdominales I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +diarrea. I-EVOLUTION + I-EVOLUTION +Como B-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +cutáneas I-TREATMENT +se I-TREATMENT +asoció I-TREATMENT +beclometasona I-TREATMENT +tópica. I-TREATMENT +Estas B-EVOLUTION +fueron I-EVOLUTION +reduciéndose I-EVOLUTION +de I-EVOLUTION +tamaño, I-EVOLUTION +disminuyendo I-EVOLUTION +las I-EVOLUTION +molestias I-EVOLUTION +locales I-EVOLUTION +tras I-EVOLUTION +3 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con B-TREATMENT +dosis I-TREATMENT +descendentes I-TREATMENT +de I-TREATMENT +prednisona I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +comprobándose B-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +pápulas I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +6 I-EVOLUTION +semanas, I-EVOLUTION +sin I-EVOLUTION +dejar I-EVOLUTION +cicatriz I-EVOLUTION +ni I-EVOLUTION +secuelas I-EVOLUTION +cutáneas. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +transplantado I-PRESENT_ILLNESS +cardiaco I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +décimo I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +postoperatorio I-PRESENT_ILLNESS +desarrolló I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +vólvulo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ciego. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +dilatada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fracción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +eyección I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +23% I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +doble I-PAST_MEDICAL_HISTORY +bypass I-PAST_MEDICAL_HISTORY +aortocoronario. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destacar I-PAST_MEDICAL_HISTORY +apendicectomía, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +sometido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +cardiaco I-PAST_MEDICAL_HISTORY +ortotópico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anastomosis I-PAST_MEDICAL_HISTORY +bicava. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +tiempo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +isquemia I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +280 I-PAST_MEDICAL_HISTORY +min I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +duración I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +circulación I-PAST_MEDICAL_HISTORY +extracorpórea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +200 I-PAST_MEDICAL_HISTORY +min. I-PAST_MEDICAL_HISTORY +Presentó I-PAST_MEDICAL_HISTORY +tendencia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +hipotensión I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +requerimiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +drogas I-PAST_MEDICAL_HISTORY +vasoactivas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hemoderivados. I-PAST_MEDICAL_HISTORY +Recibió I-PAST_MEDICAL_HISTORY +profilaxis I-PAST_MEDICAL_HISTORY +antibiótica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inducción I-PAST_MEDICAL_HISTORY +inmunosupresor I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +micofenolato I-PAST_MEDICAL_HISTORY +mofetil, I-PAST_MEDICAL_HISTORY +solu-moderin I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +daclizumab. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +postoperatorio I-PAST_MEDICAL_HISTORY +inmediato I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +diarreas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fiebre, I-PAST_MEDICAL_HISTORY +descartándose I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Clostridium I-PAST_MEDICAL_HISTORY +difficile I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +determinación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +toxina I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +heces I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +enzimoinmunoanálisis. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +décimo I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +postoperatorio I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +palpación I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +iliaca I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +leucocitosis I-PRESENT_ILLNESS +(35.000 I-PRESENT_ILLNESS +l/mm3). I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +urgente, I-EXPLORATION +objetivándose I-EXPLORATION +distensión I-EXPLORATION +de I-EXPLORATION +ciego I-EXPLORATION +de I-EXPLORATION +hasta I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +vólvulo I-EXPLORATION +tipo I-EXPLORATION +"báscula I-EXPLORATION +cecal". I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +laparotomía I-EXPLORATION +urgente I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +vólvulo I-EXPLORATION +cecal I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +intestinal, I-EXPLORATION +sin I-EXPLORATION +perforación. I-EXPLORATION +Se B-TREATMENT +practicó I-TREATMENT +hemicolectomía I-TREATMENT +derecha I-TREATMENT +con I-TREATMENT +anastomosis I-TREATMENT +íleo-cólica I-TREATMENT +manual. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +enfermo I-EVOLUTION +desarrolló I-EVOLUTION +un I-EVOLUTION +postoperatorio I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico: I-EXPLORATION +infarto I-EXPLORATION +hemorrágico I-EXPLORATION +intestinal I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +transmural. I-EXPLORATION +Fue B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +45 I-EVOLUTION +días I-EVOLUTION +post-trasplante I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +complicaciones I-EVOLUTION +postquirúrgicas I-EVOLUTION +abdominales. I-EVOLUTION +La I-EVOLUTION +función I-EVOLUTION +del I-EVOLUTION +injerto I-EVOLUTION +fue I-EVOLUTION +normal, I-EVOLUTION +con I-EVOLUTION +fracción I-EVOLUTION +de I-EVOLUTION +eyección I-EVOLUTION +del I-EVOLUTION +77% I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +trasplante. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +nuestra I-EVOLUTION +experiencia I-EVOLUTION +las I-EVOLUTION +complicaciones I-EVOLUTION +colónicas I-EVOLUTION +agudas I-EVOLUTION +afectan I-EVOLUTION +al I-EVOLUTION +2% I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +trasplantados, I-EVOLUTION +siendo I-EVOLUTION +más I-EVOLUTION +frecuentes I-EVOLUTION +en I-EVOLUTION +varones I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +edad I-EVOLUTION +media I-EVOLUTION +superior I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +55 I-EVOLUTION +años I-EVOLUTION +(2,3). I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +patogenia I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +relacionado I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +inmunosupresor, I-EVOLUTION +especialmente I-EVOLUTION +los I-EVOLUTION +esteroides, I-EVOLUTION +bien I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +rechazo I-EVOLUTION +agudo I-EVOLUTION +o I-EVOLUTION +por I-EVOLUTION +acontecer I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +días I-EVOLUTION +post-trasplante. I-EVOLUTION +La I-EVOLUTION +otra I-EVOLUTION +causa I-EVOLUTION +posible I-EVOLUTION +son I-EVOLUTION +las I-EVOLUTION +derivadas I-EVOLUTION +del I-EVOLUTION +compromiso I-EVOLUTION +vascular I-EVOLUTION +gastrointestinal I-EVOLUTION +bien I-EVOLUTION +por I-EVOLUTION +patología I-EVOLUTION +vascular I-EVOLUTION +previa I-EVOLUTION +abdominal I-EVOLUTION +o I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +bajo I-EVOLUTION +gasto I-EVOLUTION +cardiaco I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +trasplante I-EVOLUTION +(isquemia I-EVOLUTION +intestinal I-EVOLUTION +no I-EVOLUTION +oclusiva) I-EVOLUTION +(1-3). I-EVOLUTION +Deben I-EVOLUTION +descartarse I-EVOLUTION +las I-EVOLUTION +infecciones, I-EVOLUTION +especialmente I-EVOLUTION +cuando I-EVOLUTION +el I-EVOLUTION +enfermo I-EVOLUTION +había I-EVOLUTION +desarrollado I-EVOLUTION +fiebre, I-EVOLUTION +leucocitosis I-EVOLUTION +y I-EVOLUTION +diarrea. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +días I-EVOLUTION +post-trasplante I-EVOLUTION +la I-EVOLUTION +infección I-EVOLUTION +por I-EVOLUTION +Clostridium I-EVOLUTION +difficile I-EVOLUTION +cursa I-EVOLUTION +con I-EVOLUTION +diarreas, I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +leucocitosis, I-EVOLUTION +descartándose I-EVOLUTION +en I-EVOLUTION +nuestro I-EVOLUTION +caso I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +determinación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +toxina I-EVOLUTION +A I-EVOLUTION +y I-EVOLUTION +B I-EVOLUTION +(6). I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +descrito I-EVOLUTION +presentaba I-EVOLUTION +varios I-EVOLUTION +factores I-EVOLUTION +de I-EVOLUTION +riesgo I-EVOLUTION +como I-EVOLUTION +el I-EVOLUTION +tratarse I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +reintervención, I-EVOLUTION +duración I-EVOLUTION +prolongada I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +transfusión I-EVOLUTION +de I-EVOLUTION +hemoderivados I-EVOLUTION +y I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +drogas I-EVOLUTION +vasoactivas I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +(dobutamina, I-EVOLUTION +noradrenalina). I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +81 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +medicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +hospitalario I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hematoquecia I-PRESENT_ILLNESS +grave I-PRESENT_ILLNESS +(Hb I-PRESENT_ILLNESS +7, I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +g/dl). I-PRESENT_ILLNESS +No B-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta. I-EXPLORATION +Sin I-EXPLORATION +embargo, I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +estabilización I-EXPLORATION +hemodinámica I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +ulcerada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +colon I-EXPLORATION +descendente, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +submucoso, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +12 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +diverticular I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño. I-EXPLORATION +El I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +duplicación I-EXPLORATION +colónica I-EXPLORATION +a I-EXPLORATION +dicho I-EXPLORATION +nivel, I-EXPLORATION +simulando I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +divertículo, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +fija I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +borde I-EXPLORATION +superior. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +otras I-EXPLORATION +lesiones. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +histológico I-EXPLORATION +obtenido I-EXPLORATION +por I-EXPLORATION +biopsias I-EXPLORATION +endoscópicas I-EXPLORATION +fue I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +GIST I-EXPLORATION +de I-EXPLORATION +colon. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +la I-TREATMENT +evaluación I-TREATMENT +quirúrgica I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +colónica I-TREATMENT +segmentaria I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +laparoscópica. I-TREATMENT +La B-EXPLORATION +pieza I-EXPLORATION +obtenida I-EXPLORATION +contenía I-EXPLORATION +una I-EXPLORATION +duplicación I-EXPLORATION +colónica I-EXPLORATION +de I-EXPLORATION +32 I-EXPLORATION +x I-EXPLORATION +30 I-EXPLORATION +mm, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +grisáceo I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +dura, I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +mm. I-EXPLORATION +Histológicamente I-EXPLORATION +este I-EXPLORATION +nódulo I-EXPLORATION +era I-EXPLORATION +un I-EXPLORATION +GIST I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +calcificado I-EXPLORATION +(c-kit I-EXPLORATION ++, I-EXPLORATION +CD34 I-EXPLORATION ++), I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +fusocelular, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +mitótico I-EXPLORATION +< I-EXPLORATION +5/50 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +aumento. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +permanece I-EXPLORATION +asintomática I-EXPLORATION +7 I-EXPLORATION +meses I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intervención. I-EXPLORATION + I-EXPLORATION + +Una B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +artritis I-PAST_MEDICAL_HISTORY +reumatoide I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +metotrexate, I-PAST_MEDICAL_HISTORY +es B-PRESENT_ILLNESS +evaluada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mucorrea, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +rectorragia, I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +marcada I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +ponderal I-PRESENT_ILLNESS +(10 I-PRESENT_ILLNESS +kg). I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +detectó I-EXPLORATION +leve I-EXPLORATION +anemia I-EXPLORATION +ferropénica I-EXPLORATION +(hemoglobina I-EXPLORATION +9, I-EXPLORATION +2 I-EXPLORATION +g/dl, I-EXPLORATION +ferritina I-EXPLORATION +2 I-EXPLORATION +ng/ml) I-EXPLORATION +con I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +ileocolonoscopia I-EXPLORATION +con I-EXPLORATION +biopsias I-EXPLORATION +normales I-EXPLORATION +a I-EXPLORATION +ambos I-EXPLORATION +niveles. I-EXPLORATION +La I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +nodular I-EXPLORATION +con I-EXPLORATION +erosiones I-EXPLORATION +milimétricas I-EXPLORATION +parcheadas I-EXPLORATION +en I-EXPLORATION +bulbo I-EXPLORATION +duodenal, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +2a I-EXPLORATION +y I-EXPLORATION +3a I-EXPLORATION +porción I-EXPLORATION +duodenales I-EXPLORATION +había I-EXPLORATION +erosiones I-EXPLORATION +superficiales I-EXPLORATION +longitudinales I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +mínimo I-EXPLORATION +acortamiento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pliegues. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +interrogatorio I-EXPLORATION +dirigido, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +negó I-EXPLORATION +la I-EXPLORATION +ingesta I-EXPLORATION +de I-EXPLORATION +aspirina I-EXPLORATION +o I-EXPLORATION +antiinflamatorios I-EXPLORATION +no I-EXPLORATION +esteroideos I-EXPLORATION +(AINE). I-EXPLORATION +La I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +Helicobacter I-EXPLORATION +pylori I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +mediante I-EXPLORATION +biopsias I-EXPLORATION +gástricas I-EXPLORATION +parcheadas. I-EXPLORATION +Los I-EXPLORATION +coprocultivos I-EXPLORATION +para I-EXPLORATION +parásitos, I-EXPLORATION +bacterias I-EXPLORATION +y I-EXPLORATION +virus I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +gastrina I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +multicorte I-EXPLORATION +descartaron I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Zollinger-Ellison. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +biopsias I-EXPLORATION +duodenales I-EXPLORATION +mostró I-EXPLORATION +atrofia I-EXPLORATION +vellositaria I-EXPLORATION +severa I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +masiva I-EXPLORATION +por I-EXPLORATION +linfocitos I-EXPLORATION +intraepiteliales, I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +EC I-EXPLORATION +estadio I-EXPLORATION +3b I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +clasificación I-EXPLORATION +de I-EXPLORATION +Marsh-Oberhuber. I-EXPLORATION +La I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +fue I-EXPLORATION +igualmente I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +EC I-EXPLORATION +(Ig I-EXPLORATION +A I-EXPLORATION +anti-transglutaminasa I-EXPLORATION +tisular I-EXPLORATION +112 I-EXPLORATION +UI, I-EXPLORATION +rango I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +7). I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +alcanzó I-EVOLUTION +la I-EVOLUTION +remisión I-EVOLUTION +clínica, I-EVOLUTION +endoscópica I-EVOLUTION +e I-EVOLUTION +histológica I-EVOLUTION +tras I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +dieta I-EVOLUTION +sin I-EVOLUTION +gluten. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diabética B-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +insulina I-PAST_MEDICAL_HISTORY +bifásica I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +UI I-PAST_MEDICAL_HISTORY +- I-PAST_MEDICAL_HISTORY +0 I-PAST_MEDICAL_HISTORY +- I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +UI, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +acompañante, I-PRESENT_ILLNESS +salvo I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +necesidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aumentar I-PRESENT_ILLNESS +progresivamente I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +dosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +insulina I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +UI I-PRESENT_ILLNESS +- I-PRESENT_ILLNESS +0 I-PRESENT_ILLNESS +- I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +UI I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +optimizar I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +glucémico. I-PRESENT_ILLNESS +Su B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +analíticamente I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +(601.000/l) I-EXPLORATION +y I-EXPLORATION +VSG I-EXPLORATION +(107 I-EXPLORATION +mm/1a I-EXPLORATION +hora), I-EXPLORATION +siendo I-EXPLORATION +normal I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +resultados I-EXPLORATION +que I-EXPLORATION +incluían I-EXPLORATION +transaminasas, I-EXPLORATION +autoinmunidad, I-EXPLORATION +hormonas I-EXPLORATION +tiroi-deas, I-EXPLORATION +inmunoglobulinas I-EXPLORATION +e I-EXPLORATION +IgG4, I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +y I-EXPLORATION +serolo-gías I-EXPLORATION +virales I-EXPLORATION +(hepatitis, I-EXPLORATION +CMV, I-EXPLORATION +VIH, I-EXPLORATION +Epstein-Barr, I-EXPLORATION +amebiasis I-EXPLORATION +e I-EXPLORATION +hidatidosis). I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +lesiones I-EXPLORATION +ocupantes I-EXPLORATION +de I-EXPLORATION +espacio I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +4, I-EXPLORATION +3 I-EXPLORATION +x I-EXPLORATION +3, I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +respectivamente, I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +4, I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +izquierdo, I-EXPLORATION +y I-EXPLORATION +posteriormente I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +también I-EXPLORATION +manifiesta I-EXPLORATION +dos I-EXPLORATION +masas I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +y I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +cada I-EXPLORATION +una I-EXPLORATION +asentadas I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +izquierdo, I-EXPLORATION +todas I-EXPLORATION +ellas I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +densitométricas I-EXPLORATION +inespecíficas. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +percutánea I-EXPLORATION +bajo I-EXPLORATION +control I-EXPLORATION +ecográfico I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +malignidad, I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +revela I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +extenso I-EXPLORATION +formado I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +menor I-EXPLORATION +medida, I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +fibroblastos, I-EXPLORATION +con I-EXPLORATION +alguna I-EXPLORATION +célula I-EXPLORATION +gigante I-EXPLORATION +multinucleada, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +pseudotumor I-EXPLORATION +inflamatorio. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +inmunohistoquímico I-EXPLORATION +mostró I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +con I-EXPLORATION +cadenas I-EXPLORATION +kappa- I-EXPLORATION +y I-EXPLORATION +lambda- I-EXPLORATION +en I-EXPLORATION +igual I-EXPLORATION +proporción, I-EXPLORATION +con I-EXPLORATION +predominio I-EXPLORATION +de I-EXPLORATION +cadenas I-EXPLORATION +IgG I-EXPLORATION +pero I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +IgG4 I-EXPLORATION +positivas. I-EXPLORATION +Dado B-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +encontraba I-TREATMENT +asintomática I-TREATMENT +y I-TREATMENT +con I-TREATMENT +mejor I-TREATMENT +control I-TREATMENT +glucémico I-TREATMENT +no I-TREATMENT +se I-TREATMENT +adoptó I-TREATMENT +ninguna I-TREATMENT +medida I-TREATMENT +especial I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +reevaluar I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +un I-EXPLORATION +mes I-EXPLORATION +más I-EXPLORATION +tarde I-EXPLORATION +mediante I-EXPLORATION +nuevo I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +ultrasonidos, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +resolución I-EXPLORATION +espontánea I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +hepáticas. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +durante I-EVOLUTION +este I-EVOLUTION +tiempo I-EVOLUTION +permaneció I-EVOLUTION +asintomática I-EVOLUTION +y B-TREATMENT +con I-TREATMENT +descenso I-TREATMENT +progresivo I-TREATMENT +en I-TREATMENT +las I-TREATMENT +necesidades I-TREATMENT +de I-TREATMENT +insulina I-TREATMENT +hasta I-TREATMENT +estabilizarse I-TREATMENT +en I-TREATMENT +su I-TREATMENT +dosis I-TREATMENT +basal I-TREATMENT +habitual. I-TREATMENT + I-TREATMENT + +Varón, B-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +gastrectomía B-PAST_MEDICAL_HISTORY +parcial I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +Billroth I-PAST_MEDICAL_HISTORY +II I-PAST_MEDICAL_HISTORY +(gastroyeyunostomía) I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +21 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ulcus I-PAST_MEDICAL_HISTORY +gástrico. I-PAST_MEDICAL_HISTORY +Lumbalgia I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +sintomático I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +paracetamol I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +metamizol. I-PAST_MEDICAL_HISTORY +Ingresó I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +pancreatitis I-PAST_MEDICAL_HISTORY +aguda I-PAST_MEDICAL_HISTORY +biliar. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +ecoendoscopia I-EXPLORATION +oral: I-EXPLORATION +mucosa I-EXPLORATION +metaplásica I-EXPLORATION +en I-EXPLORATION +anastomosis I-EXPLORATION +de I-EXPLORATION +gastrectomía. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +colecistectomía I-TREATMENT +programada. I-TREATMENT +Desde B-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +dorsolumbar I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derechos, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hiporexia, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +palidez I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +coloración I-PRESENT_ILLNESS +amarillenta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +piel, I-PRESENT_ILLNESS +orinas I-PRESENT_ILLNESS +oscuras I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pico I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +antes. I-PRESENT_ILLNESS +En B-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +febrícula I-EXPLORATION +(37, I-EXPLORATION +2 I-EXPLORATION +oC), I-EXPLORATION +palidez I-EXPLORATION +cutánea I-EXPLORATION +e I-EXPLORATION +ictericia. I-EXPLORATION +Dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +epigastrio I-EXPLORATION +e I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +hepatomegalia I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +al I-EXPLORATION +borde I-EXPLORATION +costal. I-EXPLORATION +En I-EXPLORATION +analítica, I-EXPLORATION +destacaba: I-EXPLORATION +hiperbilirrubinemia I-EXPLORATION +(bilirrubina I-EXPLORATION +total I-EXPLORATION +3 I-EXPLORATION +mg/dl) I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +indirecta I-EXPLORATION +(bilirrubina I-EXPLORATION +directa I-EXPLORATION +0, I-EXPLORATION +02 I-EXPLORATION +mg/dl), I-EXPLORATION +LDH I-EXPLORATION +muy I-EXPLORATION +elevada I-EXPLORATION +(2.960 I-EXPLORATION +mU/ml), I-EXPLORATION +hipertransaminasemia I-EXPLORATION +ligera I-EXPLORATION +(GOT I-EXPLORATION +303 I-EXPLORATION +mU/ml, I-EXPLORATION +GPT I-EXPLORATION +129 I-EXPLORATION +mU/ml, I-EXPLORATION +GGT I-EXPLORATION +383 I-EXPLORATION +mU/ml) I-EXPLORATION +y I-EXPLORATION +ligera I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +(371 I-EXPLORATION +mU/ml). I-EXPLORATION +Además, I-EXPLORATION +insuficiencia I-EXPLORATION +renal I-EXPLORATION +leve I-EXPLORATION +(urea I-EXPLORATION +58 I-EXPLORATION +mg/dl I-EXPLORATION +creatinina I-EXPLORATION +1, I-EXPLORATION +3 I-EXPLORATION +mg/dl). I-EXPLORATION +En I-EXPLORATION +hemograma: I-EXPLORATION +anemia I-EXPLORATION +moderada I-EXPLORATION +(Hb I-EXPLORATION +8, I-EXPLORATION +1 I-EXPLORATION +g/dl; I-EXPLORATION +Hto I-EXPLORATION +24, I-EXPLORATION +3%) I-EXPLORATION +macrocítica I-EXPLORATION +(VCM I-EXPLORATION +102 I-EXPLORATION +fl) I-EXPLORATION +con I-EXPLORATION +series I-EXPLORATION +blanca I-EXPLORATION +y I-EXPLORATION +plaquetaria I-EXPLORATION +normales. I-EXPLORATION +Frotis I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +periférica I-EXPLORATION +con I-EXPLORATION +frecuentes I-EXPLORATION +esquistozitos I-EXPLORATION +y I-EXPLORATION +algunos I-EXPLORATION +esferocitos. I-EXPLORATION +Test I-EXPLORATION +de I-EXPLORATION +Coombs I-EXPLORATION +directo I-EXPLORATION +negativo. I-EXPLORATION +Haptoglobina I-EXPLORATION +baja I-EXPLORATION +(3 I-EXPLORATION +mg/dl), I-EXPLORATION +reticulocitos I-EXPLORATION +elevados I-EXPLORATION +(7,3%). I-EXPLORATION +Vitamina I-EXPLORATION +B12 I-EXPLORATION +sérica I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +fólico I-EXPLORATION +sérico I-EXPLORATION +e I-EXPLORATION +intraeritrocitario I-EXPLORATION +normales. I-EXPLORATION +Coagulación: I-EXPLORATION +hipoprotrombinemia I-EXPLORATION +(73%), I-EXPLORATION +fibrinógeno I-EXPLORATION +normal. I-EXPLORATION +Orina: I-EXPLORATION +urobilinógeno I-EXPLORATION +y I-EXPLORATION +bilirrubinuria I-EXPLORATION +positivas. I-EXPLORATION +Serologías I-EXPLORATION +VHB, I-EXPLORATION +VHC I-EXPLORATION +VIH I-EXPLORATION +negativas. I-EXPLORATION +Marcadores I-EXPLORATION +tumorales: I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +CEA I-EXPLORATION +(66 I-EXPLORATION +ng/ml, I-EXPLORATION +VN I-EXPLORATION +< I-EXPLORATION +5 I-EXPLORATION +ng/ml) I-EXPLORATION +y I-EXPLORATION +CA I-EXPLORATION +19-9 I-EXPLORATION +(82 I-EXPLORATION +U/ml, I-EXPLORATION +VN I-EXPLORATION +< I-EXPLORATION +37 I-EXPLORATION +U/ml). I-EXPLORATION +En I-EXPLORATION +gastroscopia: I-EXPLORATION +en I-EXPLORATION +muñón I-EXPLORATION +gástrico, I-EXPLORATION +5-6 I-EXPLORATION +cm I-EXPLORATION +proximal I-EXPLORATION +a I-EXPLORATION +anastomosis, I-EXPLORATION +lesión I-EXPLORATION +sobreelevada I-EXPLORATION +de I-EXPLORATION +25-30 I-EXPLORATION +mm, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +ulceración I-EXPLORATION +y I-EXPLORATION +necrosis, I-EXPLORATION +friable, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +pétrea I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +toma I-EXPLORATION +de I-EXPLORATION +biopsia, I-EXPLORATION +con I-EXPLORATION +histopatología I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +moderadamente I-EXPLORATION +bien I-EXPLORATION +diferenciado, I-EXPLORATION +tipo I-EXPLORATION +intestinal. I-EXPLORATION +En I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TAC) I-EXPLORATION +toracoabdominal: I-EXPLORATION +hepatomegalia I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +hipodensas I-EXPLORATION +de I-EXPLORATION +diferentes I-EXPLORATION +tamaños, I-EXPLORATION +diseminadas I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +hepáticas. I-EXPLORATION +Se B-TREATMENT +consultó I-TREATMENT +con I-TREATMENT +Oncología, I-TREATMENT +que I-TREATMENT +desestimó I-TREATMENT +quimioterapia, I-TREATMENT +pautándose I-TREATMENT +tratamiento I-TREATMENT +sintomático I-TREATMENT +paliativo. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +20 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +diagnóstico. I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico, I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Su I-PRESENT_ILLNESS +hijo I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +semejante I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +habían I-PRESENT_ILLNESS +ingerido I-PRESENT_ILLNESS +codornices I-PRESENT_ILLNESS +cocidas I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes. I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +diagnósticos I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertrofia I-PAST_MEDICAL_HISTORY +benigna I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +próstata I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertension I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antagonistas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +receptores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +angiotensina-II I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +torasemida, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +duodenitis I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +toma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ibuprofeno I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +resuelto I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +omeprazol. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +ingreso I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +afebril I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +abdominal, I-EXPLORATION +auscultación I-EXPLORATION +cardiaca I-EXPLORATION +ni I-EXPLORATION +respiratoria. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +mostraron I-EXPLORATION +un I-EXPLORATION +hemograma, I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +amilasa, I-EXPLORATION +lipasa I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +de I-EXPLORATION +normalidad, I-EXPLORATION +salvo I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bilirrubina I-EXPLORATION +sérica I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +80 I-EXPLORATION +mg/dl I-EXPLORATION +(límite I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +mg/dl) I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +(lactato I-EXPLORATION +deshidrogenasa) I-EXPLORATION +de I-EXPLORATION +547 I-EXPLORATION +U/l I-EXPLORATION +(límite I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +460 I-EXPLORATION +U/l). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +pequeños I-EXPLORATION +focos I-EXPLORATION +hiperecoicos I-EXPLORATION +móviles I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rama I-EXPLORATION +principal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +porta, I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +múltiples I-EXPLORATION +zonas I-EXPLORATION +hipoecogénicas I-EXPLORATION +distribuidas I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +hepáticos I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +gas. I-EXPLORATION +La I-EXPLORATION +vesícula I-EXPLORATION +biliar, I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +del I-EXPLORATION +páncreas I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +visualizadas I-EXPLORATION +no I-EXPLORATION +presentaban I-EXPLORATION +alteraciones I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +existía I-EXPLORATION +líquido I-EXPLORATION +libre. I-EXPLORATION +La I-EXPLORATION +única I-EXPLORATION +causa I-EXPLORATION +posible I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neumatosis I-EXPLORATION +podía I-EXPLORATION +ser I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +del I-EXPLORATION +estómago, I-EXPLORATION +en I-EXPLORATION +posible I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +gastroduodenitis I-EXPLORATION +enfisematosa. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +abdominopélvica, I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +gas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tronco I-EXPLORATION +y I-EXPLORATION +ramas I-EXPLORATION +distales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +porta I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +hepáticos. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +isquemia I-EXPLORATION +mesentérica, I-EXPLORATION +inflamación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +y I-EXPLORATION +alteraciones I-EXPLORATION +pélvicas. I-EXPLORATION +Al I-EXPLORATION +contrario I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +previa, I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +del I-EXPLORATION +estómago I-EXPLORATION +parecían I-EXPLORATION +normales, I-EXPLORATION +aunque I-EXPLORATION +existía I-EXPLORATION +una I-EXPLORATION +mínima I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +gas I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +cortos I-EXPLORATION +del I-EXPLORATION +estómago. I-EXPLORATION + I-EXPLORATION +Aunque I-EXPLORATION +la I-EXPLORATION +presentación I-EXPLORATION +del I-EXPLORATION +caso I-EXPLORATION +semejaba I-EXPLORATION +una I-EXPLORATION +gastroenteritis I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +contaminación I-EXPLORATION +alimentaria, I-EXPLORATION +la I-EXPLORATION +neumatosis I-EXPLORATION +portal I-EXPLORATION +motivó I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +del I-EXPLORATION +paciente. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amoxicilina-clavulámico I-TREATMENT +y I-TREATMENT +descoagulación I-TREATMENT +con I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +subcutánea I-TREATMENT +por I-TREATMENT +el I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +trombosis I-TREATMENT +portal I-TREATMENT +secundaria I-TREATMENT +a I-TREATMENT +pileflebitis. I-TREATMENT +Los B-EXPLORATION +coprocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +Entamoeba I-EXPLORATION +histolytica, I-EXPLORATION +huevos I-EXPLORATION +y I-EXPLORATION +parásitos. I-EXPLORATION +En I-EXPLORATION +un I-EXPLORATION +hemocultivo I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +extraídos I-EXPLORATION +creció I-EXPLORATION +Streptococus I-EXPLORATION +viridans. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +4 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +se I-EXPLORATION +repitió I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +abdominopélvica I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +desaparición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neumatosis I-EXPLORATION +portal. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +y I-EVOLUTION +visto I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +en I-EVOLUTION +consultas I-EVOLUTION +externas, I-EVOLUTION +encontrándose I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +ecografía I-EVOLUTION +abdominal I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +límites I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +reiterada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +Era B-PAST_MEDICAL_HISTORY +natural I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Ecuador I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +llevaba I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +viviendo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +España, I-PAST_MEDICAL_HISTORY +actualmente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Murcia. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +resección I-PAST_MEDICAL_HISTORY +intestinal I-PAST_MEDICAL_HISTORY +realizada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +país I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +colelitiasis I-PAST_MEDICAL_HISTORY +pendiente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +intervención. I-PAST_MEDICAL_HISTORY +Refería B-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +periumbilical I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta, I-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +verdosas I-PRESENT_ILLNESS +abundantes, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +patológicos, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +respetaban I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +descanso I-PRESENT_ILLNESS +nocturno, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +importante, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cuantificada. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destacaba I-EXPLORATION +palidez I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas, I-EXPLORATION +caquexia, I-EXPLORATION +distensión I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +microcítica I-EXPLORATION +(hemoglobina I-EXPLORATION +7 I-EXPLORATION +g/dl, I-EXPLORATION +VCM I-EXPLORATION +67 I-EXPLORATION +nm), I-EXPLORATION +leucocitos I-EXPLORATION +totales I-EXPLORATION +normales I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +discreta I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +eosinófilos I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +abdominal I-EXPLORATION +era I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +suboclusión I-EXPLORATION +intestinal I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +abundantes I-EXPLORATION +niveles I-EXPLORATION +hidroaéreos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +bulboduodenitis, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +informaron I-EXPLORATION +como I-EXPLORATION +inflamación I-EXPLORATION +inespecífica I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +atrofia I-EXPLORATION +vellositaria, I-EXPLORATION +y I-EXPLORATION +gastritis I-EXPLORATION +erosiva. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +tránsito I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +se I-EXPLORATION +vio I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +válvulas I-EXPLORATION +conniventes I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +duodeno I-EXPLORATION +y I-EXPLORATION +yeyuno I-EXPLORATION +y I-EXPLORATION +otros I-EXPLORATION +signos I-EXPLORATION +radiológicos I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +malabsorción, I-EXPLORATION +siendo I-EXPLORATION +las I-EXPLORATION +determinaciones I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +D-xilosa I-EXPLORATION +negativas I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +orina. I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +heces I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +a I-EXPLORATION +microbiología, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +larvas I-EXPLORATION +de I-EXPLORATION +primera I-EXPLORATION +fase I-EXPLORATION +o I-EXPLORATION +rabditiformes I-EXPLORATION +de I-EXPLORATION +Strongyloides I-EXPLORATION +stercolaris. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +la I-TREATMENT +infección I-TREATMENT +con I-TREATMENT +ivermectina I-TREATMENT +6 I-TREATMENT +g I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +consecutivos, I-TREATMENT +quedando B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +visualizándose I-EVOLUTION +el I-EVOLUTION +parásito I-EVOLUTION +en I-EVOLUTION +muestras I-EVOLUTION +de I-EVOLUTION +heces I-EVOLUTION +sucesivas I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +final I-EVOLUTION +del I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +virus I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +portal, I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Child-Pugh, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemorragia I-PAST_MEDICAL_HISTORY +digestiva I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +varices I-PAST_MEDICAL_HISTORY +esofágicas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +descompensación I-PAST_MEDICAL_HISTORY +edemoascítica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Estando B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +lista I-PRESENT_ILLNESS +activa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +trasplante I-PRESENT_ILLNESS +hepático, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +ecográfico I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +cribado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +hepatocelular, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +detectan I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +LOES I-PRESENT_ILLNESS +hepáticas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +1, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +compatibles I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +hepatocarcinoma I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +técnicas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +imagen I-PRESENT_ILLNESS +(ecografía I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +contraste I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +TAC I-PRESENT_ILLNESS +abdominal). I-PRESENT_ILLNESS +Iniciamos B-TREATMENT +tratamiento I-TREATMENT +percutáneo I-TREATMENT +mediante I-TREATMENT +etanolización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +LOE I-TREATMENT +de I-TREATMENT +mayor I-TREATMENT +tamaño, I-TREATMENT +realizando I-TREATMENT +tres I-TREATMENT +sesiones. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +tras I-EXPLORATION +tres I-EXPLORATION +días I-EXPLORATION +desde I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +última I-EXPLORATION +etanolización, I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +trombosis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tronco I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +porta I-EXPLORATION +y I-EXPLORATION +ramas I-EXPLORATION +principales, I-EXPLORATION +que I-EXPLORATION +exploramos I-EXPLORATION +con I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +(SonoVue®), I-EXPLORATION +sin I-EXPLORATION +apreciar I-EXPLORATION +captación I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +arterial I-EXPLORATION +ni I-EXPLORATION +posteriores, I-EXPLORATION +característica I-EXPLORATION +sugestiva I-EXPLORATION +de I-EXPLORATION +benignidad. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +PAAF I-EXPLORATION +realizadas I-EXPLORATION +posteriormente, I-EXPLORATION +confirman I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +benigno I-EXPLORATION +del I-EXPLORATION +trombo. I-EXPLORATION +Dado I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +hallazgo I-EXPLORATION +no I-EXPLORATION +presente I-EXPLORATION +en I-EXPLORATION +ecografías I-EXPLORATION +ni I-EXPLORATION +TAC I-EXPLORATION +abdominales I-EXPLORATION +previas, I-EXPLORATION +detectado I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +posterior I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +percutáneo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +SonoVue®, I-EXPLORATION +TAC I-EXPLORATION +y I-EXPLORATION +PAAF I-EXPLORATION +confirman I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +benigno I-EXPLORATION +del I-EXPLORATION +trombo I-EXPLORATION +portal, I-EXPLORATION +se I-EXPLORATION +considera I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +complicación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +etanolización. I-EXPLORATION +Iniciamos B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +mg/kg/día I-TREATMENT +subcutánea, I-TREATMENT +comprobando I-TREATMENT +en I-TREATMENT +controles I-TREATMENT +ecográficos I-TREATMENT +posteriores I-TREATMENT +que I-TREATMENT +la I-TREATMENT +trombosis I-TREATMENT +ha I-TREATMENT +mejorado, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +tras I-TREATMENT +22 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +tan I-TREATMENT +sólo I-TREATMENT +está I-TREATMENT +presente I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +parcial I-TREATMENT +en I-TREATMENT +la I-TREATMENT +rama I-TREATMENT +portal I-TREATMENT +izquierda. I-TREATMENT + I-TREATMENT +Finalmente B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +trasplantado, I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +actualidad. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evisceración I-PRESENT_ILLNESS +vaginal I-PRESENT_ILLNESS +espontánea I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +posmenopáusica. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +77 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +histerectomía I-PAST_MEDICAL_HISTORY +vaginal I-PAST_MEDICAL_HISTORY +13 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, B-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +salida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +asas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +intestino I-PRESENT_ILLNESS +delgado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +través I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vagina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +hora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +ataque I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +risa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +domicilio. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +evisceración I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +1 I-EXPLORATION +metro I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +congestivo I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +vagina, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +indica I-EXPLORATION +intervención I-EXPLORATION +quirúrgica I-EXPLORATION +urgente. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +urgente I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +conjunta I-TREATMENT +con I-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +ginecología I-TREATMENT +con I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +combinado I-TREATMENT +abdominal I-TREATMENT +y I-TREATMENT +vaginal. I-TREATMENT +Mediante I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +infraumbilical I-TREATMENT +se I-TREATMENT +evidencia I-TREATMENT +la I-TREATMENT +cúpula I-TREATMENT +vaginal I-TREATMENT +abierta I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +introduce I-TREATMENT +el I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +eviscerado I-TREATMENT +que I-TREATMENT +correspondía I-TREATMENT +a I-TREATMENT +íleon. I-TREATMENT +Se I-TREATMENT +reduce I-TREATMENT +el I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +abdominal I-TREATMENT +comprobando I-TREATMENT +su I-TREATMENT +viabilidad I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cierra I-TREATMENT +el I-TREATMENT +defecto I-TREATMENT +vaginal I-TREATMENT +con I-TREATMENT +material I-TREATMENT +irreabsorbible. I-TREATMENT +Se I-TREATMENT +utiliza I-TREATMENT +una I-TREATMENT +malla I-TREATMENT +Dual I-TREATMENT +Mesh I-TREATMENT +para I-TREATMENT +reforzar I-TREATMENT +la I-TREATMENT +sutura I-TREATMENT +vaginal I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cierra I-TREATMENT +el I-TREATMENT +peritoneo I-TREATMENT +del I-TREATMENT +fondo I-TREATMENT +de I-TREATMENT +saco I-TREATMENT +de I-TREATMENT +Douglas. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +satisfactorio I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION +Tras I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2001 I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +diarrea I-PAST_MEDICAL_HISTORY +líquida I-PAST_MEDICAL_HISTORY +(7-10 I-PAST_MEDICAL_HISTORY +deposiciones I-PAST_MEDICAL_HISTORY +diarias), I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +difuso I-PAST_MEDICAL_HISTORY +abdominal, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +cólico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +(18 I-PAST_MEDICAL_HISTORY +kg I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +síntomas) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +artralgias I-PRESENT_ILLNESS +recurrentes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +autolimitadas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +grandes I-PRESENT_ILLNESS +articulaciones. I-PRESENT_ILLNESS +Acude B-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +especialista I-EXPLORATION +de I-EXPLORATION +digestivo, I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +ambulatoria, I-EXPLORATION +quien I-EXPLORATION +solicita I-EXPLORATION +analítica I-EXPLORATION +elemental, I-EXPLORATION +coprocultivo, I-EXPLORATION +parásitos I-EXPLORATION +y I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +hizo, I-EXPLORATION +posteriormente, I-EXPLORATION +colonoscopia I-EXPLORATION +que I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +un I-EXPLORATION +colon I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +íleon I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +mucosa I-EXPLORATION +hiperémica, I-EXPLORATION +edematosa I-EXPLORATION +y I-EXPLORATION +friable I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +punteado I-EXPLORATION +blanquecino, I-EXPLORATION +granuloso I-EXPLORATION +y I-EXPLORATION +aislado I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +hace I-EXPLORATION +confluente I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +"grano I-EXPLORATION +de I-EXPLORATION +arroz" I-EXPLORATION +a I-EXPLORATION +medida I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +progresa I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +endoscopio. I-EXPLORATION + I-EXPLORATION +Mientras B-EVOLUTION +espera I-EVOLUTION +el I-EVOLUTION +resultado I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +biopsias, I-EVOLUTION +empeora I-EVOLUTION +su I-EVOLUTION +situación I-EVOLUTION +clínica I-EVOLUTION +con I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +número I-EVOLUTION +de I-EVOLUTION +deposiciones I-EVOLUTION +e I-EVOLUTION +hipertermia I-EVOLUTION +de I-EVOLUTION +39o I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +ingresa I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hospital. I-EVOLUTION +Se B-EXPLORATION +aprecia I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +fiebre I-EXPLORATION +de I-EXPLORATION +38, I-EXPLORATION +5o I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +difuso I-EXPLORATION +abdominal. I-EXPLORATION +No I-EXPLORATION +hay I-EXPLORATION +lesiones I-EXPLORATION +cutáneas, I-EXPLORATION +ni I-EXPLORATION +se I-EXPLORATION +palpan I-EXPLORATION +adenopatías. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +resaltan I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +datos: I-EXPLORATION +hematocrito I-EXPLORATION +29, I-EXPLORATION +8% I-EXPLORATION +(40-50), I-EXPLORATION +plaquetas I-EXPLORATION +409.000 I-EXPLORATION +mm3 I-EXPLORATION +(140-400.000), I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +4, I-EXPLORATION +9 I-EXPLORATION +g/dl, I-EXPLORATION +albúmina I-EXPLORATION +2 I-EXPLORATION +g/dl, I-EXPLORATION +hierro I-EXPLORATION +10 I-EXPLORATION +ng/dl I-EXPLORATION +(60-160), I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +transferrina I-EXPLORATION +3% I-EXPLORATION +(15-50) I-EXPLORATION +y I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +D-xilosa I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +malabsorción. I-EXPLORATION +Las I-EXPLORATION +determinaciones I-EXPLORATION +de I-EXPLORATION +bilirrubina, I-EXPLORATION +glucosa, I-EXPLORATION +urea, I-EXPLORATION +creatinina, I-EXPLORATION +vitamina I-EXPLORATION +B12, I-EXPLORATION +ácido I-EXPLORATION +fólico, I-EXPLORATION +hormonas I-EXPLORATION +tiroideas, I-EXPLORATION +triglicéridos, I-EXPLORATION +fósforo, I-EXPLORATION +magnesio, I-EXPLORATION +pruebas I-EXPLORATION +hepáticas, I-EXPLORATION +inmunoglobulinas, I-EXPLORATION +transferrina, I-EXPLORATION +ferritina I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antiendomisio I-EXPLORATION +y I-EXPLORATION +antigliadina I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +heces, I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +orina, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +y I-EXPLORATION +bacterias I-EXPLORATION +(virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +Salmonella, I-EXPLORATION +Clostridium I-EXPLORATION +difficile I-EXPLORATION +y I-EXPLORATION +micobacterias), I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +o I-EXPLORATION +negativas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +tránsito I-EXPLORATION +intestinal, I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +abdominopélvica I-EXPLORATION +sin I-EXPLORATION +apreciarse I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +La I-EXPLORATION +fibrogastroscopia I-EXPLORATION +detectó I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +segunda I-EXPLORATION +y I-EXPLORATION +tercera I-EXPLORATION +porción I-EXPLORATION +duodenal I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +marcado I-EXPLORATION +de I-EXPLORATION +pliegues I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +granular I-EXPLORATION +con I-EXPLORATION +infiltrados I-EXPLORATION +blanquecinos. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +duodenal I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +gránulos I-EXPLORATION +PAS I-EXPLORATION +positivos, I-EXPLORATION +diastasa I-EXPLORATION +resistentes, I-EXPLORATION +hallazgos I-EXPLORATION +también I-EXPLORATION +presentes I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +previa I-EXPLORATION +ileal. I-EXPLORATION +Se I-EXPLORATION +determinó I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +duodeno I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +de I-EXPLORATION +ARN I-EXPLORATION +ribosomal I-EXPLORATION +16 I-EXPLORATION +S I-EXPLORATION +de I-EXPLORATION +T. I-EXPLORATION +whippleii I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +positiva. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +(1, I-TREATMENT +2 I-TREATMENT +x I-TREATMENT +106 I-TREATMENT +unidades I-TREATMENT +al I-TREATMENT +día) I-TREATMENT +más I-TREATMENT +estreptomicina I-TREATMENT +(1 I-TREATMENT +g/día) I-TREATMENT +durante I-TREATMENT +14 I-TREATMENT +días, I-TREATMENT +seguido I-TREATMENT +de I-TREATMENT +cotrimoxazol I-TREATMENT +(800/160 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas) I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +año. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +desapareciendo I-EVOLUTION +la I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +ganando I-EVOLUTION +peso I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +dos I-EVOLUTION +semanas. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +meses, I-EVOLUTION +la I-EVOLUTION +duodenoscopia I-EVOLUTION +era I-EVOLUTION +normal I-EVOLUTION +pero I-EVOLUTION +persistían I-EVOLUTION +focos I-EVOLUTION +aislados I-EVOLUTION +de I-EVOLUTION +macrófagos I-EVOLUTION +PAS I-EVOLUTION +positivos I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +lámina I-EVOLUTION +propia. I-EVOLUTION +La B-EXPLORATION +PCR I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +duodenal I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +8 I-EXPLORATION +años I-EXPLORATION +de I-EXPLORATION +evolución, I-EXPLORATION +las I-EXPLORATION +biopsias I-EXPLORATION +duodenal I-EXPLORATION +e I-EXPLORATION +ileal I-EXPLORATION +no I-EXPLORATION +mostraban I-EXPLORATION +hallazgos I-EXPLORATION +histológicos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +al I-EXPLORATION +microscopio I-EXPLORATION +óptico. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumador, B-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +26 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EC I-PAST_MEDICAL_HISTORY +íleo-cólica. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fístula I-PAST_MEDICAL_HISTORY +perianal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +suboclusión I-PAST_MEDICAL_HISTORY +-intestinal I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +brote I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +EC, I-PAST_MEDICAL_HISTORY +objetivando I-PAST_MEDICAL_HISTORY +fístula I-PAST_MEDICAL_HISTORY +entero-vesical, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +requirió I-PAST_MEDICAL_HISTORY +intervención I-PAST_MEDICAL_HISTORY +quirúrgica I-PAST_MEDICAL_HISTORY +(resección I-PAST_MEDICAL_HISTORY +íleo-cólica). I-PAST_MEDICAL_HISTORY +Coincidiendo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +suboclusión I-PAST_MEDICAL_HISTORY +comenzó I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +edemas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +miembros I-PAST_MEDICAL_HISTORY +inferiores, I-PAST_MEDICAL_HISTORY +deterioro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +función I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +proteinuria I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +rango I-PAST_MEDICAL_HISTORY +nefrótico, I-PAST_MEDICAL_HISTORY +realizándosele I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +confirmó I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +sospecha I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +AA I-PAST_MEDICAL_HISTORY +renal. I-PAST_MEDICAL_HISTORY +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +colchicina I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal. I-TREATMENT +La I-TREATMENT +EC I-TREATMENT +recidivó I-TREATMENT +en I-TREATMENT +la I-TREATMENT +anastomosis I-TREATMENT +siendo I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +azatioprina, I-TREATMENT +con B-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +ha I-EVOLUTION +controlado I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +intestinal, I-EVOLUTION +aunque I-EVOLUTION +persiste I-EVOLUTION +la I-EVOLUTION +fístula I-EVOLUTION +perianal I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +oligosintomática. I-EVOLUTION +En B-TREATMENT +la I-TREATMENT +actualidad I-TREATMENT +mantiene I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +azatioprina I-TREATMENT +más I-TREATMENT +mesalacina, I-TREATMENT +presentando I-TREATMENT +función I-TREATMENT +renal I-TREATMENT +normal, I-TREATMENT +con I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +proteinuria I-TREATMENT +en I-TREATMENT +rango I-TREATMENT +no I-TREATMENT +nefrótico. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +fumador, B-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +quince I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +acalasia, I-PAST_MEDICAL_HISTORY +realizándose I-PAST_MEDICAL_HISTORY +dilatación I-PAST_MEDICAL_HISTORY +endoscópica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +momento, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +decisión I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +paciente. I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sólidos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +líquidos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +endoscopia I-EXPLORATION +oral I-EXPLORATION +objetivando I-EXPLORATION +esófago I-EXPLORATION +con I-EXPLORATION +abundantes I-EXPLORATION +restos I-EXPLORATION +líquidos, I-EXPLORATION +con I-EXPLORATION +paredes I-EXPLORATION +dilatadas, I-EXPLORATION +morfología I-EXPLORATION +sigmoide I-EXPLORATION +y I-EXPLORATION +mucosa I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +agrietado, I-EXPLORATION +friable I-EXPLORATION +y I-EXPLORATION +cardias I-EXPLORATION +puntiforme, I-EXPLORATION +con I-EXPLORATION +resistencia I-EXPLORATION +al I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +acalasia I-EXPLORATION +evolucionada, I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +subcardiales I-EXPLORATION +que I-EXPLORATION +justifiquen I-EXPLORATION +pseudoacalasia. I-EXPLORATION +A I-EXPLORATION +22 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +arcada I-EXPLORATION +dentaria I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +lesión I-EXPLORATION +mucosa I-EXPLORATION +excavada, I-EXPLORATION +profunda, I-EXPLORATION +cubierta I-EXPLORATION +de I-EXPLORATION +fibrina I-EXPLORATION +y I-EXPLORATION +punteado I-EXPLORATION +hemático, I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño, I-EXPLORATION +que I-EXPLORATION +abarca I-EXPLORATION +la I-EXPLORATION +mitad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +circunferencia, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +maligno I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +biopsia, I-EXPLORATION +con I-EXPLORATION +histología I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +epidermoide I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +TC I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +esófago I-EXPLORATION +marcadamente I-EXPLORATION +dilatado I-EXPLORATION +y I-EXPLORATION +engrosamiento I-EXPLORATION +parietal I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +proximal I-EXPLORATION +esofágico I-EXPLORATION +con I-EXPLORATION +probable I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +posterior I-EXPLORATION +traqueal, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +al I-EXPLORATION +realizar I-EXPLORATION +broncoscopia. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +epidermoide I-TREATMENT +de I-TREATMENT +esófago I-TREATMENT +moderadamente I-TREATMENT +diferenciado I-TREATMENT +estadio I-TREATMENT +III I-TREATMENT +con I-TREATMENT +infiltración I-TREATMENT +traqueal I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +quimioterapia I-TREATMENT +sistémica I-TREATMENT +según I-TREATMENT +esquema I-TREATMENT +cisplatino/5-fluouracilo. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +sufre I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +compatible I-EVOLUTION +con I-EVOLUTION +broncoaspiración, I-EVOLUTION +presentando I-EVOLUTION +deterioro I-EVOLUTION +clínico I-EVOLUTION +progresivo I-EVOLUTION +produciéndose I-EVOLUTION +finalmente I-EVOLUTION +el I-EVOLUTION +fallecimiento I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento, I-EVOLUTION +poniéndose I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +con I-EVOLUTION +perforación I-EVOLUTION +traqueoesofágica, I-EVOLUTION +bronconeumonía I-EVOLUTION +y I-EVOLUTION +mediastinitis I-EVOLUTION +asociada. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés, I-FAMILY_HISTORY +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +subclínico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esclerodermia I-PAST_MEDICAL_HISTORY +precoz I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +consultas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Reumatología I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Dermatología. I-PAST_MEDICAL_HISTORY +Un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +necrosis I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +pulpejos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +dedos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +manos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +estudio. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +capilaroscopia I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +compatible I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +ANA I-PAST_MEDICAL_HISTORY +positivos I-PAST_MEDICAL_HISTORY +(1/640), I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anticentrómero, I-PAST_MEDICAL_HISTORY +RNP I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +scl-70 I-PAST_MEDICAL_HISTORY +negativos. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +bosentán I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +acetilsalicílico. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +melenas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +epistaxis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +presentó I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +cifra I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +normales, I-EXPLORATION +una I-EXPLORATION +coagulación I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +VSG I-EXPLORATION +de I-EXPLORATION +48 I-EXPLORATION +mm/h. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destacaban I-EXPLORATION +múltiples I-EXPLORATION +telangiectasias I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +pulpejos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dedos, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +mucosa I-EXPLORATION +oral I-EXPLORATION +y I-EXPLORATION +región I-EXPLORATION +peribucal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +gastroscopia I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +varias I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +(menor I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mm) I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +vascular I-EXPLORATION +en I-EXPLORATION +mucosa I-EXPLORATION +esofágica, I-EXPLORATION +gástrica I-EXPLORATION +y I-EXPLORATION +duodenal, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +reciente I-EXPLORATION +ni I-EXPLORATION +restos I-EXPLORATION +hemáticos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +múltiples I-EXPLORATION +telangiectasias I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +ano I-EXPLORATION +hasta I-EXPLORATION +ciego. I-EXPLORATION +No B-EVOLUTION +presentó I-EVOLUTION +melenas I-EVOLUTION +durante I-EVOLUTION +el I-EVOLUTION +ingreso I-EVOLUTION +ni I-EVOLUTION +hubo I-EVOLUTION +un I-EVOLUTION +descenso I-EVOLUTION +del I-EVOLUTION +hematocrito I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con B-TREATMENT +suplementos I-TREATMENT +de I-TREATMENT +hierro I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +fólico I-TREATMENT +orales. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +urotelial I-PRESENT_ILLNESS +sólido I-PRESENT_ILLNESS +infiltrante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alto I-PRESENT_ILLNESS +grado, I-PRESENT_ILLNESS +pobremente I-PRESENT_ILLNESS +diferenciado, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +infiltración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lámina I-PRESENT_ILLNESS +propia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +muscular. I-PRESENT_ILLNESS +Se B-TREATMENT +realiza I-TREATMENT +cistectomía I-TREATMENT +radical I-TREATMENT +y I-TREATMENT +ureterosigmoidostomia I-TREATMENT +destubulizada I-TREATMENT +(Mainz I-TREATMENT +II) I-TREATMENT +implantándose I-TREATMENT +ambos I-TREATMENT +uréteres I-TREATMENT +en I-TREATMENT +cara I-TREATMENT +lateral I-TREATMENT +izquierda I-TREATMENT +de I-TREATMENT +la I-TREATMENT +bolsa I-TREATMENT +con I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +catéteres I-TREATMENT +que I-TREATMENT +salen I-TREATMENT +por I-TREATMENT +contraincisión I-TREATMENT +a I-TREATMENT +bolsa I-TREATMENT +de I-TREATMENT +urostomía. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +comienza I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +en I-EVOLUTION +flanco I-EVOLUTION +derecho I-EVOLUTION +con I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +irritación I-EVOLUTION +peritoneal I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +leucocitosis. I-EVOLUTION +Se I-EVOLUTION +objetiva I-EVOLUTION +migración I-EVOLUTION +subcutánea I-EVOLUTION +de I-EVOLUTION +catéter I-EVOLUTION +izquierdo. I-EVOLUTION +Se B-EXPLORATION +realiza I-EXPLORATION +TC I-EXPLORATION +urgente I-EXPLORATION +identificándose I-EXPLORATION +el I-EXPLORATION +catéter I-EXPLORATION +tipo I-EXPLORATION +pig-tail I-EXPLORATION +con I-EXPLORATION +rizo I-EXPLORATION +en I-EXPLORATION +pelvis I-EXPLORATION +renal I-EXPLORATION +izquierda I-EXPLORATION +que I-EXPLORATION +lleva I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +normal I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neovejiga, I-EXPLORATION +saliendo I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +presentando I-EXPLORATION +desde I-EXPLORATION +entonces I-EXPLORATION +una I-EXPLORATION +trayectoria I-EXPLORATION +ascendente I-EXPLORATION +anterior I-EXPLORATION +al I-EXPLORATION +ciego I-EXPLORATION +para I-EXPLORATION +posteriormente I-EXPLORATION +dirigirse I-EXPLORATION +a I-EXPLORATION +línea I-EXPLORATION +media, I-EXPLORATION +siempre I-EXPLORATION +superficial I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +asas I-EXPLORATION +girando I-EXPLORATION +en I-EXPLORATION +última I-EXPLORATION +instancia I-EXPLORATION +hacia I-EXPLORATION +flanco I-EXPLORATION +derecho. I-EXPLORATION +La I-EXPLORATION +punta I-EXPLORATION +se I-EXPLORATION +localiza I-EXPLORATION +inmediatamente I-EXPLORATION +posterior I-EXPLORATION +al I-EXPLORATION +músculo I-EXPLORATION +recto I-EXPLORATION +abdominal I-EXPLORATION +anterior I-EXPLORATION +derecho. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +ven I-EXPLORATION +burbujas I-EXPLORATION +aéreas I-EXPLORATION +extraluminares I-EXPLORATION +que I-EXPLORATION +sugieran I-EXPLORATION +perforación. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +colonoscopia I-EXPLORATION +urgente, I-EXPLORATION +introduciendo I-EXPLORATION +el I-EXPLORATION +endoscopio I-EXPLORATION +hasta I-EXPLORATION +20 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +margen I-EXPLORATION +anal. I-EXPLORATION +A I-EXPLORATION +ese I-EXPLORATION +nivel I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +neovejiga I-EXPLORATION +con I-EXPLORATION +catéter I-EXPLORATION +en I-EXPLORATION +unión I-EXPLORATION +uretero-vesical I-EXPLORATION +con I-EXPLORATION +salida I-EXPLORATION +por I-EXPLORATION +pared I-EXPLORATION +posterior, I-EXPLORATION +sin I-EXPLORATION +identificarse I-EXPLORATION +extremo I-EXPLORATION +distal. I-EXPLORATION +Se B-TREATMENT +extrae I-TREATMENT +catéter I-TREATMENT +con I-TREATMENT +pinza I-TREATMENT +sin I-TREATMENT +incidencias, I-TREATMENT +presentando B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +posteriormente I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +clínica, I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +abdominal, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +procedimiento. I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +fue B-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +ya I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +hacía I-DERIVED_FROM/TO +dos I-DERIVED_FROM/TO +años I-DERIVED_FROM/TO +tenía I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +concentración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ferritina I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +suero I-DERIVED_FROM/TO +superior I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +1.000 I-DERIVED_FROM/TO +µg/l I-DERIVED_FROM/TO +(rango I-DERIVED_FROM/TO +normal, I-DERIVED_FROM/TO +26-370). I-DERIVED_FROM/TO +El B-EXPLORATION +paciente I-EXPLORATION +tenía I-EXPLORATION +la I-EXPLORATION +ferritina I-EXPLORATION +sérica I-EXPLORATION +(1.277 I-EXPLORATION +µg/l) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +γGT I-EXPLORATION +(116 I-EXPLORATION +U/L; I-EXPLORATION +rango I-EXPLORATION +normal, I-EXPLORATION +10-60) I-EXPLORATION +aumentadas, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +del I-EXPLORATION +hígado I-EXPLORATION +nos I-EXPLORATION +llevó I-EXPLORATION +a I-EXPLORATION +sospechar I-EXPLORATION +posible I-EXPLORATION +hígado I-EXPLORATION +graso. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +analíticas I-EXPLORATION +y I-EXPLORATION +serológicas I-EXPLORATION +complementarias I-EXPLORATION +no I-EXPLORATION +revelaron I-EXPLORATION +ninguna I-EXPLORATION +anomalía. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +asintomático. I-EXPLORATION +No B-PAST_MEDICAL_HISTORY +bebía I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +consumía I-PAST_MEDICAL_HISTORY +tabaco. I-PAST_MEDICAL_HISTORY +Su B-FAMILY_HISTORY +historia I-FAMILY_HISTORY +clínica I-FAMILY_HISTORY +personal I-FAMILY_HISTORY +y I-FAMILY_HISTORY +familiar, I-FAMILY_HISTORY +y I-FAMILY_HISTORY +el I-FAMILY_HISTORY +examen I-FAMILY_HISTORY +físico I-FAMILY_HISTORY +no I-FAMILY_HISTORY +reflejaban I-FAMILY_HISTORY +nada I-FAMILY_HISTORY +destacable. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Analizamos B-EXPLORATION +los I-EXPLORATION +marcadores I-EXPLORATION +del I-EXPLORATION +metabolismo I-EXPLORATION +del I-EXPLORATION +hierro I-EXPLORATION +(niveles I-EXPLORATION +de I-EXPLORATION +hierro I-EXPLORATION +en I-EXPLORATION +suero, I-EXPLORATION +ferritina, I-EXPLORATION +receptor I-EXPLORATION +soluble I-EXPLORATION +de I-EXPLORATION +transferrina I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +transferrina), I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +hierro I-EXPLORATION +hepático I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +arquitectura I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +hepático I-EXPLORATION +mediante I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +del I-EXPLORATION +hígado. I-EXPLORATION +Las I-EXPLORATION +secciones I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +hepático I-EXPLORATION +de I-EXPLORATION +cinco I-EXPLORATION +micrómetros I-EXPLORATION +se I-EXPLORATION +tiñeron I-EXPLORATION +con I-EXPLORATION +hematoxilina-eosina, I-EXPLORATION +y I-EXPLORATION +azul I-EXPLORATION +Prusia I-EXPLORATION +de I-EXPLORATION +Perls I-EXPLORATION +para I-EXPLORATION +detectar I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +hierro. I-EXPLORATION +Se I-EXPLORATION +estudió I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +obtenida I-EXPLORATION +mediante I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +del I-EXPLORATION +hígado I-EXPLORATION +(MRI). I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +buscaron I-EXPLORATION +las I-EXPLORATION +variaciones I-EXPLORATION +alélicas I-EXPLORATION +c.845G>A I-EXPLORATION +(p.C282Y) I-EXPLORATION +y I-EXPLORATION +c.187C>G I-EXPLORATION +(p.H63D) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +HFE. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +ADN I-EXPLORATION +genómico I-EXPLORATION +se I-EXPLORATION +extrajo I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +periférica, I-EXPLORATION +la I-EXPLORATION +reacción I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +(PCR) I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +mediante I-EXPLORATION +oligonucleótidos I-EXPLORATION +específicos I-EXPLORATION +para I-EXPLORATION +amplificar I-EXPLORATION +las I-EXPLORATION +regiones I-EXPLORATION +codificantes, I-EXPLORATION +las I-EXPLORATION +regiones I-EXPLORATION +intrónicas I-EXPLORATION +adyacentes, I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +regiones I-EXPLORATION +sin I-EXPLORATION +traducir I-EXPLORATION +5 I-EXPLORATION +' I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +' I-EXPLORATION +(UTR) I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +genes: I-EXPLORATION +HFE, I-EXPLORATION +hemojuvelina I-EXPLORATION +(HJV), I-EXPLORATION +hepcidina I-EXPLORATION +(HAMP), I-EXPLORATION +receptor I-EXPLORATION +2 I-EXPLORATION +de I-EXPLORATION +transferrina I-EXPLORATION +(TFR2) I-EXPLORATION +y I-EXPLORATION +ferroportina I-EXPLORATION +(SLC40A1). I-EXPLORATION +Los I-EXPLORATION +productos I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +se I-EXPLORATION +secuenciaron I-EXPLORATION +bidireccionalmente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +secuenciador I-EXPLORATION +de I-EXPLORATION +ADN I-EXPLORATION +ABI I-EXPLORATION +Prism I-EXPLORATION +3130x1, I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +secuencias I-EXPLORATION +se I-EXPLORATION +compararon I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +(números I-EXPLORATION +de I-EXPLORATION +accesión I-EXPLORATION +del I-EXPLORATION +GenBank: I-EXPLORATION +NG_008720.1, I-EXPLORATION +NG_011568.1, I-EXPLORATION +NG_011563.1, I-EXPLORATION +NM_003227.3 I-EXPLORATION +y I-EXPLORATION +NG_009027.1, I-EXPLORATION +respectivamente, I-EXPLORATION +para I-EXPLORATION +los I-EXPLORATION +genes I-EXPLORATION +mencionados). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +obtuvo I-EXPLORATION +el I-EXPLORATION +consentimiento I-EXPLORATION +informado I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +según I-EXPLORATION +las I-EXPLORATION +recomendaciones I-EXPLORATION +locales I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +del I-EXPLORATION +hígado. I-EXPLORATION +El I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +principios I-EXPLORATION +éticos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +declaración I-EXPLORATION +de I-EXPLORATION +Helsinki I-EXPLORATION +(2008). I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +hierro I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +fueron: I-EXPLORATION +ferritina I-EXPLORATION +en I-EXPLORATION +suero, I-EXPLORATION +1.070 I-EXPLORATION +µg/l I-EXPLORATION +(rango I-EXPLORATION +normal, I-EXPLORATION +26-370 I-EXPLORATION +µg/l); I-EXPLORATION +hierro I-EXPLORATION +en I-EXPLORATION +suero, I-EXPLORATION +160 I-EXPLORATION +µg/dl I-EXPLORATION +(rango I-EXPLORATION +normal, I-EXPLORATION +59-158 I-EXPLORATION +µg/dl); I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +transferrina, I-EXPLORATION +48% I-EXPLORATION +(rango I-EXPLORATION +normal, I-EXPLORATION +20-45%); I-EXPLORATION +y I-EXPLORATION +receptor I-EXPLORATION +soluble I-EXPLORATION +de I-EXPLORATION +transferrina, I-EXPLORATION +0, I-EXPLORATION +90 I-EXPLORATION +mg/l I-EXPLORATION +(rango I-EXPLORATION +normal, I-EXPLORATION +1, I-EXPLORATION +76 I-EXPLORATION +± I-EXPLORATION +0, I-EXPLORATION +83 I-EXPLORATION +mg/l). I-EXPLORATION +La I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +hepática I-EXPLORATION +mostró I-EXPLORATION +anomalías I-EXPLORATION +difusas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intensidad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parénquima, I-EXPLORATION +asociadas I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +hierro; I-EXPLORATION +el I-EXPLORATION +contenido I-EXPLORATION +de I-EXPLORATION +hierro I-EXPLORATION +hepático I-EXPLORATION +fue I-EXPLORATION +estimado I-EXPLORATION +en I-EXPLORATION +160 I-EXPLORATION +µmol/g I-EXPLORATION +(valores I-EXPLORATION +normales, I-EXPLORATION +< I-EXPLORATION +36 I-EXPLORATION +µmol/g). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +percutánea I-EXPLORATION +guiada I-EXPLORATION +por I-EXPLORATION +ecografía. I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +histopatológica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +arquitectura I-EXPLORATION +lobular I-EXPLORATION +normal, I-EXPLORATION +estrechos I-EXPLORATION +espacios I-EXPLORATION +portales I-EXPLORATION +sin I-EXPLORATION +inflamación I-EXPLORATION +o I-EXPLORATION +fibrosis I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +vasculares I-EXPLORATION +o I-EXPLORATION +ductales. I-EXPLORATION +El I-EXPLORATION +lóbulo I-EXPLORATION +estaba I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +hepatocitos I-EXPLORATION +con I-EXPLORATION +morfología I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +depósitos I-EXPLORATION +de I-EXPLORATION +baja I-EXPLORATION +intensidad I-EXPLORATION +de I-EXPLORATION +hemosiderina, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +patrón I-EXPLORATION +típico I-EXPLORATION +de I-EXPLORATION +hemocromatosis, I-EXPLORATION +es I-EXPLORATION +decir, I-EXPLORATION +depósitos I-EXPLORATION +de I-EXPLORATION +hierro I-EXPLORATION +localizados I-EXPLORATION +casi I-EXPLORATION +exclusivamente I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +parenquimatosas I-EXPLORATION +en I-EXPLORATION +áreas I-EXPLORATION +periportales, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +granular I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +distribución I-EXPLORATION +pericanalicular. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +flebotomías I-TREATMENT +y, I-TREATMENT +después I-TREATMENT +de I-TREATMENT +20 I-TREATMENT +flebotomías I-TREATMENT +quincenales, I-TREATMENT +se I-TREATMENT +eliminaron I-TREATMENT +más I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +hierro, I-TREATMENT +y I-TREATMENT +las I-TREATMENT +concentraciones I-TREATMENT +de I-TREATMENT +γGT I-TREATMENT +y I-TREATMENT +ferritina I-TREATMENT +volvieron I-TREATMENT +a I-TREATMENT +valores I-TREATMENT +normales. I-TREATMENT +Actualmente I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +somete I-TREATMENT +a I-TREATMENT +flebotomías I-TREATMENT +de I-TREATMENT +mantenimiento I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +año. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +genes I-EXPLORATION +implicados I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +metabolismo I-EXPLORATION +del I-EXPLORATION +hierro I-EXPLORATION +mostró I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +variantes I-EXPLORATION +alélicas I-EXPLORATION +en I-EXPLORATION +estado I-EXPLORATION +heterocigoto: I-EXPLORATION +c.187C>G I-EXPLORATION +(p.H63D) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +HFE I-EXPLORATION +y I-EXPLORATION +c.840C>G I-EXPLORATION +(p.F280L) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +TFR2. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +81 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +arteriopatía I-PAST_MEDICAL_HISTORY +periférica. I-PAST_MEDICAL_HISTORY +Presenta B-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +tóxico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dispepsia I-PRESENT_ILLNESS +gástrica. I-PRESENT_ILLNESS +Estudio B-EXPLORATION +endoscópico I-EXPLORATION +que I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +neoformación I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +antral I-EXPLORATION +yuxtapilórica I-EXPLORATION +que I-EXPLORATION +dificulta I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio I-EXPLORATION +y I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +adenocarcinoma. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destaca I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +hipocrómica, I-EXPLORATION +y I-EXPLORATION +unos I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +(CEA: I-EXPLORATION +3, I-EXPLORATION +17 I-EXPLORATION +µg/l, I-EXPLORATION +CA I-EXPLORATION +19.9: I-EXPLORATION +17, I-EXPLORATION +31 I-EXPLORATION +KU/l). I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +evidencia I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +gástrica I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +por I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +curvatura I-EXPLORATION +menor I-EXPLORATION +hasta I-EXPLORATION +bulbo I-EXPLORATION +y I-EXPLORATION +primera I-EXPLORATION +porción I-EXPLORATION +duodenal I-EXPLORATION +con I-EXPLORATION +adenopatías I-EXPLORATION +adyacentes I-EXPLORATION +al I-EXPLORATION +margen I-EXPLORATION +inferior. I-EXPLORATION +Colelitiasis. I-EXPLORATION +No I-EXPLORATION +presenta I-EXPLORATION +adenopatías I-EXPLORATION +retroperitoneales I-EXPLORATION +ni I-EXPLORATION +metástasis I-EXPLORATION +a I-EXPLORATION +distancia. I-EXPLORATION +Se B-TREATMENT +practica I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +que I-TREATMENT +evidencia I-TREATMENT +neoplasia I-TREATMENT +antral I-TREATMENT +extendida I-TREATMENT +a I-TREATMENT +cuerpo I-TREATMENT +gástrico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +practica I-TREATMENT +colecistectomía, I-TREATMENT +gastrectomía I-TREATMENT +total I-TREATMENT +y I-TREATMENT +esófago-yeyunostomía I-TREATMENT +en I-TREATMENT +Y I-TREATMENT +de I-TREATMENT +Roux. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +masas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +neoplásico, I-EXPLORATION +con I-EXPLORATION +centro I-EXPLORATION +úlcero-necrótico I-EXPLORATION +y I-EXPLORATION +márgenes I-EXPLORATION +mamelonados, I-EXPLORATION +separadas I-EXPLORATION +por I-EXPLORATION +pared I-EXPLORATION +gástrica I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm. I-EXPLORATION +La I-EXPLORATION +tumoración I-EXPLORATION +más I-EXPLORATION +proximal I-EXPLORATION +mide I-EXPLORATION +65 I-EXPLORATION +x I-EXPLORATION +55 I-EXPLORATION +mm I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +neoplásica, I-EXPLORATION +de I-EXPLORATION +patrón I-EXPLORATION +difuso, I-EXPLORATION +que I-EXPLORATION +infiltra I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +gástrica I-EXPLORATION +alcanzando I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +circundante, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +no I-EXPLORATION +Hodgkin I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +linfoma I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +célula I-EXPLORATION +grande I-EXPLORATION +de I-EXPLORATION +inmunofenotipo I-EXPLORATION +B. I-EXPLORATION +La I-EXPLORATION +tumoración I-EXPLORATION +más I-EXPLORATION +distal I-EXPLORATION +mide I-EXPLORATION +55 I-EXPLORATION +x I-EXPLORATION +55 I-EXPLORATION +mm, I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +neoplásicas, I-EXPLORATION +de I-EXPLORATION +patrón I-EXPLORATION +difuso I-EXPLORATION +y I-EXPLORATION +glandular, I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +poligonales, I-EXPLORATION +con I-EXPLORATION +núcleo I-EXPLORATION +irregular, I-EXPLORATION +redondo, I-EXPLORATION +con I-EXPLORATION +nucléolo I-EXPLORATION +prominente I-EXPLORATION +y I-EXPLORATION +citoplasma I-EXPLORATION +amplio, I-EXPLORATION +eosinófilo. I-EXPLORATION +Dicha I-EXPLORATION +proliferación I-EXPLORATION +neoplásica I-EXPLORATION +infiltra I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +gástrica I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +capa I-EXPLORATION +muscular I-EXPLORATION +propia, I-EXPLORATION +sin I-EXPLORATION +alcanzar I-EXPLORATION +la I-EXPLORATION +serosa I-EXPLORATION +ni I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +adiposo. I-EXPLORATION +Se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +patrón I-EXPLORATION +intestinal I-EXPLORATION +y I-EXPLORATION +difuso. I-EXPLORATION +Márgenes I-EXPLORATION +quirúrgicos I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +no I-EXPLORATION +afectados. I-EXPLORATION +Se I-EXPLORATION +halla I-EXPLORATION +infiltración I-EXPLORATION +neoplásica I-EXPLORATION +por I-EXPLORATION +adenocarcinoma I-EXPLORATION +en I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +32 I-EXPLORATION +ganglios I-EXPLORATION +resecados, I-EXPLORATION +sin I-EXPLORATION +extensión I-EXPLORATION +extracapsular. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +sigue I-EVOLUTION +curso I-EVOLUTION +postoperatorio I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +Valorado B-TREATMENT +por I-TREATMENT +el I-TREATMENT +comité I-TREATMENT +oncológico I-TREATMENT +se I-TREATMENT +desestima I-TREATMENT +tratamiento I-TREATMENT +adyuvante I-TREATMENT +por I-TREATMENT +las I-TREATMENT +comorbilidades I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +Controlado B-EVOLUTION +en I-EVOLUTION +consultas I-EVOLUTION +externas I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +sigue I-EVOLUTION +buena I-EVOLUTION +evolución. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +cirugías I-PAST_MEDICAL_HISTORY +abdominales I-PAST_MEDICAL_HISTORY +(colecistectomía, I-PAST_MEDICAL_HISTORY +histerectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +eventroplastia) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +colon, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +remitida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cambios I-PRESENT_ILLNESS +recientes I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hábito I-PRESENT_ILLNESS +intestinal. I-PRESENT_ILLNESS +La B-EXPLORATION +colonoscopia I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +sigmoideo I-EXPLORATION +muy I-EXPLORATION +angulado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +divertículos I-EXPLORATION +que I-EXPLORATION +impedía I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +través. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +otras I-EXPLORATION +anomalías. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +situación, I-EXPLORATION +decidimos I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +con I-EXPLORATION +cápsula I-EXPLORATION +para I-EXPLORATION +evaluar I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +colon, I-EXPLORATION +observándose I-EXPLORATION +un I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +izquierdo I-EXPLORATION +estenótico, I-EXPLORATION +escasamente I-EXPLORATION +distensible I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +divertículos. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +otras I-EXPLORATION +lesiones. I-EXPLORATION +A I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +todo, I-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +con I-EXPLORATION +cápsula I-EXPLORATION +fue I-EXPLORATION +completa I-EXPLORATION +siendo I-EXPLORATION +esta I-EXPLORATION +excretada I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +finalización I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +baterías I-EXPLORATION +(< I-EXPLORATION +10 I-EXPLORATION +horas). I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +femenina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +nulípara, B-PAST_MEDICAL_HISTORY +sexualmente I-PAST_MEDICAL_HISTORY +activa, I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +cuyos I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +anticoncepción I-PAST_MEDICAL_HISTORY +hormonal I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anillo I-PAST_MEDICAL_HISTORY +vaginal, I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +flujo I-PAST_MEDICAL_HISTORY +vaginal I-PAST_MEDICAL_HISTORY +anormal I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +año, I-PAST_MEDICAL_HISTORY +algunas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +tópico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antimicóticos, I-PAST_MEDICAL_HISTORY +drenaje I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +absceso I-PAST_MEDICAL_HISTORY +adyacente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +clítoris I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +dispareunia I-PAST_MEDICAL_HISTORY +profunda I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +leucorrea I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tratadas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +mes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución. I-PAST_MEDICAL_HISTORY +Fumadora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +seguía I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +habitual. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +rápidamente I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +exacerbado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +inspiración I-PRESENT_ILLNESS +profunda, I-PRESENT_ILLNESS +movimientos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +maniobras I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Valsalva, I-PRESENT_ILLNESS +inicialmente I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +iliaca I-PRESENT_ILLNESS +derechas, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +exacerbación I-PRESENT_ILLNESS +postprandial, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +Coincidiendo I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +última I-PRESENT_ILLNESS +menstruación, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acompañaba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +moderado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipogastrio. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hábito I-PRESENT_ILLNESS +deposicional I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +síntomas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +en I-EXPLORATION +urgencias I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable, I-EXPLORATION +afebril. I-EXPLORATION +Auscultación I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +cardiacas I-EXPLORATION +normales. I-EXPLORATION +Abdomen I-EXPLORATION +no I-EXPLORATION +distendido, I-EXPLORATION +peristaltismo I-EXPLORATION +conservado, I-EXPLORATION +blando I-EXPLORATION +depresible I-EXPLORATION +muy I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +defensa I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +doloroso I-EXPLORATION +leve I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipogastrio. I-EXPLORATION +Blumberg I-EXPLORATION +positivo I-EXPLORATION +reflejado I-EXPLORATION +en I-EXPLORATION +dicha I-EXPLORATION +localización. I-EXPLORATION +Puñopercusión I-EXPLORATION +lumbar I-EXPLORATION +derecha I-EXPLORATION +positiva I-EXPLORATION +reflejada I-EXPLORATION +a I-EXPLORATION +hipocondrio I-EXPLORATION +derecho. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +genital I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +eritema I-EXPLORATION +vulvar I-EXPLORATION +y I-EXPLORATION +perianal, I-EXPLORATION +vagina I-EXPLORATION +con I-EXPLORATION +anillo I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +y I-EXPLORATION +leucorrea. I-EXPLORATION +Cérvix I-EXPLORATION +posterior I-EXPLORATION +formado I-EXPLORATION +y I-EXPLORATION +cerrado. I-EXPLORATION + I-EXPLORATION +Analíticamente I-EXPLORATION +destacaba: I-EXPLORATION +Hb: I-EXPLORATION +12, I-EXPLORATION +1 I-EXPLORATION +g/dl; I-EXPLORATION +leucocitos: I-EXPLORATION +12.800; I-EXPLORATION +neutrófilos: I-EXPLORATION +77%; I-EXPLORATION +plaquetas: I-EXPLORATION +281.000, I-EXPLORATION +quick: I-EXPLORATION +103%, I-EXPLORATION +fibrinógeno I-EXPLORATION +3, I-EXPLORATION +1 I-EXPLORATION +mg/dl; I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +mg/dl; I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +0, I-EXPLORATION +2 I-EXPLORATION +mg/dl; I-EXPLORATION +sodio I-EXPLORATION +138; I-EXPLORATION +potasio I-EXPLORATION +3, I-EXPLORATION +5; I-EXPLORATION +AST I-EXPLORATION +14; I-EXPLORATION +ALT I-EXPLORATION +12; I-EXPLORATION +amilasa I-EXPLORATION +41; I-EXPLORATION +LDH I-EXPLORATION +271; I-EXPLORATION +PCR: I-EXPLORATION +6, I-EXPLORATION +77 I-EXPLORATION +mg/dl; I-EXPLORATION +VSG I-EXPLORATION +28. I-EXPLORATION +El I-EXPLORATION +sedimento I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +estaba I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +evidenciaba I-EXPLORATION +únicamente I-EXPLORATION +neumatización I-EXPLORATION +del I-EXPLORATION +colon. I-EXPLORATION +No I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +y I-EXPLORATION +gas I-EXPLORATION +en I-EXPLORATION +ampolla I-EXPLORATION +rectal. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +patología I-EXPLORATION +hepatobiliar, I-EXPLORATION +por I-EXPLORATION +tratarse I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +más I-EXPLORATION +frecuente I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +cuadrante I-EXPLORATION +superior I-EXPLORATION +derecho, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +no I-EXPLORATION +encontrar I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +al I-EXPLORATION +respecto, I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +reporta I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +distendida, I-EXPLORATION +de I-EXPLORATION +paredes I-EXPLORATION +finas I-EXPLORATION +y I-EXPLORATION +alitiásica I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +mínima I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +perivesicular. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +descartar I-EXPLORATION +patología I-EXPLORATION +hepática, I-EXPLORATION +biliar I-EXPLORATION +litiásica I-EXPLORATION +y I-EXPLORATION +vesicular I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +que I-EXPLORATION +objetiva I-EXPLORATION +hepatomegalia I-EXPLORATION +homogénea I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +focales, I-EXPLORATION +edema I-EXPLORATION +periportal I-EXPLORATION +difuso I-EXPLORATION +; I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +no I-EXPLORATION +dilatada, I-EXPLORATION +líquido I-EXPLORATION +perivesicular, I-EXPLORATION +riñones I-EXPLORATION +normales, I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +intestinales. I-EXPLORATION +Ciego I-EXPLORATION +y I-EXPLORATION +apéndice I-EXPLORATION +normales I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +pélvica. I-EXPLORATION +Páncreas I-EXPLORATION +normal. I-EXPLORATION +Mínimo I-EXPLORATION +líquido I-EXPLORATION +pélvico I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +perianexial I-EXPLORATION +izquierdo. I-EXPLORATION +Resto I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Siendo I-EXPLORATION +descartadas I-EXPLORATION +otras I-EXPLORATION +patologías I-EXPLORATION +causantes I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +cuadrante I-EXPLORATION +superior I-EXPLORATION +izquierdo, I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +hepatobiliar, I-EXPLORATION +neumonía, I-EXPLORATION +patología I-EXPLORATION +renal, I-EXPLORATION +etc., I-EXPLORATION +tanto I-EXPLORATION +por I-EXPLORATION +analítica I-EXPLORATION +como I-EXPLORATION +por I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +imagen, I-EXPLORATION +y I-EXPLORATION +tomando I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +del I-EXPLORATION +dolor, I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +en I-EXPLORATION +eco I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +inflamatoria I-EXPLORATION +perihepática, I-EXPLORATION +líquido I-EXPLORATION +perianexial I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +inflamatorios, I-EXPLORATION +en I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +probable I-EXPLORATION +infección I-EXPLORATION +ginecológica I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +pélvico, I-EXPLORATION +se I-EXPLORATION +orienta I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +como I-EXPLORATION +perihepatitis I-EXPLORATION +de I-EXPLORATION +origen I-EXPLORATION +infeccioso, I-EXPLORATION +motivo I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +ecografía I-EXPLORATION +transvaginal I-EXPLORATION +que I-EXPLORATION +reporta I-EXPLORATION +útero I-EXPLORATION +y I-EXPLORATION +ovarios I-EXPLORATION +normales, I-EXPLORATION +endometrio I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +mm I-EXPLORATION +homogéneo, I-EXPLORATION +sin I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +en I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +saco I-EXPLORATION +de I-EXPLORATION +Douglas. I-EXPLORATION +Se I-EXPLORATION +obtienen I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +flujo I-EXPLORATION +vaginal I-EXPLORATION +para I-EXPLORATION +cultivos I-EXPLORATION +que I-EXPLORATION +resultan I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Candida I-EXPLORATION +albicans, I-EXPLORATION +Gardnerella I-EXPLORATION +vaginalis I-EXPLORATION +y I-EXPLORATION +Ureraplasma I-EXPLORATION +urealiticum. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +amplificación I-EXPLORATION +genética I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +(reacción I-EXPLORATION +de I-EXPLORATION +cadena I-EXPLORATION +de I-EXPLORATION +polimerasa) I-EXPLORATION +para I-EXPLORATION +Chlamydia I-EXPLORATION +trachomatis I-EXPLORATION +fue I-EXPLORATION +positivo. I-EXPLORATION + I-EXPLORATION +Una B-TREATMENT +vez I-TREATMENT +confirmado I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +como I-TREATMENT +una I-TREATMENT +perihepatitis I-TREATMENT +por I-TREATMENT +C. I-TREATMENT +trachomatis I-TREATMENT +de I-TREATMENT +punto I-TREATMENT +de I-TREATMENT +partida I-TREATMENT +de I-TREATMENT +una I-TREATMENT +EIP, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +azitromicina I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +única, I-TREATMENT +presentando B-EVOLUTION +franca I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios I-EVOLUTION +al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +24-48 I-EVOLUTION +horas. I-EVOLUTION +Así B-TREATMENT +mismo I-TREATMENT +iniciamos I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +óvulos I-TREATMENT +de I-TREATMENT +clotrimazol I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +del I-TREATMENT +prurito I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +leucorrea. I-TREATMENT +Debido B-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +Chlamydia I-EXPLORATION +trachomatis I-EXPLORATION +es I-EXPLORATION +un I-EXPLORATION +germen I-EXPLORATION +de I-EXPLORATION +transmisión I-EXPLORATION +sexual, I-EXPLORATION +se I-EXPLORATION +practicaron I-EXPLORATION +pruebas I-EXPLORATION +serológicas I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +otros I-EXPLORATION +agentes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +categoría I-EXPLORATION +como I-EXPLORATION +VIH I-EXPLORATION +y I-EXPLORATION +VDRL I-EXPLORATION +siendo I-EXPLORATION +ambas I-EXPLORATION +negativas. I-EXPLORATION +Después I-EXPLORATION +de I-EXPLORATION +haber I-EXPLORATION +culminado I-EXPLORATION +tratamiento I-EXPLORATION +antibiótico, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +tomografía I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +que I-EXPLORATION +destaca I-EXPLORATION +una I-EXPLORATION +fina I-EXPLORATION +línea I-EXPLORATION +de I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +saco I-EXPLORATION +de I-EXPLORATION +Douglas. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +estudio I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Al B-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +1 I-EVOLUTION +mes I-EVOLUTION +se I-EVOLUTION +cita I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +para I-EVOLUTION +valorar I-EVOLUTION +estado I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +nuevo I-EVOLUTION +control I-EVOLUTION +analítico, I-EVOLUTION +quien I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +con I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +sin I-EVOLUTION +leucorrea, I-EVOLUTION +dispareunia, I-EVOLUTION +ni I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +palpación I-EVOLUTION +superficial I-EVOLUTION +y I-EVOLUTION +profunda. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +únicos I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +acude B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +mucocutánea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +coluria, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +cólicas, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +mostraba I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +peritonismo. I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +destacaba I-EXPLORATION +bilirrubina I-EXPLORATION +5, I-EXPLORATION +6 I-EXPLORATION +mg/dl, I-EXPLORATION +GOT I-EXPLORATION +608 I-EXPLORATION +UI/l I-EXPLORATION +y I-EXPLORATION +GPT I-EXPLORATION +720 I-EXPLORATION +UI/l. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +coledocolitiasis I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +colédoco I-EXPLORATION +(22, I-EXPLORATION +4 I-EXPLORATION +mm) I-EXPLORATION +y I-EXPLORATION +colelitiasis. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +CPRE, I-EXPLORATION +confirmándose I-EXPLORATION +la I-EXPLORATION +coledocolitiasis; I-EXPLORATION +se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +esfinterotomía I-TREATMENT +endoscópica I-TREATMENT +y I-TREATMENT +extracción I-TREATMENT +del I-TREATMENT +cálculo I-TREATMENT +en I-TREATMENT +colédoco. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +2 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +finalizar I-EVOLUTION +la I-EVOLUTION +prueba, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +comienza I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +dolor I-EVOLUTION +súbito I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +derecho. I-EVOLUTION +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal, I-EXPLORATION +taquicardia, I-EXPLORATION +taquipnea I-EXPLORATION +e I-EXPLORATION +hipotensión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +95/60. I-EXPLORATION +Analíticamente I-EXPLORATION +destacaba I-EXPLORATION +bilirrubina I-EXPLORATION +3, I-EXPLORATION +4 I-EXPLORATION +mg/dl, I-EXPLORATION +GOT I-EXPLORATION +315, I-EXPLORATION +amilasa I-EXPLORATION +64 I-EXPLORATION +U/l, I-EXPLORATION +GPT I-EXPLORATION +450, I-EXPLORATION +leucocitos I-EXPLORATION +15.400/mm3, I-EXPLORATION +hemoglobina I-EXPLORATION +5, I-EXPLORATION +5 I-EXPLORATION +g/dl I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +4 I-EXPLORATION +mg/dl. I-EXPLORATION +Se B-TREATMENT +administró I-TREATMENT +fluidoterapia I-TREATMENT +con I-TREATMENT +parcial I-TREATMENT +respuesta I-TREATMENT +hemodinámica. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +evidenciándose I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +intraperitoneal I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +gotieras I-EXPLORATION +y I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +saco I-EXPLORATION +de I-EXPLORATION +Douglas, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hipodensa I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +mal I-EXPLORATION +definidos I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +aerobilia I-EXPLORATION +en I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extrahepática, I-EXPLORATION +sin I-EXPLORATION +neumoperitoneo. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +estos I-TREATMENT +hallazgos I-TREATMENT +y I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +inestabilidad I-TREATMENT +hemodinámica I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +intervenir I-TREATMENT +quirúrgicamente I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +hemoperitoneo I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +subcapsular I-EXPLORATION +hepático I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +parcialmente I-EXPLORATION +roto I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +segmentos I-EXPLORATION +V-VI I-EXPLORATION +hepáticos. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +evacuación I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +y I-TREATMENT +hemostasia I-TREATMENT +local I-TREATMENT +con I-TREATMENT +electrocoagulación I-TREATMENT +y I-TREATMENT +Surgicel®, I-TREATMENT +dejando I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +tipo I-TREATMENT +Jackson-Pratt I-TREATMENT +en I-TREATMENT +espacio I-TREATMENT +subfrénico I-TREATMENT +derecho. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +estuvo I-EVOLUTION +ingresada I-EVOLUTION +en I-EVOLUTION +UCI I-EVOLUTION +durante I-EVOLUTION +48 I-EVOLUTION +horas. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +sangrado I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +objetivó I-EVOLUTION +ninguna I-EVOLUTION +colección, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +4 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +rectorragia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +coágulos, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Otros I-PRESENT_ILLNESS +síntomas: I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +anorrectal I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +defecar, I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +defecatoria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +estreñimiento I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año. I-PRESENT_ILLNESS +La B-EVOLUTION +rectorragia I-EVOLUTION +cedió I-EVOLUTION +espontáneamente I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +ingreso. I-EVOLUTION + I-EVOLUTION +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +autoadministraba I-PAST_MEDICAL_HISTORY +supositorios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +paracetamol-codeína I-PAST_MEDICAL_HISTORY +(500/300 I-PAST_MEDICAL_HISTORY +mg) I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cefalea I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Exploración B-EXPLORATION +física: I-EXPLORATION +normal, I-EXPLORATION +pero I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +muy I-EXPLORATION +doloroso, I-EXPLORATION +palpando I-EXPLORATION +zonas I-EXPLORATION +induradas I-EXPLORATION +e I-EXPLORATION +irregulares I-EXPLORATION +en I-EXPLORATION +mucosa I-EXPLORATION +rectal, I-EXPLORATION +apareciendo I-EXPLORATION +sangre I-EXPLORATION +fresca I-EXPLORATION +en I-EXPLORATION +guante. I-EXPLORATION + I-EXPLORATION +Analítica, I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen: I-EXPLORATION +normales. I-EXPLORATION +Colonoscopia I-EXPLORATION +total: I-EXPLORATION +pérdida I-EXPLORATION +del I-EXPLORATION +patrón I-EXPLORATION +vascular I-EXPLORATION +normal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +rectal, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +gran I-EXPLORATION +ulceración I-EXPLORATION +difusa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +con I-EXPLORATION +pseudopólipos I-EXPLORATION +aislados, I-EXPLORATION +extendiéndose I-EXPLORATION +unos I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +desde I-EXPLORATION +margen I-EXPLORATION +anal. I-EXPLORATION +Anatomía-patológica: I-EXPLORATION +ulceración I-EXPLORATION +inespecífica. I-EXPLORATION +Tomografía I-EXPLORATION +computerizada: I-EXPLORATION +estenosis I-EXPLORATION +rectal I-EXPLORATION +concéntrica I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +perirectales. I-EXPLORATION +Serologías I-EXPLORATION +y I-EXPLORATION +tuberculina: I-EXPLORATION +negativas. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +momento, I-EXPLORATION +se I-EXPLORATION +interrogó I-EXPLORATION +de I-EXPLORATION +nuevo I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente, I-EXPLORATION +que I-EXPLORATION +finalmente I-EXPLORATION +admitió I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +supositorios I-EXPLORATION +al I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +paracetamol-codeína I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +último I-EXPLORATION +año. I-EXPLORATION +Entonces I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +como I-EXPLORATION +rectitis/úlcera I-EXPLORATION +rectal I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +supositorios I-EXPLORATION +de I-EXPLORATION +paracetamol-codeína, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +adicción I-EXPLORATION +a I-EXPLORATION +opiáceos I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +confirmado I-EXPLORATION +y I-EXPLORATION +seguido I-EXPLORATION +por I-EXPLORATION +Psiquiatría. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +suspendieron I-TREATMENT +los I-TREATMENT +supositorios I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +enemas I-TREATMENT +de I-TREATMENT +hidrocortisona, I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +benzodiazepinas I-TREATMENT +por I-TREATMENT +la I-TREATMENT +adicción I-TREATMENT +a I-TREATMENT +opiáceos. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +mejoró I-EVOLUTION +significativamente I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION +Las B-EXPLORATION +colonoscopias I-EXPLORATION +realizadas I-EXPLORATION +al I-EXPLORATION +segundo I-EXPLORATION +y I-EXPLORATION +sexto I-EXPLORATION +mes I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +alta I-EXPLORATION +demostraron I-EXPLORATION +progresiva I-EXPLORATION +mejoría I-EXPLORATION +y I-EXPLORATION +curación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +rectales. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +a I-TREATMENT +los I-TREATMENT +8 I-TREATMENT +meses. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +meses I-EVOLUTION +estaba I-EVOLUTION +completamente I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +nacionalidad I-PAST_MEDICAL_HISTORY +argentina, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +estreñimiento. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +presenta I-EXPLORATION +discomfort I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +inferior I-EXPLORATION +con I-EXPLORATION +sensación I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +hipogastrio. I-EXPLORATION +Tacto I-EXPLORATION +rectal I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +descarta I-EXPLORATION +patología I-EXPLORATION +ginecológica I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +Rx I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +abundante I-EXPLORATION +material I-EXPLORATION +fecal. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +es I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +objetiva I-EXPLORATION +un I-EXPLORATION +fecaloma I-EXPLORATION +recto-sigmoidal I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +colon. I-EXPLORATION +Los I-EXPLORATION +enemas I-EXPLORATION +de I-EXPLORATION +limpieza I-EXPLORATION +son I-EXPLORATION +efectivos I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +practica I-EXPLORATION +fibrocolonoscopia I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION +Durante B-FAMILY_HISTORY +el I-FAMILY_HISTORY +ingreso I-FAMILY_HISTORY +se I-FAMILY_HISTORY +reinterroga I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +destacando I-FAMILY_HISTORY +como I-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +la I-FAMILY_HISTORY +muerte I-FAMILY_HISTORY +de I-FAMILY_HISTORY +su I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +por I-FAMILY_HISTORY +afectación I-FAMILY_HISTORY +cardíaca I-FAMILY_HISTORY +por I-FAMILY_HISTORY +ECH I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +45 I-FAMILY_HISTORY +años. I-FAMILY_HISTORY +Se B-EXPLORATION +realiza I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +ECH I-EXPLORATION +siendo I-EXPLORATION +esta I-EXPLORATION +positiva. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +sometida I-EVOLUTION +a I-EVOLUTION +tratamiento I-EVOLUTION +conservador, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +sin I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +intervención I-EVOLUTION +quirúrgica. I-EVOLUTION + I-EVOLUTION + +Una B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +fue B-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +células I-PAST_MEDICAL_HISTORY +renales I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +1. I-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +nefrectomía I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +quimioterapia I-PAST_MEDICAL_HISTORY +adyuvante. I-PAST_MEDICAL_HISTORY +Tres I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +tarde I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +metástasis I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cerebral. I-PAST_MEDICAL_HISTORY +Hace B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año, I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hemorragia I-PRESENT_ILLNESS +digestiva I-PRESENT_ILLNESS +alta. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +aceptable I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +nutricional, I-EXPLORATION +TA I-EXPLORATION +120/70 I-EXPLORATION +y I-EXPLORATION +exploración I-EXPLORATION +cardiorrespiratoria I-EXPLORATION +normal. I-EXPLORATION +Abdomen I-EXPLORATION +blando, I-EXPLORATION +depresible I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +palpables. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +analítico I-EXPLORATION +reveló I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +3 I-EXPLORATION +g/dl. I-EXPLORATION +Un I-EXPLORATION +TAC I-EXPLORATION +toraco-abdominal I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +cuerpo I-EXPLORATION +y I-EXPLORATION +antro I-EXPLORATION +gástrico I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor I-EXPLORATION +sin I-EXPLORATION +invasión I-EXPLORATION +de I-EXPLORATION +estructuras I-EXPLORATION +adyacentes. I-EXPLORATION +Una I-EXPLORATION +endoscopia I-EXPLORATION +alta I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +cuerpo I-EXPLORATION +y I-EXPLORATION +antro I-EXPLORATION +gástrico. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +gastrectomía I-TREATMENT +subtotal I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +demostró I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +renal. I-EXPLORATION + I-EXPLORATION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Crohn I-PAST_MEDICAL_HISTORY +cólica I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +11 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +actualmente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +mesalazina, I-PAST_MEDICAL_HISTORY +y B-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hipogastrio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +esporádicos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +apetito. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +contexto I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +palpa I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +dura I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +vacío I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +iliaca I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +palpó I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +pétrea, I-EXPLORATION +no I-EXPLORATION +dolorosa, I-EXPLORATION +desplazable I-EXPLORATION +ligeramente I-EXPLORATION +aunque I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +profundos. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +detectó I-EXPLORATION +leucocitosis I-EXPLORATION +(16,79x10e9/l) I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +y I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +122.0 I-EXPLORATION +g/l. I-EXPLORATION +Tanto I-EXPLORATION +la I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +(89, I-EXPLORATION +0 I-EXPLORATION +mm/h) I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(38, I-EXPLORATION +6 I-EXPLORATION +mg/l) I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +elevadas. I-EXPLORATION +Los I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +(antígeno I-EXPLORATION +carcinoembrionario, I-EXPLORATION +beta-2-microglobulina, I-EXPLORATION +antígeno I-EXPLORATION +C.A. I-EXPLORATION +15.3, I-EXPLORATION +19.9 I-EXPLORATION +y I-EXPLORATION +125) I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +tomografía I-EXPLORATION +computadorizada I-EXPLORATION +abdominal I-EXPLORATION +apreciándose I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +que I-EXPLORATION +englobaba I-EXPLORATION +al I-EXPLORATION +colon I-EXPLORATION +sigmoideo I-EXPLORATION +(flecha I-EXPLORATION +hueca), I-EXPLORATION +íleon I-EXPLORATION +distal I-EXPLORATION +(flecha I-EXPLORATION +blanca) I-EXPLORATION +y I-EXPLORATION +ciego I-EXPLORATION +(flecha I-EXPLORATION +negra) I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +múltiples I-EXPLORATION +adenopatías I-EXPLORATION +en I-EXPLORATION +algunos I-EXPLORATION +casos I-EXPLORATION +formando I-EXPLORATION +conglomerados I-EXPLORATION +(asteriscos). I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +sigmoideo I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +B I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes, I-EXPLORATION +con I-EXPLORATION +inmunofenotipo I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +centrogerminal. I-EXPLORATION +Ingresa B-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +según I-TREATMENT +protocolo I-TREATMENT +GELTAMO, I-TREATMENT +falleciendo B-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sólidos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +padecía I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +etílico I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +B8 I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Child-Pugh. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +gastroscopia I-EXPLORATION +encontrando I-EXPLORATION +dilatación I-EXPLORATION +y I-EXPLORATION +atonía I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +esofágico, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +tres I-EXPLORATION +cordones I-EXPLORATION +varicosos I-EXPLORATION +de I-EXPLORATION +mediano I-EXPLORATION +tamaño I-EXPLORATION +en I-EXPLORATION +tercio I-EXPLORATION +inferior. I-EXPLORATION +Un I-EXPLORATION +tránsito I-EXPLORATION +baritado I-EXPLORATION +mostró I-EXPLORATION +dilatación I-EXPLORATION +esofágica I-EXPLORATION +con I-EXPLORATION +afilamiento I-EXPLORATION +distal. I-EXPLORATION +La I-EXPLORATION +manometría I-EXPLORATION +constató I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +peristaltismo I-EXPLORATION +en I-EXPLORATION +cuerpo I-EXPLORATION +esofágico. I-EXPLORATION +Un I-EXPLORATION +TC I-EXPLORATION +toraco-abdominal I-EXPLORATION +descartó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +regional. I-EXPLORATION +Se I-EXPLORATION +obtuvo I-EXPLORATION +6 I-EXPLORATION +sobre I-EXPLORATION +un I-EXPLORATION +score I-EXPLORATION +de I-EXPLORATION +disfagia I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +puntos I-EXPLORATION +(2). I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +acalasia I-EXPLORATION +y B-TREATMENT +tras I-TREATMENT +valorar I-TREATMENT +las I-TREATMENT +diferentes I-TREATMENT +opciones I-TREATMENT +terapéuticas I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +ITB I-TREATMENT +guiada I-TREATMENT +por I-TREATMENT +ecoendoscopia. I-TREATMENT +Mediante I-TREATMENT +ecoendoscopio I-TREATMENT +Pentax I-TREATMENT +EG-3830UT I-TREATMENT +se I-TREATMENT +localizó I-TREATMENT +el I-TREATMENT +EEI I-TREATMENT +como I-TREATMENT +área I-TREATMENT +hipoecoica I-TREATMENT +engrosada I-TREATMENT +(7 I-TREATMENT +mm) I-TREATMENT +en I-TREATMENT +continuidad I-TREATMENT +con I-TREATMENT +la I-TREATMENT +capa I-TREATMENT +muscular I-TREATMENT +propia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +esofágica. I-TREATMENT +En I-TREATMENT +dicha I-TREATMENT +zona I-TREATMENT +se I-TREATMENT +inyectó I-TREATMENT +mediante I-TREATMENT +aguja I-TREATMENT +de I-TREATMENT +ecoendoscopio I-TREATMENT +de I-TREATMENT +22 I-TREATMENT +G I-TREATMENT +EchoTip I-TREATMENT +Ultra I-TREATMENT +(COOK I-TREATMENT +Medical), I-TREATMENT +un I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +(20 I-TREATMENT +UI) I-TREATMENT +(BoTox; I-TREATMENT +Inc., I-TREATMENT +Irvine, I-TREATMENT +Calif.) I-TREATMENT +diluida I-TREATMENT +a I-TREATMENT +1/5 I-TREATMENT +por I-TREATMENT +cuadrante I-TREATMENT +evitando I-TREATMENT +la I-TREATMENT +inyección I-TREATMENT +intravariz. I-TREATMENT +No B-EVOLUTION +hubo I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +toleró I-EVOLUTION +dieta I-EVOLUTION +sólida I-EVOLUTION +en I-EVOLUTION +72 I-EVOLUTION +horas. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +9 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +solo I-EVOLUTION +refiere I-EVOLUTION +disfagia I-EVOLUTION +ocasional, I-EVOLUTION +puntuando I-EVOLUTION +1 I-EVOLUTION +sobre I-EVOLUTION +9 I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +score I-EVOLUTION +de I-EVOLUTION +disfagia. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +94 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardiaca I-PAST_MEDICAL_HISTORY +clase I-PAST_MEDICAL_HISTORY +funcional I-PAST_MEDICAL_HISTORY +III, I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +litiasis I-PAST_MEDICAL_HISTORY +vesicular I-PAST_MEDICAL_HISTORY +conocida I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +requirió I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +esfinterotomía I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +endoscopia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +coledocolitiasis I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +88 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +desestimó I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +colecistectomía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +comorbilidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +intensificado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +días. I-PRESENT_ILLNESS +Refería I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cuadrante I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas. I-PRESENT_ILLNESS +Negó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Una B-EXPLORATION +punción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa, I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +11, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +objetivó I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +purulento. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica, I-EXPLORATION +presentaba I-EXPLORATION +únicamente I-EXPLORATION +leucocitosis I-EXPLORATION +(17,6.103/μl) I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +del I-EXPLORATION +88, I-EXPLORATION +9%. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +litiasis I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vesícula, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +contactaba I-EXPLORATION +directamente I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +adyacente, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +10 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +8, I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +con I-EXPLORATION +aire I-EXPLORATION +y I-EXPLORATION +calcificaciones I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mismas I-EXPLORATION +características I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +del I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +correspondiendo I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +Empiema I-EXPLORATION +necessitatis I-EXPLORATION +por I-EXPLORATION +colecistitis. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +comorbilidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +únicamente I-TREATMENT +desbridamiento I-TREATMENT +y I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +del I-TREATMENT +empiema I-TREATMENT +bajo I-TREATMENT +sedación. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +correcta. I-EVOLUTION +Fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +noveno I-EVOLUTION +día I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hemiabdomen I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +oC, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS +El B-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +inferior, I-EXPLORATION +más I-EXPLORATION +intenso I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +defensa I-EXPLORATION +y I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Blumberg I-EXPLORATION +positivo. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +leucocitosis I-EXPLORATION +ni I-EXPLORATION +neutrofilia I-EXPLORATION +(leucocitos I-EXPLORATION +8, I-EXPLORATION +8 I-EXPLORATION +x I-EXPLORATION +109/L, I-EXPLORATION +neutrófilos I-EXPLORATION +70%) I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +únicamente I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +intestinales. I-EXPLORATION +Se I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +evidencia I-EXPLORATION +un I-EXPLORATION +apéndice I-EXPLORATION +cecal I-EXPLORATION +en I-EXPLORATION +disposición I-EXPLORATION +pélvica, I-EXPLORATION +discretamente I-EXPLORATION +engrosado, I-EXPLORATION +con I-EXPLORATION +mínimos I-EXPLORATION +cambios I-EXPLORATION +inflamatorios I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +adyacente I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +x I-EXPLORATION +9 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +punta, I-EXPLORATION +sin I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +intraabdominal, I-EXPLORATION +pneumoperitoneo I-EXPLORATION +ni I-EXPLORATION +adenopatías I-EXPLORATION +retroperitoneales I-EXPLORATION +o I-EXPLORATION +pélvicas I-EXPLORATION +significativas. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +presunción I-TREATMENT +de I-TREATMENT +apendicitis I-TREATMENT +aguda I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +apendicectomía I-TREATMENT +laparotómica, I-TREATMENT +hallando I-TREATMENT +un I-TREATMENT +apéndice I-TREATMENT +gangrenoso I-TREATMENT +perforado I-TREATMENT +con I-TREATMENT +líquido I-TREATMENT +libre I-TREATMENT +intraabdominal. I-TREATMENT +El B-EVOLUTION +curso I-EVOLUTION +postoperatorio I-EVOLUTION +transcurre I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +identifica I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +mucinosa I-EXPLORATION +apendicular I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +malignidad I-EXPLORATION +con I-EXPLORATION +extravasación I-EXPLORATION +de I-EXPLORATION +mucina I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +epitelio I-EXPLORATION +extraapendicular, I-EXPLORATION +con I-EXPLORATION +margen I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +libre I-EXPLORATION +y I-EXPLORATION +cambios I-EXPLORATION +típicos I-EXPLORATION +de I-EXPLORATION +apendicitis I-EXPLORATION +aguda I-EXPLORATION +sobreañadidos. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +19 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +seguido I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Departamento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Pediatría I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +anemia I-PRESENT_ILLNESS +ferropénica. I-PRESENT_ILLNESS +Se B-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +gastroscopia, I-PAST_MEDICAL_HISTORY +colonoscopia, I-PAST_MEDICAL_HISTORY +tránsito I-PAST_MEDICAL_HISTORY +gastrointestinal, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +gammagrafía I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +descartar I-PAST_MEDICAL_HISTORY +divertículo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Meckel, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +todas I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +pruebas I-PAST_MEDICAL_HISTORY +negativas. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +todos I-PAST_MEDICAL_HISTORY +estos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +asintomático I-PAST_MEDICAL_HISTORY +recibiendo I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hierro I-PAST_MEDICAL_HISTORY +oral. I-PAST_MEDICAL_HISTORY +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +seguimiento I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +estudio. I-DERIVED_FROM/TO +Se B-EXPLORATION +le I-EXPLORATION +repitieron I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +diagnósticas I-EXPLORATION +iniciales I-EXPLORATION +(gastroscopia, I-EXPLORATION +colonoscopia I-EXPLORATION +y I-EXPLORATION +tránsito I-EXPLORATION +gastrointestinal), I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +conseguir I-EXPLORATION +llegar I-EXPLORATION +al I-EXPLORATION +diagnóstico. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +objetivo I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +mural I-EXPLORATION +concéntrico I-EXPLORATION +ileal I-EXPLORATION +con I-EXPLORATION +realce I-EXPLORATION +homogéneo I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +sugerían I-EXPLORATION +como I-EXPLORATION +primera I-EXPLORATION +posibilidad I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +inflamatoria I-EXPLORATION +intestinal I-EXPLORATION +crónica I-EXPLORATION +tipo I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn, I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +descartarse I-EXPLORATION +linfoma I-EXPLORATION +intestinal. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +rechazó I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +con I-TREATMENT +cápsula I-TREATMENT +endoscópica, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +5-ASA I-TREATMENT +y I-TREATMENT +hierro I-TREATMENT +intravenoso. I-TREATMENT + I-TREATMENT +Fue B-EVOLUTION +ingresado I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hospital I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +por I-EVOLUTION +anemia I-EVOLUTION +severa I-EVOLUTION +(hemoglobina: I-EVOLUTION +4, I-EVOLUTION +8 I-EVOLUTION +g/dl), I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +melenas, I-EVOLUTION +aceptando B-TREATMENT +esta I-TREATMENT +vez I-TREATMENT +realizarse I-TREATMENT +cápsula I-TREATMENT +endoscópica. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +lesión I-EXPLORATION +polipoidea I-EXPLORATION +submucosa I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +violáceo I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +corresponder I-EXPLORATION +a I-EXPLORATION +íleon I-EXPLORATION +proximal, I-EXPLORATION +que I-EXPLORATION +ocluía I-EXPLORATION +la I-EXPLORATION +mitad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +circunferencia I-EXPLORATION +ileal I-EXPLORATION +y I-EXPLORATION +pareciendo I-EXPLORATION +rezumar I-EXPLORATION +sangre I-EXPLORATION +de I-EXPLORATION +dicha I-EXPLORATION +zona. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +laparotomía I-TREATMENT +encontrando I-TREATMENT +una I-TREATMENT +tumoración I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +longitud I-TREATMENT +de I-TREATMENT +color I-TREATMENT +púrpura, I-TREATMENT +vascularizada, I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +resecada, I-TREATMENT +siendo I-TREATMENT +diagnosticado I-TREATMENT +histológicamente I-TREATMENT +como I-TREATMENT +hemangioma I-TREATMENT +cavernoso I-TREATMENT +gigante I-TREATMENT +de I-TREATMENT +intestino I-TREATMENT +delgado. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +cinco I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía, I-EVOLUTION +permanecido I-EVOLUTION +posteriormente I-EVOLUTION +asintomático, I-EVOLUTION +con I-EVOLUTION +análisis I-EVOLUTION +de I-EVOLUTION +sangre I-EVOLUTION +normales I-EVOLUTION +desde I-EVOLUTION +entonces. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +espalda I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +consuntivo. I-PRESENT_ILLNESS +En B-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +halló I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +páncreas I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +mal I-EXPLORATION +definidos, I-EXPLORATION +heterogénea I-EXPLORATION +e I-EXPLORATION +hipoecogénica, I-EXPLORATION +sin I-EXPLORATION +invasión I-EXPLORATION +vascular I-EXPLORATION +ni I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +y I-EXPLORATION +dos I-EXPLORATION +nódulos I-EXPLORATION +hepáticos I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +incierta. I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +inyección I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +bolo I-EXPLORATION +convencional I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +4 I-EXPLORATION +ml I-EXPLORATION +del I-EXPLORATION +contraste I-EXPLORATION +ecográfico I-EXPLORATION +hexafluoruro I-EXPLORATION +de I-EXPLORATION +azufre I-EXPLORATION +(Sonovue®, I-EXPLORATION +Bracco, I-EXPLORATION +Milán). I-EXPLORATION +La I-EXPLORATION +fase I-EXPLORATION +arterial I-EXPLORATION +(10-30 I-EXPLORATION +segundos) I-EXPLORATION +definió I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +pancreática I-EXPLORATION +hipocaptante I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +al I-EXPLORATION +parénquima I-EXPLORATION +vecino I-EXPLORATION +que I-EXPLORATION +estenosaba I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +esplénica. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +venosa I-EXPLORATION +(30-120 I-EXPLORATION +segundos) I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +permeabilidad I-EXPLORATION +del I-EXPLORATION +eje I-EXPLORATION +venoso I-EXPLORATION +esplenoportomesentérico I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +barrido I-EXPLORATION +hepático I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +tardía I-EXPLORATION +(> I-EXPLORATION +120 I-EXPLORATION +segundos) I-EXPLORATION +detectó I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +hipocaptantes. I-EXPLORATION +En I-EXPLORATION +resumen, I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +ecográficas I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +masa I-EXPLORATION +pancreática I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +maligna I-EXPLORATION +con I-EXPLORATION +invasión I-EXPLORATION +vascular I-EXPLORATION +arterial I-EXPLORATION +y I-EXPLORATION +metastásica I-EXPLORATION +hepática. I-EXPLORATION +Estos I-EXPLORATION +datos I-EXPLORATION +fueron I-EXPLORATION +corroborados I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +helicoidal. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +figura I-EXPLORATION +1 I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +cómo I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +angiográficas I-EXPLORATION +con I-EXPLORATION +ecografía I-EXPLORATION +contrastada I-EXPLORATION +y I-EXPLORATION +angioTAC I-EXPLORATION +fueron I-EXPLORATION +equiparables. I-EXPLORATION +La I-EXPLORATION +PAAF I-EXPLORATION +guiada I-EXPLORATION +por I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +hepático I-EXPLORATION +fue I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +pancreático. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +quimioterapia I-TREATMENT +paliativa. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes, I-PAST_MEDICAL_HISTORY +estudiada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +hemorragia I-PAST_MEDICAL_HISTORY +digestiva I-PAST_MEDICAL_HISTORY +oculta I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +CE. I-PAST_MEDICAL_HISTORY +Su B-PRESENT_ILLNESS +lectura I-PRESENT_ILLNESS +objetivó I-PRESENT_ILLNESS +detención I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +estenosis. I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingesta, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cierre I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Analítica: B-EXPLORATION +9.400 I-EXPLORATION +leucocitos/µl, I-EXPLORATION +hemoglobina: I-EXPLORATION +11, I-EXPLORATION +2 I-EXPLORATION +g/dl, I-EXPLORATION +plaquetas I-EXPLORATION +y I-EXPLORATION +coagulación I-EXPLORATION +normales. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +abdomen: I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +y I-EXPLORATION +artefacto I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +CE. I-EXPLORATION +Tomografía I-EXPLORATION +computerizada I-EXPLORATION +: I-EXPLORATION +obstrucción I-EXPLORATION +intestinal I-EXPLORATION +mecánica I-EXPLORATION +completa I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +CE. I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +cirugía I-TREATMENT +abdominal I-TREATMENT +urgente, I-TREATMENT +encontrando I-TREATMENT +una I-TREATMENT +distensión I-TREATMENT +del I-TREATMENT +intestino I-TREATMENT +proximal I-TREATMENT +a I-TREATMENT +4 I-TREATMENT +estenosis I-TREATMENT +de I-TREATMENT +íleon I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +inflamatorio, I-TREATMENT +causando I-TREATMENT +una I-TREATMENT +de I-TREATMENT +ellas I-TREATMENT +una I-TREATMENT +obstrucción I-TREATMENT +completa, I-TREATMENT +en I-TREATMENT +cuyo I-TREATMENT +interior I-TREATMENT +se I-TREATMENT +palpaba I-TREATMENT +la I-TREATMENT +CE. I-TREATMENT +Se I-TREATMENT +resecaron I-TREATMENT +30 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +íleon I-TREATMENT +que I-TREATMENT +incluían I-TREATMENT +3 I-TREATMENT +de I-TREATMENT +las I-TREATMENT +4 I-TREATMENT +estenosis, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +anastomosis I-TREATMENT +latero-lateral I-TREATMENT +mecánica I-TREATMENT +y I-TREATMENT +estricturoplastia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +estenosis I-TREATMENT +restante. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +transcurrió I-EVOLUTION +favorablemente, I-EVOLUTION +siendo I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +7.o I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION +El B-EXPLORATION +resultado I-EXPLORATION +histológico I-EXPLORATION +del I-EXPLORATION +espécimen I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +estudiada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +epigastralgia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +ó I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +mejoran I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +emesis. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +relevancia I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +anticonceptivos I-PAST_MEDICAL_HISTORY +orales I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +tan I-EXPLORATION +sólo, I-EXPLORATION +leucocitos I-EXPLORATION +en I-EXPLORATION +3.570 I-EXPLORATION +x I-EXPLORATION +109/l, I-EXPLORATION +Hb I-EXPLORATION +115 I-EXPLORATION +g/l I-EXPLORATION +con I-EXPLORATION +VCM I-EXPLORATION +de I-EXPLORATION +78 I-EXPLORATION +fl. I-EXPLORATION +Resto I-EXPLORATION +en I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +Entre I-EXPLORATION +episodios I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +asintomática I-EXPLORATION +con I-EXPLORATION +hábito I-EXPLORATION +intestinal I-EXPLORATION +normal I-EXPLORATION +sin I-EXPLORATION +productos I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +objetivan I-EXPLORATION +imágenes I-EXPLORATION +heterogéneas I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +calcio I-EXPLORATION +de I-EXPLORATION +4-5 I-EXPLORATION +cm I-EXPLORATION +proyectadas I-EXPLORATION +sobre I-EXPLORATION +flexura I-EXPLORATION +hepática I-EXPLORATION +del I-EXPLORATION +colon. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +objetiva I-EXPLORATION +barro I-EXPLORATION +biliar I-EXPLORATION +y I-EXPLORATION +adyacente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +mm, I-EXPLORATION +heterogénea I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +hiperecogénicas I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +hidatídico. I-EXPLORATION +A I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +referir I-EXPLORATION +convivencia I-EXPLORATION +continuada I-EXPLORATION +con I-EXPLORATION +perros I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +endémica I-EXPLORATION +de I-EXPLORATION +hidatidosis I-EXPLORATION +como I-EXPLORATION +es I-EXPLORATION +España I-EXPLORATION +(1,2), I-EXPLORATION +y I-EXPLORATION +orientar I-EXPLORATION +inicialmente I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +hacia I-EXPLORATION +esta I-EXPLORATION +patología, I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +hidatidosis I-EXPLORATION +resulta I-EXPLORATION +negativa. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +hepatomegalia I-EXPLORATION +con I-EXPLORATION +LOE I-EXPLORATION +parcialmente I-EXPLORATION +calcificada I-EXPLORATION +en I-EXPLORATION +segmento I-EXPLORATION +V I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +mm I-EXPLORATION +y I-EXPLORATION +morfología I-EXPLORATION +redondeada I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +lobulados I-EXPLORATION +e I-EXPLORATION +imágenes I-EXPLORATION +redondeadas I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +tamaño I-EXPLORATION +en I-EXPLORATION +periferia. I-EXPLORATION +La I-EXPLORATION +imagen I-EXPLORATION +es I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +quiste I-EXPLORATION +hidatídico I-EXPLORATION +sin I-EXPLORATION +descartar I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +hemangioma I-EXPLORATION +parcialmente I-EXPLORATION +calcificado. I-EXPLORATION +La I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +numerosas I-EXPLORATION +microlitiasis I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios. I-EXPLORATION +Se I-EXPLORATION +objetiva I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +modo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +un I-EXPLORATION +hemangioma I-EXPLORATION +de I-EXPLORATION +31 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +segmento I-EXPLORATION +IV I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +quistes I-EXPLORATION +corticales I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +riñones. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +programa I-TREATMENT +colecistectomía I-TREATMENT +más I-TREATMENT +quistoperiquistectomía I-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +presunción I-TREATMENT +de I-TREATMENT +quiste I-TREATMENT +hidatídico I-TREATMENT +más I-TREATMENT +colelitiasis. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +abordaje I-TREATMENT +mediante I-TREATMENT +laparotomía I-TREATMENT +subcostal I-TREATMENT +derecha. I-TREATMENT +Se I-TREATMENT +objetiva I-TREATMENT +vesícula I-TREATMENT +biliar I-TREATMENT +con I-TREATMENT +tumoración I-TREATMENT +intravesicular I-TREATMENT +de I-TREATMENT +consistencia I-TREATMENT +pétrea I-TREATMENT +que I-TREATMENT +no I-TREATMENT +infiltra I-TREATMENT +parénquima I-TREATMENT +hepático, I-TREATMENT +sin I-TREATMENT +LOE I-TREATMENT +en I-TREATMENT +segmento I-TREATMENT +V. I-TREATMENT +Mediante B-EXPLORATION +biopsia I-EXPLORATION +intraoperatoria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +se I-EXPLORATION +diagnostica I-EXPLORATION +como I-EXPLORATION +angiomioma I-EXPLORATION +vesicular I-EXPLORATION +benigno, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +colecistectomía I-TREATMENT +simple, I-TREATMENT +que I-TREATMENT +incluye I-TREATMENT +la I-TREATMENT +totalidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +tumoral. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +transcurriendo I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +posterior I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +describe I-EXPLORATION +masa I-EXPLORATION +sólida, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +y I-EXPLORATION +crecimiento I-EXPLORATION +expansivo I-EXPLORATION +que I-EXPLORATION +respeta I-EXPLORATION +mucosa I-EXPLORATION +y I-EXPLORATION +serosa I-EXPLORATION +císticas. I-EXPLORATION +La I-EXPLORATION +histología I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +concluyeron I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +leiomioma I-EXPLORATION +intramural I-EXPLORATION +y I-EXPLORATION +endocavitario I-EXPLORATION +con I-EXPLORATION +calcificaciones I-EXPLORATION +y I-EXPLORATION +osificación I-EXPLORATION +distrófica, I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +benigno I-EXPLORATION +sin I-EXPLORATION +infiltrar I-EXPLORATION +parénquima I-EXPLORATION +hepático. I-EXPLORATION +La I-EXPLORATION +muestra I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +VEB I-EXPLORATION +y I-EXPLORATION +C-Kit I-EXPLORATION +/ I-EXPLORATION +CD-117. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática, I-EVOLUTION +tras I-EVOLUTION +realización I-EVOLUTION +de I-EVOLUTION +ecografía I-EVOLUTION +abdominal I-EVOLUTION +no I-EVOLUTION +muestra I-EVOLUTION +recidiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +ni I-EVOLUTION +otras I-EVOLUTION +alteraciones I-EVOLUTION +15 I-EVOLUTION +meses I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rectorragia I-PRESENT_ILLNESS +masiva I-PRESENT_ILLNESS +indolora, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +síncope. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacan: I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +epidermoide I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cérvix I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2004 I-PAST_MEDICAL_HISTORY +(histerectomía, I-PAST_MEDICAL_HISTORY +doble I-PAST_MEDICAL_HISTORY +anexectomía, I-PAST_MEDICAL_HISTORY +radioterapia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +braquiterapia), I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +epidermoide I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +lengua I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2005 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +resección I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +atípica I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +metástasis. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +estable, I-EXPLORATION +destacando I-EXPLORATION +una I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +8 I-EXPLORATION +g/dl I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +del I-EXPLORATION +24%. I-EXPLORATION +La I-EXPLORATION +radiología I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +eran I-EXPLORATION +inespecíficas. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +endoscópicos I-EXPLORATION +evidenciaban I-EXPLORATION +abundantes I-EXPLORATION +restos I-EXPLORATION +hemáticos I-EXPLORATION +en I-EXPLORATION +colon, I-EXPLORATION +sin I-EXPLORATION +identificar I-EXPLORATION +causa. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +con I-EXPLORATION +gas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +psoas I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +estos I-TREATMENT +hallazgos I-TREATMENT +y I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +rectorragia, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +intervenida I-TREATMENT +al I-TREATMENT +cuarto I-TREATMENT +día I-TREATMENT +del I-TREATMENT +ingreso, I-TREATMENT +realizándose I-TREATMENT +una I-TREATMENT +laparotomía I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +un I-TREATMENT +proceso I-TREATMENT +inflamatorio I-TREATMENT +retrocecal I-TREATMENT +afectando I-TREATMENT +a I-TREATMENT +ciego, I-TREATMENT +apéndice I-TREATMENT +y I-TREATMENT +englobando I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +iliaca I-TREATMENT +derecha, I-TREATMENT +comprobándose I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +fistulización I-TREATMENT +iliaco-apendicular. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +hemicolectomía I-TREATMENT +derecha I-TREATMENT +ampliada I-TREATMENT +y I-TREATMENT +by-pass I-TREATMENT +fémoro-femoral I-TREATMENT +con I-TREATMENT +vena I-TREATMENT +safena. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +14 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +anatomía-patológica I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +pieza I-EXPLORATION +de I-EXPLORATION +hemicolectomía I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +mucosa I-EXPLORATION +y I-EXPLORATION +abundante I-EXPLORATION +material I-EXPLORATION +sanguíneo I-EXPLORATION +parcialmente I-EXPLORATION +organizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lecho I-EXPLORATION +apendicular. I-EXPLORATION +Focos I-EXPLORATION +metastáticos I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +escamosas I-EXPLORATION +afectando I-EXPLORATION +a I-EXPLORATION +serosa, I-EXPLORATION +tejido I-EXPLORATION +graso I-EXPLORATION +y I-EXPLORATION +áreas I-EXPLORATION +perineurales I-EXPLORATION +y I-EXPLORATION +perivasculares I-EXPLORATION +(grandes I-EXPLORATION +vasos). I-EXPLORATION +Ganglios I-EXPLORATION +linfáticos I-EXPLORATION +aislados I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +malignidad. I-EXPLORATION +Material I-EXPLORATION +endoarterial I-EXPLORATION +con I-EXPLORATION +grupos I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +de I-EXPLORATION +hábito I-EXPLORATION +escamoso. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Filipinas, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +regresado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +país I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes, I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pancreatitis I-PRESENT_ILLNESS +aguda. I-PRESENT_ILLNESS +Presenta B-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +eosinofilia, I-EXPLORATION +hipertransaminasemia I-EXPLORATION +leve I-EXPLORATION +(< I-EXPLORATION +90 I-EXPLORATION +mg/dl) I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +distendida I-EXPLORATION +con I-EXPLORATION +paredes I-EXPLORATION +engrosadas I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +una I-EXPLORATION +estructura I-EXPLORATION +alargada I-EXPLORATION +hiperecogénica I-EXPLORATION +con I-EXPLORATION +movimientos I-EXPLORATION +ondulatorios I-EXPLORATION +espontáneos. I-EXPLORATION +Se I-EXPLORATION +extendía I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +conducto I-EXPLORATION +biliar I-EXPLORATION +principal I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +papila. I-EXPLORATION +Ante B-TREATMENT +este I-TREATMENT +hallazgo, I-TREATMENT +se I-TREATMENT +administra I-TREATMENT +albendazol I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +colangiopancreatografía I-TREATMENT +retrógrada I-TREATMENT +endoscópica I-TREATMENT +(CPRE) I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +después I-TREATMENT +para I-TREATMENT +extraer I-TREATMENT +el I-TREATMENT +parásito. I-TREATMENT +Sin B-EXPLORATION +embargo, I-EXPLORATION +la I-EXPLORATION +papila I-EXPLORATION +estaba I-EXPLORATION +rasgada I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +el I-EXPLORATION +mismo. I-EXPLORATION +Una I-EXPLORATION +nueva I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +colangiorresonancia I-EXPLORATION +magnética I-EXPLORATION +confirmaron I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +parásito I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +iliaca I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Febrícula I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +vómito I-PRESENT_ILLNESS +alimentario. I-PRESENT_ILLNESS +Deposiciones I-PRESENT_ILLNESS +normales. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presentaba I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +La I-EXPLORATION +palpación I-EXPLORATION +abdominal I-EXPLORATION +objetivó I-EXPLORATION +defensa I-EXPLORATION +voluntaria I-EXPLORATION +en I-EXPLORATION +FID, I-EXPLORATION +Blumberg I-EXPLORATION +y I-EXPLORATION +psoas I-EXPLORATION +positivo. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +mostraba I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +y I-EXPLORATION +eosinofilia. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +visualizó I-EXPLORATION +apéndice I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm I-EXPLORATION +retrocecal. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +apendicectomía I-TREATMENT +laparotómica I-TREATMENT +urgente, I-TREATMENT +apreciando I-TREATMENT +inflamación I-TREATMENT +macroscópica I-TREATMENT +del I-TREATMENT +apéndice, I-TREATMENT +sin I-TREATMENT +líquido. I-TREATMENT +Exploración B-EXPLORATION +ileal I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico, I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +AA, I-EXPLORATION +visualizándose I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +inflamación I-EXPLORATION +aguda I-EXPLORATION +invadiendo I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +apendicular I-EXPLORATION +y I-EXPLORATION +oxiuros I-EXPLORATION +ocluyendo I-EXPLORATION +la I-EXPLORATION +luz. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +estos I-TREATMENT +hallazgos, I-TREATMENT +se I-TREATMENT +contactó I-TREATMENT +con I-TREATMENT +la I-TREATMENT +familia I-TREATMENT +para I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +mebendazol. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Asmática, B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +sustitutivo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +portadora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +marcapasos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +bloqueo I-PAST_MEDICAL_HISTORY +aurículo-ventricular I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2o I-PAST_MEDICAL_HISTORY +grado. I-PAST_MEDICAL_HISTORY +Apendicectomizada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +distensión, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +saciedad I-PRESENT_ILLNESS +precoz, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +postprandiales I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2-3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +tiempo I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +perdido I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destaca I-EXPLORATION +abdomen I-EXPLORATION +distendido, I-EXPLORATION +timpanizado, I-EXPLORATION +doloroso I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación. I-EXPLORATION +Ruidos I-EXPLORATION +metálicos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +urgencias I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +marcada I-EXPLORATION +dilatación I-EXPLORATION +gástrica I-EXPLORATION +y I-EXPLORATION +duodenal I-EXPLORATION +(signo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +doble I-EXPLORATION +burbuja). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +gastroscopia I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +estómago I-EXPLORATION +con I-EXPLORATION +motilidad I-EXPLORATION +prácticamente I-EXPLORATION +ausente I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +restos I-EXPLORATION +alimentarios. I-EXPLORATION +El I-EXPLORATION +duodeno I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +edematoso I-EXPLORATION +con I-EXPLORATION +imposibilidad I-EXPLORATION +de I-EXPLORATION +pasar I-EXPLORATION +a I-EXPLORATION +segunda I-EXPLORATION +porción, I-EXPLORATION +se I-EXPLORATION +toman I-EXPLORATION +biopsias I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +informadas I-EXPLORATION +posteriormente I-EXPLORATION +como I-EXPLORATION +duodenitis I-EXPLORATION +inespecífica I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +malignas. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +visualiza I-EXPLORATION +dilatación I-EXPLORATION +gástrica I-EXPLORATION +y I-EXPLORATION +duodenal I-EXPLORATION +con I-EXPLORATION +estenosis I-EXPLORATION +en I-EXPLORATION +3a I-EXPLORATION +porción I-EXPLORATION +duodenal. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +resultados I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +EGD I-EXPLORATION +baritado I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +3 I-EXPLORATION +estenosis I-EXPLORATION +lisas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +regulares, I-EXPLORATION +en I-EXPLORATION +segunda-tercera I-EXPLORATION +porción I-EXPLORATION +duodenal, I-EXPLORATION +con I-EXPLORATION +paso I-EXPLORATION +dificultoso I-EXPLORATION +de I-EXPLORATION +contraste, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +diafragmas. I-EXPLORATION + I-EXPLORATION +Dado B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +hallazgos, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +rehistorió I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +comentó I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +tenido I-PAST_MEDICAL_HISTORY +saciedad I-PAST_MEDICAL_HISTORY +precoz I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +digestiones I-PAST_MEDICAL_HISTORY +lentas, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +persona I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +delgada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +talla I-PAST_MEDICAL_HISTORY +corta. I-PAST_MEDICAL_HISTORY +Se B-TREATMENT +realizó I-TREATMENT +gastroenteroanastomosis I-TREATMENT +en I-TREATMENT +Y I-TREATMENT +Roux. I-TREATMENT + I-TREATMENT + +Presentamos B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +77 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +paquetes/año, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +sólidos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +líquidos I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +endoscopia I-EXPLORATION +detecta I-EXPLORATION +una I-EXPLORATION +neoformación I-EXPLORATION +exofítica I-EXPLORATION +en I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +esófago I-EXPLORATION +de I-EXPLORATION +seis I-EXPLORATION +centímetros I-EXPLORATION +que I-EXPLORATION +provoca I-EXPLORATION +estenosis I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz. I-EXPLORATION +El I-EXPLORATION +escáner I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +esofágica I-EXPLORATION +sin I-EXPLORATION +extensión I-EXPLORATION +local I-EXPLORATION +ni I-EXPLORATION +a I-EXPLORATION +distancia. I-EXPLORATION +La I-EXPLORATION +broncoscopia I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +malignidad I-EXPLORATION +descartando I-EXPLORATION +así I-EXPLORATION +invasión I-EXPLORATION +del I-EXPLORATION +árbol I-EXPLORATION +respiratorio. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +fusiformes I-EXPLORATION +mesenquimales I-EXPLORATION +dispuestas I-EXPLORATION +en I-EXPLORATION +haces, I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vascularización I-EXPLORATION +y I-EXPLORATION +elevado I-EXPLORATION +índice I-EXPLORATION +mitótico I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +abundante I-EXPLORATION +necrosis. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +inmunohistoquímico I-EXPLORATION +es I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +desmina, I-EXPLORATION +proteína I-EXPLORATION +S-100, I-EXPLORATION +c-kit I-EXPLORATION +y I-EXPLORATION +citoqueratina I-EXPLORATION +C117 I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +para I-EXPLORATION +las I-EXPLORATION +citoqueratinas I-EXPLORATION +AE1/AE3, I-EXPLORATION +CAM5, I-EXPLORATION +2 I-EXPLORATION +y I-EXPLORATION +5/6. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +lo I-EXPLORATION +tanto, I-EXPLORATION +concluíamos I-EXPLORATION +que I-EXPLORATION +nuestro I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +mesenquimal I-EXPLORATION +maligno I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +sarcoma I-EXPLORATION +pobremente I-EXPLORATION +diferenciado. I-EXPLORATION +Fue B-TREATMENT +valorado I-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +y I-TREATMENT +oncológico, I-TREATMENT +desestimando I-TREATMENT +los I-TREATMENT +mismos I-TREATMENT +por I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +su I-TREATMENT +estado I-TREATMENT +general, I-TREATMENT +con I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +endoprótesis. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +79 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +artritis I-PRESENT_ILLNESS +metacarpofalángica, I-PRESENT_ILLNESS +recibe I-PRESENT_ILLNESS +amoxilicina-clavulánico I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +ciprofloxacino I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +finalización I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +antibiótico, I-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +diarreicas I-PRESENT_ILLNESS +acuosas I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +patológicos I-PRESENT_ILLNESS +(tanto I-PRESENT_ILLNESS +diurnas I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +nocturnas), I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +oC, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +decaimiento I-PRESENT_ILLNESS +progresivo. I-PRESENT_ILLNESS +Acude B-EVOLUTION +en I-EVOLUTION +varias I-EVOLUTION +ocasiones I-EVOLUTION +al I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencias, I-EVOLUTION +realizándose I-EVOLUTION +coprocultivos I-EVOLUTION +y I-EVOLUTION +determinación I-EVOLUTION +de I-EVOLUTION +toxina I-EVOLUTION +de I-EVOLUTION +Clostridium I-EVOLUTION +difficile I-EVOLUTION +que I-EVOLUTION +resultan I-EVOLUTION +negativos I-EVOLUTION +con I-EVOLUTION +posterior I-EVOLUTION +alta I-EVOLUTION +por I-EVOLUTION +mejoría I-EVOLUTION +tras I-EVOLUTION +medidas I-EVOLUTION +astringentes I-EVOLUTION +(aunque I-EVOLUTION +sin I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +cuadro). I-EVOLUTION +Una I-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +reingresa I-EVOLUTION +por I-EVOLUTION +continuar I-EVOLUTION +con I-EVOLUTION +abundantes I-EVOLUTION +diarreas I-EVOLUTION +acuosas, I-EVOLUTION +dolor I-EVOLUTION +abdominal, I-EVOLUTION +febrícula I-EVOLUTION +y I-EVOLUTION +decaimiento. I-EVOLUTION +Analíticamente B-EXPLORATION +solo I-EXPLORATION +destaca I-EXPLORATION +una I-EXPLORATION +ligera I-EXPLORATION +anemia I-EXPLORATION +normocítica I-EXPLORATION +normocrómica. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +realizada I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +úlceras I-EXPLORATION +de I-EXPLORATION +diferentes I-EXPLORATION +tamaños I-EXPLORATION +y I-EXPLORATION +profundidad, I-EXPLORATION +con I-EXPLORATION +fondo I-EXPLORATION +blanquecino I-EXPLORATION +y I-EXPLORATION +halo I-EXPLORATION +enrojecido, I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa I-EXPLORATION +hasta I-EXPLORATION +colon I-EXPLORATION +ascendente. I-EXPLORATION +Las I-EXPLORATION +biopsias I-EXPLORATION +confirmaron I-EXPLORATION +el I-EXPLORATION +diagnóstico. I-EXPLORATION +Se I-EXPLORATION +extrajeron I-EXPLORATION +hemocultivos I-EXPLORATION +por I-EXPLORATION +fiebre I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Clostridium I-EXPLORATION +ramosum. I-EXPLORATION +Tras B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +endoscópica, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +metronidazol, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +posterior. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +periumbilical, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ausencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +expulsión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +heces I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +deshidratación I-EXPLORATION +cutáneo-mucosa I-EXPLORATION +importante I-EXPLORATION +y I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +12.100/mm3. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +con I-EXPLORATION +niveles I-EXPLORATION +hidroaéreos I-EXPLORATION +y I-EXPLORATION +neumoperitoneo. I-EXPLORATION +Un I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +confirmó I-EXPLORATION +los I-EXPLORATION +hallazgos, I-EXPLORATION +y I-EXPLORATION +mostró I-EXPLORATION +aerobilia, I-EXPLORATION +un I-EXPLORATION +cálculo I-EXPLORATION +impactado I-EXPLORATION +en I-EXPLORATION +yeyuno I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +fístula I-EXPLORATION +colecisto-duodenal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +laparotomía I-EXPLORATION +urgente I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +cálculo I-EXPLORATION +intraluminal I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +localizado I-EXPLORATION +a I-EXPLORATION +100 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +de I-EXPLORATION +Treitz I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +perforación I-EXPLORATION +puntiforme I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +borde I-EXPLORATION +mesentérico I-EXPLORATION +a I-EXPLORATION +40 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +de I-EXPLORATION +Treitz. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +enterotomía, I-TREATMENT +extracción I-TREATMENT +del I-TREATMENT +cálculo I-TREATMENT +y I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +intestino I-TREATMENT +perforado. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +recuperó I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +perforación I-EXPLORATION +intestinal, I-EXPLORATION +con I-EXPLORATION +material I-EXPLORATION +necrótico I-EXPLORATION +y I-EXPLORATION +restos I-EXPLORATION +alimenticios I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +divertículos I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +proximidades I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +perforación. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +rectorragia I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +finalizar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +deposición; I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +niega I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +acompañante, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hábito I-PRESENT_ILLNESS +intestinal, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +es I-EXPLORATION +normal I-EXPLORATION +salvo I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +hemorroides I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +rectal. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +tanto I-EXPLORATION +la I-EXPLORATION +hematimetría I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +son I-EXPLORATION +estrictamente I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +solicita I-TREATMENT +una I-TREATMENT +colonoscopia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +observa I-TREATMENT +pólipo I-TREATMENT +submucoso I-TREATMENT +que I-TREATMENT +se I-TREATMENT +extirpa I-TREATMENT +y I-TREATMENT +hemorroides I-TREATMENT +internas. I-TREATMENT +La B-EXPLORATION +histopatología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +extirpada I-EXPLORATION +dio I-EXPLORATION +como I-EXPLORATION +resultado I-EXPLORATION +granuloma I-EXPLORATION +eosinofílico I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +parásito I-EXPLORATION +Anisakis. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +junio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2010 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hepatitis I-PRESENT_ILLNESS +aguda I-PRESENT_ILLNESS +colestásica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +probable I-PRESENT_ILLNESS +origen I-PRESENT_ILLNESS +etílico. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esquizofrenia I-PAST_MEDICAL_HISTORY +paranoide I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +olanzapina I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg/24 I-PAST_MEDICAL_HISTORY +h I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +11 I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY +Aunque B-EXPLORATION +la I-EXPLORATION +evolución I-EXPLORATION +inicial I-EXPLORATION +del I-EXPLORATION +cuadro I-EXPLORATION +clínico I-EXPLORATION +era I-EXPLORATION +favorable, I-EXPLORATION +con I-EXPLORATION +normalización I-EXPLORATION +paulatina I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +(bilirrubina I-EXPLORATION +y I-EXPLORATION +coagulación), I-EXPLORATION +cada I-EXPLORATION +vez I-EXPLORATION +estaba I-EXPLORATION +más I-EXPLORATION +acentuada I-EXPLORATION +la I-EXPLORATION +citolisis. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +completo I-EXPLORATION +(virus, I-EXPLORATION +autoanticuerpos, I-EXPLORATION +fármacos, I-EXPLORATION +etc.) I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Al B-TREATMENT +haber I-TREATMENT +casos I-TREATMENT +descritos I-TREATMENT +en I-TREATMENT +la I-TREATMENT +literatura I-TREATMENT +de I-TREATMENT +hepatotoxicidad I-TREATMENT +a I-TREATMENT +olanzapina, I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +el I-TREATMENT +fármaco I-TREATMENT +y I-TREATMENT +se I-TREATMENT +sustituye I-TREATMENT +por I-TREATMENT +haloperidol, I-TREATMENT +existiendo I-TREATMENT +mejoría I-TREATMENT +evidente I-TREATMENT +de I-TREATMENT +la I-TREATMENT +citolisis I-TREATMENT +hasta B-EVOLUTION +su I-EVOLUTION +total I-EVOLUTION +normalización. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +enólico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +cardiopulmonares I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +encefalopatía I-PRESENT_ILLNESS +hepática I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +estreñimiento. I-PRESENT_ILLNESS +En B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +radiopaca, I-EXPLORATION +redondeada I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +regulares I-EXPLORATION +en I-EXPLORATION +hemitórax I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +existía I-EXPLORATION +en I-EXPLORATION +controles I-EXPLORATION +previos I-EXPLORATION +iniciándose I-EXPLORATION +tratamiento I-EXPLORATION +antibiótico I-EXPLORATION +empírico I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +neumonía. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +torácica I-EXPLORATION +la I-EXPLORATION +colección I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +lisos I-EXPLORATION +y I-EXPLORATION +regulares I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +contenido I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +"agua" I-EXPLORATION +planteándose I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +ascitis I-EXPLORATION +intratorácica I-EXPLORATION +loculada. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +mejoró I-EVOLUTION +rápidamente I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +síntomas, I-EVOLUTION +pero I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +persistía I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +anteriormente I-EVOLUTION +descrita, I-EVOLUTION +la I-EVOLUTION +cual I-EVOLUTION +desapareció I-EVOLUTION +al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +con B-TREATMENT +terapia I-TREATMENT +diurética. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos. I-PAST_MEDICAL_HISTORY +Presenta B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +brusca, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +biliosos I-PRESENT_ILLNESS +incoercibles I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +profusa. I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +rectorragia I-PRESENT_ILLNESS +abundante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sangre I-PRESENT_ILLNESS +fresca I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +coágulos, I-PRESENT_ILLNESS +emisión I-PRESENT_ILLNESS +independiente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +alivio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +destacado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +extranjero I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +misión I-PRESENT_ILLNESS +militar I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +realizado I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +centrales I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +alta I-PRESENT_ILLNESS +temperatura I-PRESENT_ILLNESS +ambiente, I-PRESENT_ILLNESS +sesiones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +entrenamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +musculación I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carrera I-PRESENT_ILLNESS +continua. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +clínica, I-PRESENT_ILLNESS +además, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +entrenamiento I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +inmediatamente I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +copiosa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alimento. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +trasladado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +local I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +febrícula, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +objetivó I-PRESENT_ILLNESS +"leucocitosis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +elevación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +creatinina" I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +colonoscopia I-PRESENT_ILLNESS +cuyo I-PRESENT_ILLNESS +informe I-PRESENT_ILLNESS +refleja I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +cantidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sangre I-PRESENT_ILLNESS +intraluminal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mucosa I-PRESENT_ILLNESS +intensamente I-PRESENT_ILLNESS +edematosa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +sigma I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +impide I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +endoscopio. I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +mantenido I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +observación I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dieta I-PRESENT_ILLNESS +absoluta, I-PRESENT_ILLNESS +sueroterapia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ciprofloxacino I-PRESENT_ILLNESS +intravenoso. I-PRESENT_ILLNESS +Ante B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +persistencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +aparición I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +somnolencia I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +palidez I-DERIVED_FROM/TO +cérea, I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +médicos I-DERIVED_FROM/TO +militares I-DERIVED_FROM/TO +españoles I-DERIVED_FROM/TO +encargados I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +solicitaron I-DERIVED_FROM/TO +evacuación I-DERIVED_FROM/TO +aérea I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-EXPLORATION +su I-EXPLORATION +llegada, I-EXPLORATION +48 I-EXPLORATION +horas I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +inicio I-EXPLORATION +del I-EXPLORATION +cuadro, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +hipertenso, I-EXPLORATION +taquicárdico, I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +saturación I-EXPLORATION +basal I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +y I-EXPLORATION +febrícula. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +blando, I-EXPLORATION +discretamente I-EXPLORATION +distendido I-EXPLORATION +y I-EXPLORATION +timpánico, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +(superficial I-EXPLORATION +y I-EXPLORATION +profunda) I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa, I-EXPLORATION +con I-EXPLORATION +contractura I-EXPLORATION +voluntaria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +musculatura, I-EXPLORATION +sin I-EXPLORATION +claros I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +y I-EXPLORATION +ruidos I-EXPLORATION +hidroaéreos I-EXPLORATION +presentes. I-EXPLORATION +Al I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +el I-EXPLORATION +dedil I-EXPLORATION +mostraba I-EXPLORATION +restos I-EXPLORATION +hemáticos I-EXPLORATION +frescos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +analítica I-EXPLORATION +completa I-EXPLORATION +con I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +26.010 I-EXPLORATION +células I-EXPLORATION +(85% I-EXPLORATION +neutrófilos) I-EXPLORATION +y I-EXPLORATION +glucosa I-EXPLORATION +146 I-EXPLORATION +mg/dl I-EXPLORATION +como I-EXPLORATION +únicos I-EXPLORATION +hallazgos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +abdominopélvica I-EXPLORATION +(sin I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +intravenoso) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +halló I-EXPLORATION +una I-EXPLORATION +marcada I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared, I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +grasa I-EXPLORATION +pericólica, I-EXPLORATION +gran I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +intraabdominal I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +ganglios I-EXPLORATION +mesentéricos I-EXPLORATION +menores I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm. I-EXPLORATION +Se I-EXPLORATION +descartaron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +perforación I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +defectos I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +vasculares. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +urgente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +solo I-EXPLORATION +pudieron I-EXPLORATION +introducirse I-EXPLORATION +100 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +endoscopio I-EXPLORATION +debido I-EXPLORATION +al I-EXPLORATION +alto I-EXPLORATION +riesgo I-EXPLORATION +de I-EXPLORATION +perforación, I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +ulceraciones I-EXPLORATION +geográficas I-EXPLORATION +profundas I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +rectosigma I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +edematosa I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +hematoma I-EXPLORATION +submucoso, I-EXPLORATION +más I-EXPLORATION +intensas I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +regiones I-EXPLORATION +proximales I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +pseudotumoral I-EXPLORATION +(que I-EXPLORATION +se I-EXPLORATION +biopsiaron). I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +endoscópico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +colitis I-EXPLORATION +isquémica, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +posteriormente I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +anatomopatológicos. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +enfermo I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +con B-TREATMENT +tratamiento I-TREATMENT +conservador I-TREATMENT +con I-TREATMENT +dieta I-TREATMENT +absoluta, I-TREATMENT +nutrición I-TREATMENT +parenteral, I-TREATMENT +-antibioterapia I-TREATMENT +intravenosa, I-TREATMENT +analgesia I-TREATMENT +y I-TREATMENT +corticoterapia I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +bajas. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +colonoscopia I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +12 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +persistían I-EXPLORATION +las I-EXPLORATION +alteraciones I-EXPLORATION +anteriormente I-EXPLORATION +descritas. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +alteraciones I-EXPLORATION +vasculares I-EXPLORATION +en I-EXPLORATION +angio-TC. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +inmunológicos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +hipercoagulabilidad I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +focos I-EXPLORATION +trombóticos. I-EXPLORATION +Los I-EXPLORATION +coprocultivos I-EXPLORATION +fueron I-EXPLORATION +reiteradamente I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +asimismo I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +inflamatoria I-EXPLORATION +intestinal I-EXPLORATION +por I-EXPLORATION +histología I-EXPLORATION +no I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +dicha I-EXPLORATION +patología. I-EXPLORATION +El B-EVOLUTION +enfermo I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +asintomático I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +29 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +ingreso. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +colonoscopia I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +6 I-EXPLORATION +semanas I-EXPLORATION +del I-EXPLORATION +alta, I-EXPLORATION +que I-EXPLORATION +constató I-EXPLORATION +restitución I-EXPLORATION +ad I-EXPLORATION +integrum I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa. I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +descartar I-EXPLORATION +otra I-EXPLORATION +etiología, I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +del I-EXPLORATION +cuadro I-EXPLORATION +fue I-EXPLORATION +un I-EXPLORATION +secuestro I-EXPLORATION +vascular I-EXPLORATION +producido I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +demandas I-EXPLORATION +sanguíneas I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +ejercicio I-EXPLORATION +intenso I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +día I-EXPLORATION +caluroso, I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +gran I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +gasto I-EXPLORATION +cardiaco I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +territorio I-EXPLORATION +mesentérico. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +hiporexia, I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +cutánea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +conjuntival, I-PRESENT_ILLNESS +orinas I-PRESENT_ILLNESS +colúricas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +heces I-PRESENT_ILLNESS +hipocólicas. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +urgente I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +citolisis I-EXPLORATION +(GOT I-EXPLORATION +1720 I-EXPLORATION +UI/dl, I-EXPLORATION +GPT I-EXPLORATION +2660 I-EXPLORATION +UI/dl), I-EXPLORATION +hiperbilirrubinemia I-EXPLORATION +(bilirrubina I-EXPLORATION +total I-EXPLORATION +20, I-EXPLORATION +94 I-EXPLORATION +mg/dl) I-EXPLORATION +y I-EXPLORATION +coagulopatía I-EXPLORATION +(actividad I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +45%, I-EXPLORATION +INR I-EXPLORATION +1, I-EXPLORATION +79). I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +serologías I-EXPLORATION +virales I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +HBsAg I-EXPLORATION +positivo I-EXPLORATION +con I-EXPLORATION +antiHBc I-EXPLORATION +IgM I-EXPLORATION +positivo I-EXPLORATION +y I-EXPLORATION +AgHBe I-EXPLORATION +positivo. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +del I-EXPLORATION +VHC, I-EXPLORATION +VHD I-EXPLORATION +y I-EXPLORATION +VIH I-EXPLORATION +resultaron I-EXPLORATION +negativas. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +insuficiencia I-TREATMENT +hepática I-TREATMENT +aguda I-TREATMENT +grave, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +instaurar I-TREATMENT +tratamiento I-TREATMENT +específico I-TREATMENT +para I-TREATMENT +la I-TREATMENT +hepatitis I-TREATMENT +aguda I-TREATMENT +por I-TREATMENT +VHB I-TREATMENT +con I-TREATMENT +tenofovir I-TREATMENT +245 I-TREATMENT +mg/24 I-TREATMENT +horas I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +día I-TREATMENT +1 I-TREATMENT +de I-TREATMENT +ingreso I-TREATMENT +hospitalario. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +ingresado I-EVOLUTION +durante I-EVOLUTION +14 I-EVOLUTION +días, I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +encefalopatía I-EVOLUTION +hepática I-EVOLUTION +ni I-EVOLUTION +signos I-EVOLUTION +externos I-EVOLUTION +de I-EVOLUTION +sangrado I-EVOLUTION +en I-EVOLUTION +ningún I-EVOLUTION +momento, I-EVOLUTION +mejorando I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +analíticas I-EVOLUTION +a I-EVOLUTION +partir I-EVOLUTION +del I-EVOLUTION +día I-EVOLUTION ++7 I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antiviral. I-EVOLUTION +Posteriormente, B-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +continuó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tenofovir I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +ambulatoria, I-TREATMENT +produciéndose I-TREATMENT +la I-TREATMENT +seroconversión I-TREATMENT +antiHBe I-TREATMENT +al I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +negativizando I-TREATMENT +el I-TREATMENT +AgHBs I-TREATMENT +a I-TREATMENT +las I-TREATMENT +8 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT +Tras I-TREATMENT +2 I-TREATMENT +serologías I-TREATMENT +consecutivas I-TREATMENT +AgHBs I-TREATMENT +negativo I-TREATMENT +y I-TREATMENT +antiHBs I-TREATMENT +positivo I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antiviral. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +28 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +seguía I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +hormonal I-PAST_MEDICAL_HISTORY +anticonceptivo I-PAST_MEDICAL_HISTORY +(etonogestrel I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +etinilestradiol) I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +anillo I-PAST_MEDICAL_HISTORY +intravaginal I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +debido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +trastornos I-PAST_MEDICAL_HISTORY +menstruales. I-PAST_MEDICAL_HISTORY + B-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +tiempo I-PRESENT_ILLNESS +desarrolló I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +estreñimiento I-PRESENT_ILLNESS +crónico I-PRESENT_ILLNESS +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +colon I-EXPLORATION +descendente I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +edematosa I-EXPLORATION +y I-EXPLORATION +friable I-EXPLORATION +con I-EXPLORATION +ulceraciones I-EXPLORATION +superficiales I-EXPLORATION +cubiertas I-EXPLORATION +por I-EXPLORATION +fibrina. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +biopsias I-EXPLORATION +mostró I-EXPLORATION +cambios I-EXPLORATION +atróficos I-EXPLORATION +y I-EXPLORATION +regenerativos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +epitelio I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +microtrombos. I-EXPLORATION +El I-EXPLORATION +infiltrado I-EXPLORATION +neutrofílico I-EXPLORATION +era I-EXPLORATION +mínimo, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +importante I-EXPLORATION +edema I-EXPLORATION +submucoso. I-EXPLORATION +Los I-EXPLORATION +cambios I-EXPLORATION +eran I-EXPLORATION +atribuibles I-EXPLORATION +a I-EXPLORATION +isquemia, I-EXPLORATION +aunque I-EXPLORATION +las I-EXPLORATION +causas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +isquemia I-EXPLORATION +estaban I-EXPLORATION +aún I-EXPLORATION +por I-EXPLORATION +determinar. I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +colonoscopia, I-EXPLORATION +se I-EXPLORATION +retiró I-EXPLORATION +el I-EXPLORATION +anillo I-EXPLORATION +vaginal I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +repitió I-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +4 I-EXPLORATION +meses I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +resolución I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones. I-EXPLORATION +El B-TREATMENT +estreñimiento I-TREATMENT +se I-TREATMENT +corrigió I-TREATMENT +con I-TREATMENT +medidas I-TREATMENT +convencionales. I-TREATMENT +Con B-EXPLORATION +la I-EXPLORATION +finalidad I-EXPLORATION +de I-EXPLORATION +excluir I-EXPLORATION +otras I-EXPLORATION +posibles I-EXPLORATION +causas I-EXPLORATION +de I-EXPLORATION +colitis I-EXPLORATION +isquémica, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +analítico, I-EXPLORATION +electrocardiograma, I-EXPLORATION +ecocardiograma I-EXPLORATION +y I-EXPLORATION +angio-TC I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +hipercoagulabilidad I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +S I-EXPLORATION +antigénica I-EXPLORATION +y I-EXPLORATION +anticoagulante. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectaron I-EXPLORATION +el I-EXPLORATION +factor I-EXPLORATION +V I-EXPLORATION +de I-EXPLORATION +Leyden I-EXPLORATION +ni I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +FII I-EXPLORATION +G20210A I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +protrombina. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +familiar I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +padre I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +intermitentes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +melenas. I-PRESENT_ILLNESS +Estudio I-PRESENT_ILLNESS +inicial I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +EDA I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +colonoscopia I-PRESENT_ILLNESS +normal. I-PRESENT_ILLNESS +Ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +melenas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +anemización. I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +de I-EXPLORATION +nuevo I-EXPLORATION +EDA I-EXPLORATION +y I-EXPLORATION +colonoscopia, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +tránsito I-EXPLORATION +intestinal I-EXPLORATION +seguido I-EXPLORATION +de I-EXPLORATION +cápsula I-EXPLORATION +endoscópica I-EXPLORATION +(CE) I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +reseñables. I-EXPLORATION +Ante I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +clínico I-EXPLORATION +de I-EXPLORATION +HDOO I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +angioTAC: I-EXPLORATION +"lesión I-EXPLORATION +sólida I-EXPLORATION +hipercaptante I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +3 I-EXPLORATION +x I-EXPLORATION +4, I-EXPLORATION +4 I-EXPLORATION +x I-EXPLORATION +4, I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +con I-EXPLORATION +crecimiento I-EXPLORATION +exofítico I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +asa I-EXPLORATION +yeyunal, I-EXPLORATION +con I-EXPLORATION +hipertrofia I-EXPLORATION +vascular I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +nutricios I-EXPLORATION +que I-EXPLORATION +drenan I-EXPLORATION +directamente I-EXPLORATION +a I-EXPLORATION +ramas I-EXPLORATION +arteriales I-EXPLORATION +mesentéricas, I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +GIST, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +adenopatías". I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +intervenida: I-TREATMENT +resección I-TREATMENT +segmentaria I-TREATMENT +de I-TREATMENT +yeyuno I-TREATMENT +medio. I-TREATMENT +Estudio B-EXPLORATION +histológico I-EXPLORATION +e I-EXPLORATION +inmunohistoquímico: I-EXPLORATION +GIST I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +malignidad: I-EXPLORATION +tamaño I-EXPLORATION +< I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +< I-EXPLORATION +1 I-EXPLORATION +mitosis/10 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +aumento, I-EXPLORATION +diferenciación I-EXPLORATION +muscular I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +proliferativo I-EXPLORATION +< I-EXPLORATION +1 I-EXPLORATION +%, I-EXPLORATION +medido I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +anticuerpo I-EXPLORATION +monoclonal I-EXPLORATION +KI67. I-EXPLORATION +La B-TREATMENT +resección I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +tumor I-TREATMENT +sin I-TREATMENT +afectación I-TREATMENT +metastásica I-TREATMENT +determina I-TREATMENT +la I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +farmacológico I-TREATMENT +posterior I-TREATMENT +con I-TREATMENT +inhibidores I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tirosin I-TREATMENT +quinasa I-TREATMENT +(imatinib). I-TREATMENT +Tres B-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +EC I-PRESENT_ILLNESS +ileal I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +1978, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +perianal I-PRESENT_ILLNESS +(EPA) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +larga I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +difícil I-PRESENT_ILLNESS +control. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Debido B-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +severidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +EPA, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +observándose I-EXPLORATION +una I-EXPLORATION +abscesificación I-EXPLORATION +del I-EXPLORATION +paquete I-EXPLORATION +adenopático I-EXPLORATION +intraabdominal. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +laparotomía I-TREATMENT +exploradora I-TREATMENT +con I-TREATMENT +biopsia I-TREATMENT +intraoperatoria I-TREATMENT +con I-TREATMENT +histología I-TREATMENT +de I-TREATMENT +adenocarcinoma I-TREATMENT +mucinoso I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +grado, I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +una I-TREATMENT +amputación I-TREATMENT +abdominoperineal I-TREATMENT +amplia I-TREATMENT +con I-TREATMENT +cistoprostatectomía I-TREATMENT +radical I-TREATMENT +por I-TREATMENT +infiltración I-TREATMENT +vesical, I-TREATMENT +no I-TREATMENT +pudiendo I-TREATMENT +resecar I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +obturatriz I-TREATMENT +también I-TREATMENT +infiltrada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +tumor. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +histológica I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado I-EXPLORATION +de I-EXPLORATION +recto I-EXPLORATION +y I-EXPLORATION +periné, I-EXPLORATION +implantado I-EXPLORATION +sobre I-EXPLORATION +fístula I-EXPLORATION +perineal I-EXPLORATION +profunda. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +descartó I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +radioterapia, I-TREATMENT +estando I-TREATMENT +actualmente I-TREATMENT +con I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematoquecia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología. I-PRESENT_ILLNESS +Destaca B-EXPLORATION +hemiabdomen I-EXPLORATION +derecho I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +sin I-EXPLORATION +masas, I-EXPLORATION +anemia I-EXPLORATION +ferropénica I-EXPLORATION +(hemoglobina I-EXPLORATION +6, I-EXPLORATION +6 I-EXPLORATION +g/dl I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +transferrina I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +%) I-EXPLORATION +y I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +gastroscopia I-EXPLORATION +y I-EXPLORATION +colonoscopia I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +lesiones I-EXPLORATION +potencialmente I-EXPLORATION +sangrantes. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +tránsito I-EXPLORATION +gastrointestinal, I-EXPLORATION +un I-EXPLORATION +dudoso I-EXPLORATION +defecto I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +último I-EXPLORATION +asa I-EXPLORATION +ileal. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +cápsula I-EXPLORATION +endoscópica I-EXPLORATION +que I-EXPLORATION +detecta I-EXPLORATION +10 I-EXPLORATION +minutos I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +imagen I-EXPLORATION +del I-EXPLORATION +ciego I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +submucoso I-EXPLORATION +erosionada I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm, I-EXPLORATION +con I-EXPLORATION +sangrado I-EXPLORATION +en I-EXPLORATION +sábana. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +este I-EXPLORATION +hallazgo I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +una I-EXPLORATION +exploración I-EXPLORATION +quirúrgica. I-EXPLORATION +Se I-EXPLORATION +identifica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +a I-EXPLORATION +70 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +ileocecal I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +< I-EXPLORATION +1 I-EXPLORATION +cm, I-EXPLORATION +rosada I-EXPLORATION +sobre I-EXPLORATION +mucosa I-EXPLORATION +pálida; I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +lesiones I-EXPLORATION +ni I-EXPLORATION +adenopatías I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +asas, I-EXPLORATION +mesenterio I-EXPLORATION +y I-EXPLORATION +cavidad I-EXPLORATION +abdominal. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +enterectomía I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +cm I-TREATMENT +con I-TREATMENT +márgenes I-TREATMENT +de I-TREATMENT +seguridad I-TREATMENT +de I-TREATMENT +3 I-TREATMENT +cm I-TREATMENT +y I-TREATMENT +anastomosis I-TREATMENT +término-terminal. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +describe I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +eosinófilas I-EXPLORATION +epitelioides I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +irregular I-EXPLORATION +y I-EXPLORATION +nucléolos I-EXPLORATION +prominentes, I-EXPLORATION +formando I-EXPLORATION +lóbulos I-EXPLORATION +y I-EXPLORATION +pequeñas I-EXPLORATION +luces I-EXPLORATION +vasculares I-EXPLORATION +que I-EXPLORATION +contienen I-EXPLORATION +hematíes. I-EXPLORATION +La I-EXPLORATION +inmunohistoquímica I-EXPLORATION +CD34+ I-EXPLORATION +con I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +Ki67 I-EXPLORATION +del I-EXPLORATION +20 I-EXPLORATION +% I-EXPLORATION +traduce I-EXPLORATION +malignidad I-EXPLORATION +intermedia, I-EXPLORATION +siendo I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +hemangioendotelioma. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +mediante I-EXPLORATION +PET-TAC I-EXPLORATION +no I-EXPLORATION +detectó I-EXPLORATION +captación I-EXPLORATION +patológica. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +remisión I-EVOLUTION +tras I-EVOLUTION +tres I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +76 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +ingresada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cirugía I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +anemia, I-PRESENT_ILLNESS +ascitis, I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +generalizada, I-PRESENT_ILLNESS +neurológicamente I-PRESENT_ILLNESS +estuporosa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +rectal I-PRESENT_ILLNESS +prolapsada I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +irreductible. I-PRESENT_ILLNESS +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +venido I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +diarrea I-PAST_MEDICAL_HISTORY +mucosa, I-PAST_MEDICAL_HISTORY +sangrado I-PAST_MEDICAL_HISTORY +rectal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +prolapso I-PAST_MEDICAL_HISTORY +rectal I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +rectal I-EXPLORATION +prolapsada I-EXPLORATION +e I-EXPLORATION +incarcerada I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +que I-EXPLORATION +secretaba I-EXPLORATION +abundante I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +moco. I-EXPLORATION +Analíticamente I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +anémica I-EXPLORATION +con I-EXPLORATION +hemoglobina I-EXPLORATION +6 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +18 I-EXPLORATION +%, I-EXPLORATION +y I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +insuficiencia I-EXPLORATION +renal I-EXPLORATION +aguda I-EXPLORATION +(urea I-EXPLORATION +158 I-EXPLORATION +mg/dl, I-EXPLORATION +creatinina I-EXPLORATION +1, I-EXPLORATION +94 I-EXPLORATION +mg/dl), I-EXPLORATION +hiponatrémica I-EXPLORATION +e I-EXPLORATION +hipopotasémica I-EXPLORATION +(sodio, I-EXPLORATION +126 I-EXPLORATION +mEq/ I-EXPLORATION +l; I-EXPLORATION +potasio, I-EXPLORATION +2, I-EXPLORATION +6 I-EXPLORATION +mEq/l). I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +urgente I-EXPLORATION +que I-EXPLORATION +informa I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +rectal I-EXPLORATION +prolapsada, I-EXPLORATION +ascitis I-EXPLORATION +y I-EXPLORATION +metástasis I-EXPLORATION +hepáticas I-EXPLORATION +múltiples I-EXPLORATION +algunas I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +necrosadas. I-EXPLORATION +Debido B-TREATMENT +al I-TREATMENT +intenso I-TREATMENT +dolor I-TREATMENT +que I-TREATMENT +le I-TREATMENT +causaba I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +prolapsada I-TREATMENT +y I-TREATMENT +a I-TREATMENT +la I-TREATMENT +profusa I-TREATMENT +mucorrea I-TREATMENT +y I-TREATMENT +rectorragia, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +intervenida I-TREATMENT +quirúrgicamente, I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +corregida I-TREATMENT +la I-TREATMENT +insuficiencia I-TREATMENT +renal, I-TREATMENT +realizándose I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +transanal I-TREATMENT +con I-TREATMENT +carácter I-TREATMENT +paliativo. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +complicaciones I-EVOLUTION +cardiorrespiratorias. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +exfumador, B-PAST_MEDICAL_HISTORY +asintomático, I-PAST_MEDICAL_HISTORY +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +julio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2001 I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +hepatomegalia I-DERIVED_FROM/TO +(de I-DERIVED_FROM/TO +4 I-DERIVED_FROM/TO +cm I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +expensas I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +lóbulo I-DERIVED_FROM/TO +hepático I-DERIVED_FROM/TO +derecho) I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +colestasis I-DERIVED_FROM/TO +disociada I-DERIVED_FROM/TO +-fosfatasa I-DERIVED_FROM/TO +alcalina I-DERIVED_FROM/TO +(FA) I-DERIVED_FROM/TO +873 I-DERIVED_FROM/TO +IU/L I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +gamma-glutaryl I-DERIVED_FROM/TO +transpeptidasa I-DERIVED_FROM/TO +(GGT) I-DERIVED_FROM/TO +637 I-DERIVED_FROM/TO +IU/L- I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +analítica I-DERIVED_FROM/TO +rutinaria. I-DERIVED_FROM/TO +El B-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +parámetros, I-EXPLORATION +incluyendo I-EXPLORATION +ANA I-EXPLORATION +(anticuerpos I-EXPLORATION +antinucleares), I-EXPLORATION +AMA I-EXPLORATION +(anticuerpos I-EXPLORATION +antimitocondriales), I-EXPLORATION +ASMA I-EXPLORATION +(anticuerpos I-EXPLORATION +anti-músculo I-EXPLORATION +liso) I-EXPLORATION +y I-EXPLORATION +LKM I-EXPLORATION +(anticuerpos I-EXPLORATION +anti I-EXPLORATION +anti-antígenos I-EXPLORATION +microsomales I-EXPLORATION +de I-EXPLORATION +hígado I-EXPLORATION +y I-EXPLORATION +riñón), I-EXPLORATION +porfirias, I-EXPLORATION +ceruloplasmina, I-EXPLORATION +alfa-fetoproteína, I-EXPLORATION +beta2-microglobulina, I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +(VHB), I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hepatitis I-EXPLORATION +C I-EXPLORATION +(VHC) I-EXPLORATION +y I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana I-EXPLORATION +(VIH) I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +IgG I-EXPLORATION +1.900 I-EXPLORATION +mg/dl I-EXPLORATION +(690-1400), I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +gammapatía I-EXPLORATION +monoclonal I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +mieloma I-EXPLORATION +tras I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +diátesis I-EXPLORATION +protrombótica I-EXPLORATION +también I-EXPLORATION +resultó I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +ecográfico I-EXPLORATION +no I-EXPLORATION +aportó I-EXPLORATION +datos I-EXPLORATION +relevantes. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +insinuó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +subdiafragmática, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +VIII I-EXPLORATION +y I-EXPLORATION +IV, I-EXPLORATION +de I-EXPLORATION +contorno I-EXPLORATION +mal I-EXPLORATION +definido, I-EXPLORATION +hipodensa, I-EXPLORATION +a I-EXPLORATION +ambos I-EXPLORATION +lados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +suprahepática I-EXPLORATION +media. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +hepática I-EXPLORATION +objetivó I-EXPLORATION +dos I-EXPLORATION +lesiones I-EXPLORATION +hepáticas I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +× I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +× I-EXPLORATION +2 I-EXPLORATION +cm, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +IV-VIII I-EXPLORATION +y I-EXPLORATION +II-III I-EXPLORATION +respectivamente, I-EXPLORATION +que I-EXPLORATION +encajaban I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +suprahepática I-EXPLORATION +media I-EXPLORATION +y I-EXPLORATION +desplazaban I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +suprahepática I-EXPLORATION +derecha, I-EXPLORATION +sin I-EXPLORATION +apreciarse I-EXPLORATION +trombosis I-EXPLORATION +intravascular, I-EXPLORATION +ni I-EXPLORATION +otras I-EXPLORATION +lesiones I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +extrahepática, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +esplenomegalia I-EXPLORATION +e I-EXPLORATION +hipoplasia I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +colangiocarcinoma I-EXPLORATION +y I-EXPLORATION +menos I-EXPLORATION +probablemente I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +hepatocarcinoma I-EXPLORATION +sobre I-EXPLORATION +un I-EXPLORATION +hígado I-EXPLORATION +no I-EXPLORATION +cirrótico, I-EXPLORATION +se I-EXPLORATION +desestimó I-EXPLORATION +la I-EXPLORATION +PAAF I-EXPLORATION +(punción-aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +diagnóstico-terapéutica, I-EXPLORATION +observándose I-EXPLORATION +un I-EXPLORATION +hígado I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +lisa I-EXPLORATION +y I-EXPLORATION +brillante, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +quístico, I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +obtuvieron I-EXPLORATION +biopsias I-EXPLORATION +en I-EXPLORATION +cuña. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +histopatológico I-EXPLORATION +intraoperatorio I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +fibro-inflamatorio I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +agregados I-EXPLORATION +linfoides, I-EXPLORATION +hialinización I-EXPLORATION +vascular, I-EXPLORATION +en I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +microorganismos I-EXPLORATION +y I-EXPLORATION +atipia, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +pseudotumor I-EXPLORATION +inflamatorio I-EXPLORATION +hepático. I-EXPLORATION +Dado B-TREATMENT +que I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +no I-TREATMENT +cumplía I-TREATMENT +criterios I-TREATMENT +de I-TREATMENT +malignidad I-TREATMENT +y I-TREATMENT +dada I-TREATMENT +la I-TREATMENT +alta I-TREATMENT +morbimortalidad I-TREATMENT +asociada, I-TREATMENT +se I-TREATMENT +desestimó I-TREATMENT +su I-TREATMENT +resección I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +y I-TREATMENT +esteroideo, I-TREATMENT +sin I-TREATMENT +respuesta. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +enero I-EVOLUTION +de I-EVOLUTION +2006 I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +alta I-EVOLUTION +autolimitada, I-EVOLUTION +seguido I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +fiebre, I-EVOLUTION +astenia, I-EVOLUTION +hiporexia I-EVOLUTION +y I-EVOLUTION +alteración I-EVOLUTION +del I-EVOLUTION +comportamiento. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +subictericia I-EXPLORATION +cutáneo-mucosa, I-EXPLORATION +bradipsiquia, I-EXPLORATION +flapping I-EXPLORATION +tardío, I-EXPLORATION +hepatomegalia I-EXPLORATION +y I-EXPLORATION +ascitis. I-EXPLORATION +Analíticamente I-EXPLORATION +destacaba I-EXPLORATION +anemia I-EXPLORATION +de I-EXPLORATION +procesos I-EXPLORATION +crónicos I-EXPLORATION +(hemoglobina I-EXPLORATION +9, I-EXPLORATION +1 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +26, I-EXPLORATION +3%, I-EXPLORATION +VCM I-EXPLORATION +95), I-EXPLORATION +ligera I-EXPLORATION +trombopenia I-EXPLORATION +(116.000), I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +4, I-EXPLORATION +3 I-EXPLORATION +mg/dl I-EXPLORATION +(bilirrubina I-EXPLORATION +conjugada: I-EXPLORATION +3, I-EXPLORATION +8 I-EXPLORATION +mg/dl) I-EXPLORATION +GOT I-EXPLORATION +56 I-EXPLORATION +UI/l, I-EXPLORATION +GPT I-EXPLORATION +106 I-EXPLORATION +UI/l, I-EXPLORATION +GGT I-EXPLORATION +335 I-EXPLORATION +UI/l, I-EXPLORATION +FA I-EXPLORATION +700 I-EXPLORATION +UI/l. I-EXPLORATION +Gamma I-EXPLORATION +30, I-EXPLORATION +7% I-EXPLORATION +(10,5-19,5), I-EXPLORATION +leucocitos I-EXPLORATION +7.700 I-EXPLORATION +y I-EXPLORATION +800 I-EXPLORATION +linfocitos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +ascítico I-EXPLORATION +reveló I-EXPLORATION +900 I-EXPLORATION +células I-EXPLORATION +(> I-EXPLORATION +250 I-EXPLORATION +polimorfonucleares/mm3), I-EXPLORATION +albúmina I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +g/dl, I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +0, I-EXPLORATION +6 I-EXPLORATION +g/dl, I-EXPLORATION +GASA I-EXPLORATION +> I-EXPLORATION +1, I-EXPLORATION +1. I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +negativo. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +peritonitis I-TREATMENT +bacteriana I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +(cefalosporina I-TREATMENT +de I-TREATMENT +tercera I-TREATMENT +generación) I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínico-analítica. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +gastroscopia I-TREATMENT +se I-TREATMENT +observaron I-TREATMENT +varices I-TREATMENT +esofágicas I-TREATMENT +grado I-TREATMENT +II/III, I-TREATMENT +iniciándose I-TREATMENT +tratamiento I-TREATMENT +beta-bloqueante. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +RM, I-EXPLORATION +que I-EXPLORATION +describía I-EXPLORATION +un I-EXPLORATION +hígado I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +crónica I-EXPLORATION +y I-EXPLORATION +cómo I-EXPLORATION +el I-EXPLORATION +PTI I-EXPLORATION +comprimía I-EXPLORATION +y I-EXPLORATION +colapsaba I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +trayecto I-EXPLORATION +intrahepático. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +Budd-Chiari I-TREATMENT +subagudo I-TREATMENT +secundario I-TREATMENT +al I-TREATMENT +PTI I-TREATMENT +hepático, I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +TIPS I-TREATMENT +(anastomosis I-TREATMENT +porto-sistémica I-TREATMENT +transyugular I-TREATMENT +tipo I-TREATMENT +Wallstent I-TREATMENT +autoexpandible I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +mm I-TREATMENT +de I-TREATMENT +calibre) I-TREATMENT +con I-TREATMENT +buenos I-TREATMENT +resultados I-TREATMENT +durante I-TREATMENT +los I-TREATMENT +cinco I-TREATMENT +años I-TREATMENT +de I-TREATMENT +seguimiento. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +urente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +epigastrio, I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +saciedad I-PRESENT_ILLNESS +temprana, I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +blandas, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +kg, I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +adinamia. I-PRESENT_ILLNESS +Dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +hospitalario I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematemesis. I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sífilis I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +ingreso I-EXPLORATION +hospitalario I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +en I-EXPLORATION +anasarca I-EXPLORATION +y I-EXPLORATION +palidez I-EXPLORATION +mucocutánea. I-EXPLORATION +Se I-EXPLORATION +objetivó I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +epigastrio, I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +ni I-EXPLORATION +visceromegalias, I-EXPLORATION +con I-EXPLORATION +onda I-EXPLORATION +ascítica. I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +máculas I-EXPLORATION +violáceas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +paladar I-EXPLORATION +duro, I-EXPLORATION +el I-EXPLORATION +piso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +glande I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +vascular, I-EXPLORATION +no I-EXPLORATION +sangrantes, I-EXPLORATION +con I-EXPLORATION +laceración I-EXPLORATION +del I-EXPLORATION +surco I-EXPLORATION +balano-prepucial I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +grado I-EXPLORATION +II I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +miembros I-EXPLORATION +inferiores. I-EXPLORATION +Se I-EXPLORATION +documentó I-EXPLORATION +VIH I-EXPLORATION +positivo I-EXPLORATION +por I-EXPLORATION +ELISA, I-EXPLORATION +confirmado I-EXPLORATION +por I-EXPLORATION +Western I-EXPLORATION +Blot, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +hipoproteinemia I-EXPLORATION +sin I-EXPLORATION +etiología I-EXPLORATION +clara; I-EXPLORATION +se I-EXPLORATION +descartaron I-EXPLORATION +causas I-EXPLORATION +cardiacas, I-EXPLORATION +hepáticas, I-EXPLORATION +renales I-EXPLORATION +o I-EXPLORATION +nutricionales. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +abdominal I-EXPLORATION +contrastada I-EXPLORATION +reportó I-EXPLORATION +engrosamiento I-EXPLORATION +polipoide I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +gástricas I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +extensa I-EXPLORATION +lesión I-EXPLORATION +gástrica I-EXPLORATION +difusa I-EXPLORATION +multinodular I-EXPLORATION +y I-EXPLORATION +exofítica, I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuerpo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +fondo. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +gástrica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +marcada I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +foveolares, I-EXPLORATION +formando I-EXPLORATION +invaginaciones I-EXPLORATION +profundas I-EXPLORATION +y I-EXPLORATION +reemplazando I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +oxíntica I-EXPLORATION +original. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lámina I-EXPLORATION +propia I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +SK I-EXPLORATION +confirmado I-EXPLORATION +con I-EXPLORATION +inmunomarcación I-EXPLORATION +para I-EXPLORATION +herpes I-EXPLORATION +virus I-EXPLORATION +humano I-EXPLORATION +tipo I-EXPLORATION +8 I-EXPLORATION +(HHV8). I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +antirretroviral I-TREATMENT +y I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +para I-TREATMENT +ulterior I-TREATMENT +inicio I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +antraciclinas. I-TREATMENT + I-TREATMENT + +Los B-PRESENT_ILLNESS +autores I-PRESENT_ILLNESS +presentan I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +insuficiente B-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónico I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemodiálisis, I-PAST_MEDICAL_HISTORY +referenciado B-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +realización I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cápsula I-DERIVED_FROM/TO +endoscópica I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +hemorragia I-DERIVED_FROM/TO +gastrointestinal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +causa I-DERIVED_FROM/TO +oscura, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +necesidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +transfusión I-DERIVED_FROM/TO +sanguínea, I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +esclarecida I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +gastroscopia I-DERIVED_FROM/TO +o I-DERIVED_FROM/TO +colonoscopia. I-DERIVED_FROM/TO +Se B-EXPLORATION +usó I-EXPLORATION +una I-EXPLORATION +cápsula I-EXPLORATION +PillCam I-EXPLORATION +SB I-EXPLORATION +(Given I-EXPLORATION +Imaging, I-EXPLORATION +Israel). I-EXPLORATION +La I-EXPLORATION +ingesta I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +fue I-EXPLORATION +presenciada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +médico. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +tuvo I-EVOLUTION +dificultad I-EVOLUTION +en I-EVOLUTION +iniciar I-EVOLUTION +la I-EVOLUTION +deglución, I-EVOLUTION +con I-EVOLUTION +varias I-EVOLUTION +tentativas I-EVOLUTION +sin I-EVOLUTION +éxito. I-EVOLUTION +Súbitamente I-EVOLUTION +desarrolló I-EVOLUTION +una I-EVOLUTION +crisis I-EVOLUTION +de I-EVOLUTION +tos I-EVOLUTION +vigorosa I-EVOLUTION +que I-EVOLUTION +revertió I-EVOLUTION +espontáneamente I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +algunos I-EVOLUTION +minutos, I-EVOLUTION +sin I-EVOLUTION +recurrencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +respiratoria. I-EVOLUTION +El B-EXPLORATION +grabador I-EXPLORATION +de I-EXPLORATION +datos I-EXPLORATION +fue I-EXPLORATION +recuperado I-EXPLORATION +agotada I-EXPLORATION +la I-EXPLORATION +duración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +batería I-EXPLORATION +(9 I-EXPLORATION +h) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +fue I-EXPLORATION +interpretado I-EXPLORATION +al I-EXPLORATION +día I-EXPLORATION +siguiente. I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +que, I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +periodo I-EXPLORATION +de I-EXPLORATION +permanencia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +oral I-EXPLORATION +de I-EXPLORATION +75 I-EXPLORATION +segundos, I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +transitó I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +aérea, I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +típica I-EXPLORATION +estructura I-EXPLORATION +anular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tráquea I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +bifurcación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +bronquios I-EXPLORATION +principales. I-EXPLORATION +Después I-EXPLORATION +de I-EXPLORATION +cerca I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +minutos I-EXPLORATION +de I-EXPLORATION +inactividad, I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +transmite I-EXPLORATION +imágenes I-EXPLORATION +del I-EXPLORATION +esófago. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tubo I-EXPLORATION +digestivo, I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +sigue I-EXPLORATION +el I-EXPLORATION +trayecto I-EXPLORATION +habitual, I-EXPLORATION +alcanzando I-EXPLORATION +el I-EXPLORATION +ciego I-EXPLORATION +transcurridas I-EXPLORATION +7 I-EXPLORATION +h I-EXPLORATION +28 I-EXPLORATION +m. I-EXPLORATION +Se I-EXPLORATION +identificaron I-EXPLORATION +abundantes I-EXPLORATION +angiodisplasias I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +intestino I-EXPLORATION +delgado, I-EXPLORATION +probable I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hemorragia I-EXPLORATION +gastrointestinal I-EXPLORATION +en I-EXPLORATION +este I-EXPLORATION +paciente. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +valvulopatía I-PAST_MEDICAL_HISTORY +mitral, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular, I-PAST_MEDICAL_HISTORY +estudiada B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +anemia I-PRESENT_ILLNESS +ferropénica. I-PRESENT_ILLNESS +La B-EXPLORATION +colonoscopia I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +vegetante I-EXPLORATION +polilobulada, I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +el I-EXPLORATION +60-70 I-EXPLORATION +% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +cecal, I-EXPLORATION +con I-EXPLORATION +resultado I-EXPLORATION +histopatológico I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +marcado I-EXPLORATION +estrechamiento I-EXPLORATION +cecal I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +8 I-EXPLORATION +x I-EXPLORATION +4, I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +3, I-EXPLORATION +7 I-EXPLORATION +cm, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +obstrucción. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +paravertebral I-EXPLORATION +derecha, I-EXPLORATION +entre I-EXPLORATION +D1-D2, I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +en I-EXPLORATION +reloj I-EXPLORATION +de I-EXPLORATION +arena I-EXPLORATION +de I-EXPLORATION +22 I-EXPLORATION +x I-EXPLORATION +29 I-EXPLORATION +x I-EXPLORATION +21mm, I-EXPLORATION +que I-EXPLORATION +crecía I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +espinal, I-EXPLORATION +ensanchando I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +intervertebral. I-EXPLORATION +Mediante I-EXPLORATION +PAAF-USE, I-EXPLORATION +se I-EXPLORATION +accedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +esófago, I-EXPLORATION +observando I-EXPLORATION +en I-EXPLORATION +disposición I-EXPLORATION +para-espinal I-EXPLORATION +derecha I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +redondeada I-EXPLORATION +de I-EXPLORATION +30 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +hiperecogénica I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +ecogenicidad I-EXPLORATION +grasa, I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +3 I-EXPLORATION +pases I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +de I-EXPLORATION +25-gauge I-EXPLORATION +(ECHO-25-HD I-EXPLORATION +Cook©). I-EXPLORATION +La I-EXPLORATION +punción I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +sin I-EXPLORATION +jeringa I-EXPLORATION +de I-EXPLORATION +aspiración, I-EXPLORATION +mediante I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +retirada I-EXPLORATION +lenta I-EXPLORATION +del I-EXPLORATION +estilete I-EXPLORATION +y I-EXPLORATION +movimientos I-EXPLORATION +de I-EXPLORATION +entrada-salida, I-EXPLORATION +con I-EXPLORATION +patólogo I-EXPLORATION +in I-EXPLORATION +situ, I-EXPLORATION +obteniéndose I-EXPLORATION +material I-EXPLORATION +suficiente I-EXPLORATION +para I-EXPLORATION +establecer I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +meningioma I-EXPLORATION +(inmunorreactividad I-EXPLORATION +intensa I-EXPLORATION +para I-EXPLORATION +receptores I-EXPLORATION +progesterona; I-EXPLORATION +TTF-1 I-EXPLORATION +y I-EXPLORATION +CK I-EXPLORATION +AE3-AE1 I-EXPLORATION +negativas) I-EXPLORATION +(parte I-EXPLORATION +inferior I-EXPLORATION +Fig. I-EXPLORATION +1), I-EXPLORATION +apreciándose I-EXPLORATION +células I-EXPLORATION +redondas I-EXPLORATION +de I-EXPLORATION +mediano I-EXPLORATION +tamaño, I-EXPLORATION +sin I-EXPLORATION +atipia I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +modificaciones I-EXPLORATION +nucleares I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +pseudoinclusiones I-EXPLORATION +y I-EXPLORATION +cuerpos I-EXPLORATION +de I-EXPLORATION +psammoma, I-EXPLORATION +que I-EXPLORATION +formaban I-EXPLORATION +estructuras I-EXPLORATION +lobuladas I-EXPLORATION +rodeadas I-EXPLORATION +por I-EXPLORATION +tabiques I-EXPLORATION +de I-EXPLORATION +colágeno. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +hemicolectomía I-TREATMENT +derecha I-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +adenocarcinoma I-TREATMENT +de I-TREATMENT +ciego, I-TREATMENT +sin I-TREATMENT +afectación I-TREATMENT +en I-TREATMENT +los I-TREATMENT +11 I-TREATMENT +ganglios I-TREATMENT +resecados, I-TREATMENT +ni I-TREATMENT +factores I-TREATMENT +de I-TREATMENT +riesgo I-TREATMENT +(pT2 I-TREATMENT +pN0 I-TREATMENT +Mx). I-TREATMENT +Se B-EVOLUTION +recomendó I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +revisiones, I-EVOLUTION +no I-EVOLUTION +hallándose, I-EVOLUTION +cumplidos I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +recaída I-EVOLUTION +local I-EVOLUTION +o I-EVOLUTION +a I-EVOLUTION +distancia. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +procedente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Marruecos I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colecistectomía, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos, I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +sexual. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +picos I-PRESENT_ILLNESS +febriles I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +oC, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +epigastrio, I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disfagia. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presentaba I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +abdominal, I-EXPLORATION +focalizado I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal, I-EXPLORATION +tinte I-EXPLORATION +ictérico, I-EXPLORATION +y I-EXPLORATION +muguet I-EXPLORATION +oral. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +anamnesis I-EXPLORATION +y I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destacaban I-EXPLORATION +hemoglobina I-EXPLORATION +10, I-EXPLORATION +9 I-EXPLORATION +g/dl, I-EXPLORATION +VCM I-EXPLORATION +82 I-EXPLORATION +fl, I-EXPLORATION +leucocitos I-EXPLORATION +2.300 I-EXPLORATION +cél/μl, I-EXPLORATION +58, I-EXPLORATION +3% I-EXPLORATION +de I-EXPLORATION +neutrófilos, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +0, I-EXPLORATION +1 I-EXPLORATION +mg/dl, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +1, I-EXPLORATION +44 I-EXPLORATION +mg/dl, I-EXPLORATION +FA I-EXPLORATION +663 I-EXPLORATION +U/l, I-EXPLORATION +GGT I-EXPLORATION +185 I-EXPLORATION +U/l, I-EXPLORATION +GOT I-EXPLORATION +231U/l, I-EXPLORATION +GPT I-EXPLORATION +156 I-EXPLORATION +U/l; I-EXPLORATION +gammaglobulinas I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +04 I-EXPLORATION +g/dl, I-EXPLORATION +Ig I-EXPLORATION +A I-EXPLORATION +553 I-EXPLORATION +mg/dl, I-EXPLORATION +Ig I-EXPLORATION +G I-EXPLORATION +2400 I-EXPLORATION +mg/dl I-EXPLORATION +e I-EXPLORATION +IgM I-EXPLORATION +62 I-EXPLORATION +mg/dl; I-EXPLORATION +autoanticuerpos I-EXPLORATION +anticitoplasma I-EXPLORATION +de I-EXPLORATION +neutrófilo I-EXPLORATION +perinucleares I-EXPLORATION +(p-ANCA) I-EXPLORATION +positivos I-EXPLORATION +1: I-EXPLORATION +320 I-EXPLORATION +U/l I-EXPLORATION +patrón I-EXPLORATION +atípico, I-EXPLORATION +y I-EXPLORATION +antimúsculo I-EXPLORATION +liso I-EXPLORATION +(SMA) I-EXPLORATION +positivos I-EXPLORATION +1: I-EXPLORATION +320 I-EXPLORATION +U/l. I-EXPLORATION +Autoanticuerpos I-EXPLORATION +anticitoplasma I-EXPLORATION +de I-EXPLORATION +neutrófilo I-EXPLORATION +citoplasmáticos I-EXPLORATION +(c-ANCA), I-EXPLORATION +antinucleares I-EXPLORATION +(ANA), I-EXPLORATION +antimitocondriales I-EXPLORATION +(AMA), I-EXPLORATION +antimicrosomales I-EXPLORATION +(LKM-1) I-EXPLORATION +y I-EXPLORATION +antisacaromices I-EXPLORATION +(ASCA) I-EXPLORATION +negativos. I-EXPLORATION +Serología I-EXPLORATION +VIH I-EXPLORATION +positiva I-EXPLORATION +con I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +millones I-EXPLORATION +de I-EXPLORATION +copias/ml, I-EXPLORATION +CMV I-EXPLORATION +IgG I-EXPLORATION +positiva I-EXPLORATION +con I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +2 I-EXPLORATION +a I-EXPLORATION +5 I-EXPLORATION +millones I-EXPLORATION +de I-EXPLORATION +copias/ml, I-EXPLORATION +rubéola I-EXPLORATION +IgG I-EXPLORATION +positiva I-EXPLORATION +y I-EXPLORATION +Toxoplasma I-EXPLORATION +gondii I-EXPLORATION +IgG I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +250 I-EXPLORATION +UI/ml. I-EXPLORATION +Serología I-EXPLORATION +VHB, I-EXPLORATION +VHC, I-EXPLORATION +VHA, I-EXPLORATION +LUES, I-EXPLORATION +Brucella, I-EXPLORATION +Cryptococcus, I-EXPLORATION +Leishmania, I-EXPLORATION +CMV I-EXPLORATION +IgM I-EXPLORATION +negativa; I-EXPLORATION +VEB I-EXPLORATION +IgM I-EXPLORATION +resultado I-EXPLORATION +indeterminado. I-EXPLORATION +Antígeno I-EXPLORATION +de I-EXPLORATION +Giardia I-EXPLORATION +lamblia I-EXPLORATION +y I-EXPLORATION +Cryptosporidium I-EXPLORATION +en I-EXPLORATION +heces, I-EXPLORATION +antígeno I-EXPLORATION +de I-EXPLORATION +Legionella I-EXPLORATION +y I-EXPLORATION +neumococo I-EXPLORATION +en I-EXPLORATION +orina, I-EXPLORATION +baciloscopias I-EXPLORATION +en I-EXPLORATION +esputo I-EXPLORATION +y I-EXPLORATION +orina I-EXPLORATION +por I-EXPLORATION +tres, I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +urocultivos I-EXPLORATION +negativos. I-EXPLORATION +Desarrollo I-EXPLORATION +de I-EXPLORATION +Candida I-EXPLORATION +albicans I-EXPLORATION +en I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +esputo. I-EXPLORATION +Mantoux I-EXPLORATION +negativo. I-EXPLORATION +Las I-EXPLORATION +poblaciones I-EXPLORATION +linfocitarias I-EXPLORATION +eran I-EXPLORATION +de I-EXPLORATION +177 I-EXPLORATION +CD4/μl, I-EXPLORATION +534 I-EXPLORATION +CD3/μl, I-EXPLORATION +346 I-EXPLORATION +CD8/μl I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cociente I-EXPLORATION +CD4/CD8 I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +51. I-EXPLORATION +Fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +colédoco I-EXPLORATION +dilatado I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +fusiforme, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +placas I-EXPLORATION +blanquecinas I-EXPLORATION +por I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +esófago I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +candidiasis I-EXPLORATION +esofágica. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +colangiorresonancia I-EXPLORATION +que I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +ectasia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +con I-EXPLORATION +algún I-EXPLORATION +segmento I-EXPLORATION +estenótico I-EXPLORATION +y I-EXPLORATION +ligera I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +hepatocolédoco I-EXPLORATION +sin I-EXPLORATION +estenosis I-EXPLORATION +ni I-EXPLORATION +litiasis. I-EXPLORATION +Durante B-TREATMENT +el I-TREATMENT +ingreso I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +con I-TREATMENT +ganciclovir I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +intravenoso I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +semanas, I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +valganciclovir I-TREATMENT +900 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +horas. I-TREATMENT +A I-TREATMENT +partir I-TREATMENT +de I-TREATMENT +la I-TREATMENT +segunda I-TREATMENT +semana I-TREATMENT +se I-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +antirretroviral I-TREATMENT +(emtricitabina/tenofovir, I-TREATMENT +darunavir I-TREATMENT +y I-TREATMENT +ritonavir) I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +tolerancia. I-TREATMENT +Junto I-TREATMENT +a I-TREATMENT +esto, I-TREATMENT +se I-TREATMENT +pautó I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +fluconazol I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +durante I-TREATMENT +7 I-TREATMENT +días, I-TREATMENT +ácido I-TREATMENT +ursodesoxicólico I-TREATMENT +300 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas, I-TREATMENT +colestiramina I-TREATMENT +4 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas, I-TREATMENT +dexclorfeniramina I-TREATMENT +6 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +cotrimoxazol I-TREATMENT +800/160 I-TREATMENT +mg I-TREATMENT +lunes, I-TREATMENT +miércoles I-TREATMENT +y I-TREATMENT +viernes. I-TREATMENT +A B-EXPLORATION +pesar I-EXPLORATION +del I-EXPLORATION +tratamiento I-EXPLORATION +médico I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +continuaba I-EXPLORATION +con I-EXPLORATION +colestasis I-EXPLORATION +y I-EXPLORATION +citolisis I-EXPLORATION +(bilirrubina I-EXPLORATION +total I-EXPLORATION +10, I-EXPLORATION +26 I-EXPLORATION +mg/dl, I-EXPLORATION +FA I-EXPLORATION +544 I-EXPLORATION +U/l, I-EXPLORATION +GGT I-EXPLORATION +175 I-EXPLORATION +U/l, I-EXPLORATION +GOT I-EXPLORATION +448 I-EXPLORATION +U/l, I-EXPLORATION +GPT I-EXPLORATION +170 I-EXPLORATION +U/l) I-EXPLORATION +motivo I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +CPRE I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +25 I-EXPLORATION +días I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +instauración I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +ganciclovir. I-EXPLORATION +La B-TREATMENT +CPRE I-TREATMENT +confirmó I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +dilatación I-TREATMENT +fusiforme I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +biliar I-TREATMENT +extrahepática, I-TREATMENT +con I-TREATMENT +normalidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intrahepática, I-TREATMENT +y I-TREATMENT +permitió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +esfinterotomía, I-TREATMENT +colocándosele I-TREATMENT +una I-TREATMENT +endoprótesis I-TREATMENT +plástica I-TREATMENT +en I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +extrahepática. I-TREATMENT +Cuatro B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +CPRE I-EVOLUTION +mejoró I-EVOLUTION +tanto I-EVOLUTION +clínica I-EVOLUTION +como I-EVOLUTION +analíticamente I-EVOLUTION +(FA I-EVOLUTION +310 I-EVOLUTION +U/l, I-EVOLUTION +GGT I-EVOLUTION +94 I-EVOLUTION +U/l, I-EVOLUTION +GOT I-EVOLUTION +212 I-EVOLUTION +U/l, I-EVOLUTION +GPT I-EVOLUTION +84 I-EVOLUTION +U/l, I-EVOLUTION +carga I-EVOLUTION +viral I-EVOLUTION +de I-EVOLUTION +CMV I-EVOLUTION +negativa I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +VIH I-EVOLUTION +1.602 I-EVOLUTION +copias/ml). I-EVOLUTION +En I-EVOLUTION +las I-EVOLUTION +revisiones I-EVOLUTION +posteriores I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +estable I-EVOLUTION +con I-EVOLUTION +elevación I-EVOLUTION +persistente I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fosfatasa I-EVOLUTION +alcalina I-EVOLUTION +en I-EVOLUTION +rangos I-EVOLUTION +de I-EVOLUTION +400-600 I-EVOLUTION +U/l, I-EVOLUTION +carga I-EVOLUTION +viral I-EVOLUTION +de I-EVOLUTION +VIH I-EVOLUTION +y I-EVOLUTION +CMV I-EVOLUTION +negativas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-EXPLORATION +presencia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +excrecente, I-EXPLORATION +ulcerada I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +dura I-EXPLORATION +en I-EXPLORATION +flanco I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +acompañada I-EXPLORATION +de I-EXPLORATION +otra I-EXPLORATION +similar I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +infraclavicular I-EXPLORATION +izquierda. I-EXPLORATION +Presenta I-EXPLORATION +disfagia I-EXPLORATION +a I-EXPLORATION +sólidos I-EXPLORATION +y I-EXPLORATION +líquidos I-EXPLORATION +semanas I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +dichas I-EXPLORATION +lesiones, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +kg I-EXPLORATION +de I-EXPLORATION +peso. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +endoscópico I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +excrecente I-EXPLORATION +y I-EXPLORATION +ulcerada, I-EXPLORATION +a I-EXPLORATION +22 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arcada I-EXPLORATION +dental, I-EXPLORATION +que I-EXPLORATION +ocluye I-EXPLORATION +casi I-EXPLORATION +completamente I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +del I-EXPLORATION +esófago I-EXPLORATION +con I-EXPLORATION +resultado I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +epidermoide I-EXPLORATION +infiltrante. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +dérmicas I-EXPLORATION +revela I-EXPLORATION +infiltración I-EXPLORATION +cutánea I-EXPLORATION +metastásica I-EXPLORATION +por I-EXPLORATION +carcinoma I-EXPLORATION +epidermoide, I-EXPLORATION +inmunohistoquimica I-EXPLORATION +más I-EXPLORATION +paracitoqueratina I-EXPLORATION +alto I-EXPLORATION +peso I-EXPLORATION +molecular I-EXPLORATION +y I-EXPLORATION +vimentina. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +indicaron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +metastásica I-EXPLORATION +ósea I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +costal I-EXPLORATION +izquierdo, I-EXPLORATION +cuerpo I-EXPLORATION +vertebral I-EXPLORATION +D9 I-EXPLORATION +y I-EXPLORATION +hueso I-EXPLORATION +iliaco I-EXPLORATION +derecho. I-EXPLORATION +Finalmente B-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +prótesis I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +quimioterápico. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hidatidosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2009 I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +portal I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +cavernomatosis I-PAST_MEDICAL_HISTORY +portal I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +complicación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cirugía, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +asociada. I-PAST_MEDICAL_HISTORY +Presentó I-PAST_MEDICAL_HISTORY +varices I-PAST_MEDICAL_HISTORY +esofágicas I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +III-IV I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sangrado I-PAST_MEDICAL_HISTORY +digestivo. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematemesis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +melénicas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +gastroscopia I-EXPLORATION +urgente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +4 I-EXPLORATION +cordones I-EXPLORATION +varicosos I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +desde I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +esofágico I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +prolongan I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +subcardial, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +rojos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +pared I-EXPLORATION +aunque I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +activo. I-EXPLORATION +Se B-TREATMENT +colocaron I-TREATMENT +9 I-TREATMENT +bandas I-TREATMENT +de I-TREATMENT +ligadura I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +inmediatas. I-TREATMENT +En B-EXPLORATION +estómago I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +lesiones I-EXPLORATION +potencialmente I-EXPLORATION +sangrantes I-EXPLORATION +ni I-EXPLORATION +restos I-EXPLORATION +hemáticos, I-EXPLORATION +ni I-EXPLORATION +tampoco I-EXPLORATION +en I-EXPLORATION +duodeno. I-EXPLORATION +Posteriormente B-EVOLUTION +presentó I-EVOLUTION +múltiples I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +melenas, I-EVOLUTION +con I-EVOLUTION +anemización I-EVOLUTION +secundaria I-EVOLUTION +y I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +transfusión I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +total I-EVOLUTION +de I-EVOLUTION +22 I-EVOLUTION +UCH. I-EVOLUTION +Se B-TREATMENT +realizaron I-TREATMENT +dos I-TREATMENT +intentos I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endoscópica I-TREATMENT +de I-TREATMENT +controlar I-TREATMENT +el I-TREATMENT +sangrado I-TREATMENT +sin I-TREATMENT +objetivar I-TREATMENT +sangrado I-TREATMENT +de I-TREATMENT +las I-TREATMENT +escaras I-TREATMENT +de I-TREATMENT +las I-TREATMENT +bandas I-TREATMENT +previas I-TREATMENT +ni I-TREATMENT +a I-TREATMENT +otro I-TREATMENT +nivel I-TREATMENT +gastrointestinal. I-TREATMENT +En B-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +realizada, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +varices I-EXPLORATION +esofágicas I-EXPLORATION +secundarias I-EXPLORATION +a I-EXPLORATION +trombosis I-EXPLORATION +crónica I-EXPLORATION +del I-EXPLORATION +eje I-EXPLORATION +espleno-portal, I-EXPLORATION +esplenomegalia I-EXPLORATION +y I-EXPLORATION +ascitis I-EXPLORATION +sin I-EXPLORATION +identificar I-EXPLORATION +sangrado I-EXPLORATION +activo. I-EXPLORATION +Una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +mostró I-EXPLORATION +hidatidosis I-EXPLORATION +hepática I-EXPLORATION +ya I-EXPLORATION +descrita I-EXPLORATION +en I-EXPLORATION +estudios I-EXPLORATION +anteriores, I-EXPLORATION +cavernomatosis I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +trombosis I-EXPLORATION +portal I-EXPLORATION +y I-EXPLORATION +esplenomegalia. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +decidimos I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +arteriografía I-EXPLORATION +abdominal I-EXPLORATION +selectiva I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +celiaco I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +mesentérica I-EXPLORATION +superior I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +identificó I-EXPLORATION +puntos I-EXPLORATION +sangrantes I-EXPLORATION +activos I-EXPLORATION +ni I-EXPLORATION +malformaciones I-EXPLORATION +vasculares. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +hallazgos, I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +enteroscopia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +rodilla I-EXPLORATION +duodenal I-EXPLORATION +un I-EXPLORATION +conglomerado I-EXPLORATION +de I-EXPLORATION +varices I-EXPLORATION +submucosas I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +comprueban I-EXPLORATION +con I-EXPLORATION +ecoendoscopio I-EXPLORATION +radial. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +inyectar I-TREATMENT +3 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +pegamento I-TREATMENT +(cianoacrilato) I-TREATMENT +en I-TREATMENT +varices I-TREATMENT +duodenales I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +inmediatas. I-TREATMENT +Tras B-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +sin I-EVOLUTION +recidiva I-EVOLUTION +del I-EVOLUTION +sangrado I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +hematemesis I-EVOLUTION +de I-EVOLUTION +alto I-EVOLUTION +volumen I-EVOLUTION +que I-EVOLUTION +le I-EVOLUTION +ocasionó I-EVOLUTION +una I-EVOLUTION +broncoaspiración I-EVOLUTION +y I-EVOLUTION +secundariamente I-EVOLUTION +parada I-EVOLUTION +cardiorrespiratoria I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +maniobras I-EVOLUTION +de I-EVOLUTION +resucitación I-EVOLUTION +realizadas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hipertenso, B-PAST_MEDICAL_HISTORY +diabético I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +alcohólico, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Child, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +portal. I-PAST_MEDICAL_HISTORY +Presentaba I-PAST_MEDICAL_HISTORY +varices I-PAST_MEDICAL_HISTORY +esofágicas I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +II I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +requerido I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sangrado I-PAST_MEDICAL_HISTORY +digestivo. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematemesis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rectorragia. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +gastroscopia I-EXPLORATION +urgente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +tres I-EXPLORATION +cordones I-EXPLORATION +varicosos I-EXPLORATION +de I-EXPLORATION +mediano-pequeño I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +rojos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +pared I-EXPLORATION +que I-EXPLORATION +afectaban I-EXPLORATION +a I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +esófago, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +activo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +realizar I-EXPLORATION +la I-EXPLORATION +exploración. I-EXPLORATION +Se B-TREATMENT +colocaron I-TREATMENT +dos I-TREATMENT +bandas I-TREATMENT +de I-TREATMENT +ligadura. I-TREATMENT +Una B-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +reveló I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +crónica I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hipertensión I-EXPLORATION +portal, I-EXPLORATION +flujo I-EXPLORATION +portal I-EXPLORATION +hepatófugo I-EXPLORATION +y I-EXPLORATION +ascitis. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +sangrado I-EXPLORATION +activo I-EXPLORATION +ni I-EXPLORATION +lesiones I-EXPLORATION +potencialmente I-EXPLORATION +sangrantes I-EXPLORATION +en I-EXPLORATION +estómago I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +duodeno. I-EXPLORATION +Posteriormente B-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +deposiciones I-EVOLUTION +melénicas, I-EVOLUTION +realizándose B-EXPLORATION +endoscopia I-EXPLORATION +que I-EXPLORATION +observó I-EXPLORATION +tres I-EXPLORATION +cordones I-EXPLORATION +varicosos I-EXPLORATION +pequeños I-EXPLORATION +con I-EXPLORATION +2 I-EXPLORATION +escaras I-EXPLORATION +en I-EXPLORATION +tercio I-EXPLORATION +distal I-EXPLORATION +y I-EXPLORATION +cierto I-EXPLORATION +edema. I-EXPLORATION +En I-EXPLORATION +estómago I-EXPLORATION +sangre I-EXPLORATION +roja I-EXPLORATION +en I-EXPLORATION +curvatura I-EXPLORATION +mayor. I-EXPLORATION +En I-EXPLORATION +duodeno I-EXPLORATION +presentaba I-EXPLORATION +variz I-EXPLORATION +duodenal I-EXPLORATION +en I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +con I-EXPLORATION +pezón I-EXPLORATION +de I-EXPLORATION +fibrina. I-EXPLORATION +Se B-TREATMENT +inyectó I-TREATMENT +1 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +cianoacrilato I-TREATMENT +y I-TREATMENT +4 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +etoxiesclerol. I-TREATMENT +Tras B-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +endoscópico I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +exteriorización I-EVOLUTION +de I-EVOLUTION +sangrado I-EVOLUTION +ni I-EVOLUTION +anemización I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +es I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION +Tras I-EVOLUTION +trece I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +nuevos I-EVOLUTION +ingresos I-EVOLUTION +por I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +alta I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +sangrado I-EVOLUTION +por I-EVOLUTION +variz I-EVOLUTION +duodenal. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Graves-Basedow, I-PAST_MEDICAL_HISTORY +artritis I-PAST_MEDICAL_HISTORY +reumatoide I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +CU I-PAST_MEDICAL_HISTORY +corticodependiente I-PAST_MEDICAL_HISTORY +refractaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +inmunosupresores I-PAST_MEDICAL_HISTORY +tiopurínicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antiTNF, I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +asociadas I-PAST_MEDICAL_HISTORY +son I-PAST_MEDICAL_HISTORY +eritema I-PAST_MEDICAL_HISTORY +nodoso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +perianal I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +precisó I-PAST_MEDICAL_HISTORY +drenaje I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +abscesos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +colocación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +seton I-PAST_MEDICAL_HISTORY +laxo I-PAST_MEDICAL_HISTORY +sobre I-PAST_MEDICAL_HISTORY +fístula I-PAST_MEDICAL_HISTORY +anal I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Controlada B-TREATMENT +por I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Enfermedad I-TREATMENT +Inflamatoria I-TREATMENT +Intestinal I-TREATMENT +(EII), I-TREATMENT +es I-TREATMENT +refractaria I-TREATMENT +al I-TREATMENT +tratamiento, I-TREATMENT +manteniéndose I-TREATMENT +lesiones I-TREATMENT +evidentes I-TREATMENT +endoscópicas I-TREATMENT +e I-TREATMENT +histológicas, I-TREATMENT +unido I-TREATMENT +a I-TREATMENT +importante I-TREATMENT +afectación I-TREATMENT +de I-TREATMENT +su I-TREATMENT +estado I-TREATMENT +general I-TREATMENT +y I-TREATMENT +calidad I-TREATMENT +de I-TREATMENT +vida, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +recomienda I-TREATMENT +tratamiento I-TREATMENT +quirúrgico. I-TREATMENT +Dada I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +perianal I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +pancoloproctectomía I-TREATMENT +e I-TREATMENT +ileostomía I-TREATMENT +terminal I-TREATMENT +en I-TREATMENT +fosa I-TREATMENT +ilíaca I-TREATMENT +derecha. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +CU. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +es I-EVOLUTION +lenta, I-EVOLUTION +con I-EVOLUTION +infección I-EVOLUTION +del I-EVOLUTION +tracto I-EVOLUTION +urinario I-EVOLUTION +e I-EVOLUTION +íleo I-EVOLUTION +paralítico I-EVOLUTION +que B-TREATMENT +requiere I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +sonda I-TREATMENT +naso-gástrica. I-TREATMENT + I-TREATMENT +Previo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +había I-TREATMENT +retirado I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tiopurinas I-TREATMENT +y I-TREATMENT +antiTNF I-TREATMENT +y I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +ingreso I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +pauta I-TREATMENT +de I-TREATMENT +retirada I-TREATMENT +de I-TREATMENT +corticoides I-TREATMENT +orales I-TREATMENT +hasta I-TREATMENT +su I-TREATMENT +suspensión I-TREATMENT +completa. I-TREATMENT +Es B-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta, I-EVOLUTION +asintomática, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +35 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION +Siete I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +consulta I-EVOLUTION +de I-EVOLUTION +estomaterapia I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +una I-EVOLUTION +ulceración I-EVOLUTION +de I-EVOLUTION +bordes I-EVOLUTION +anfractuosos I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +absceso I-EVOLUTION +subcutáneo I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +proximidad I-EVOLUTION +del I-EVOLUTION +estoma, I-EVOLUTION +que I-EVOLUTION +le I-EVOLUTION +origina I-EVOLUTION +intenso I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +dificultad I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +aplicación I-EVOLUTION +del I-EVOLUTION +dispositivo I-EVOLUTION +colector. I-EVOLUTION + I-EVOLUTION +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +ulceración I-EXPLORATION +profunda, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +irregulares I-EXPLORATION +e I-EXPLORATION +indurados, I-EXPLORATION +sumamente I-EXPLORATION +dolorosa, I-EXPLORATION +que I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +gran I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +margen I-EXPLORATION +izquierdo I-EXPLORATION +e I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +estoma; I-EXPLORATION +en I-EXPLORATION +proximidad, I-EXPLORATION +pequeña I-EXPLORATION +colección I-EXPLORATION +purulenta I-EXPLORATION +que, I-EXPLORATION +al I-EXPLORATION +drenarla, I-EXPLORATION +pone I-EXPLORATION +en I-EXPLORATION +evidencia I-EXPLORATION +otra I-EXPLORATION +ulceración, I-EXPLORATION +con I-EXPLORATION +márgenes I-EXPLORATION +necróticos I-EXPLORATION +y I-EXPLORATION +eritematosos, I-EXPLORATION +tunelizada I-EXPLORATION +mediante I-EXPLORATION +un I-EXPLORATION +pequeño I-EXPLORATION +puente I-EXPLORATION +dérmico I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +anterior. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +PGP I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +ingreso I-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +vigilar I-TREATMENT +evolución. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +cultivo I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +histológico; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +ningún I-EXPLORATION +germen I-EXPLORATION +anormal I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +informado I-EXPLORATION +de I-EXPLORATION +inflamación I-EXPLORATION +inespecífica. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +mediante I-TREATMENT +tacrolimus I-TREATMENT +vía I-TREATMENT +tópica, I-TREATMENT +en I-TREATMENT +solución I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +3 I-TREATMENT +%, I-TREATMENT +una I-TREATMENT +aplicación I-TREATMENT +diaria; I-TREATMENT +adalimumab: I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +inducción I-TREATMENT +de I-TREATMENT +80 I-TREATMENT +mg I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +40 I-TREATMENT +mg I-TREATMENT +subcutáneos I-TREATMENT +cada I-TREATMENT +dos I-TREATMENT +semanas, I-TREATMENT +de I-TREATMENT +mantenimiento; I-TREATMENT +metilprednisolona: I-TREATMENT +32 I-TREATMENT +mg I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +pauta I-TREATMENT +descendente I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +14 I-TREATMENT +días; I-TREATMENT +y I-TREATMENT +metronidazol I-TREATMENT +y I-TREATMENT +ciprofloxacino I-TREATMENT +a I-TREATMENT +las I-TREATMENT +dosis I-TREATMENT +habituales I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +semanas. I-TREATMENT + I-TREATMENT +Sobreañadido I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +general, I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +curas I-TREATMENT +locales I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Estomaterapia, I-TREATMENT +aplicándose I-TREATMENT +apósito I-TREATMENT +absorbente I-TREATMENT +hidrocoloide I-TREATMENT +transparente I-TREATMENT +(carboximetilcelulosa I-TREATMENT +y I-TREATMENT +film I-TREATMENT +de I-TREATMENT +poliuretano), I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +que I-TREATMENT +se I-TREATMENT +adapta I-TREATMENT +dispositivo I-TREATMENT +de I-TREATMENT +ileostomía I-TREATMENT +de I-TREATMENT +doble I-TREATMENT +sistema I-TREATMENT +y I-TREATMENT +cinturón, I-TREATMENT +realizando I-TREATMENT +cambios I-TREATMENT +diarios I-TREATMENT +para I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +tacrolimus I-TREATMENT +tópico. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +fue I-EVOLUTION +muy I-EVOLUTION +satisfactoria I-EVOLUTION +con I-EVOLUTION +resolución I-EVOLUTION +completa I-EVOLUTION +del I-EVOLUTION +pioderma I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +ocho I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION +Continúa I-EVOLUTION +seguimiento I-EVOLUTION +en I-EVOLUTION +consultas I-EVOLUTION +externas I-EVOLUTION +y I-EVOLUTION +diez I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +han I-EVOLUTION +desaparecido I-EVOLUTION +y B-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +precisa I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +de I-TREATMENT +mantenimiento. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus, I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardiaca, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +vascular I-PAST_MEDICAL_HISTORY +periférica, I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +ferropénica I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY +Seguía I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +furosemida, I-PAST_MEDICAL_HISTORY +hidralacina, I-PAST_MEDICAL_HISTORY +sulfato I-PAST_MEDICAL_HISTORY +ferroso, I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +acetilsalicílico, I-PAST_MEDICAL_HISTORY +lisinopril, I-PAST_MEDICAL_HISTORY +carvedilol, I-PAST_MEDICAL_HISTORY +doxazosina I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insulina. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +EDA I-EXPLORATION +por I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +anemia, I-EXPLORATION +visualizándose I-EXPLORATION +bandas I-EXPLORATION +longitudinales I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +negruzco I-EXPLORATION +en I-EXPLORATION +antro I-EXPLORATION +gástrico I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +manchas I-EXPLORATION +puntiformes I-EXPLORATION +oscuras I-EXPLORATION +en I-EXPLORATION +bulbo I-EXPLORATION +y I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +duodenal. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +confirmó, I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Perls, I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +depósitos I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +férrico. I-EXPLORATION + I-EXPLORATION + +Varón, B-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +enólica, I-PAST_MEDICAL_HISTORY +hemorragia I-PAST_MEDICAL_HISTORY +digestiva I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +varices I-PAST_MEDICAL_HISTORY +esofágicas, I-PAST_MEDICAL_HISTORY +trombosis I-PAST_MEDICAL_HISTORY +portal I-PAST_MEDICAL_HISTORY +recanalizada, I-PAST_MEDICAL_HISTORY +derivación I-PAST_MEDICAL_HISTORY +percutánea I-PAST_MEDICAL_HISTORY +portosistémica I-PAST_MEDICAL_HISTORY +intrahepática I-PAST_MEDICAL_HISTORY +(DPPI) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cavernomatosis I-PAST_MEDICAL_HISTORY +portal. I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +colangitis I-PRESENT_ILLNESS +aguda. I-PRESENT_ILLNESS +Se B-EXPLORATION +solicita I-EXPLORATION +colangiopancreatografía I-EXPLORATION +retrógrada I-EXPLORATION +endoscópica, I-EXPLORATION +objetivándose I-EXPLORATION +una I-EXPLORATION +VB I-EXPLORATION +extrahepática I-EXPLORATION +irregular, I-EXPLORATION +con I-EXPLORATION +estenosis I-EXPLORATION +y I-EXPLORATION +dilataciones; I-EXPLORATION +se I-EXPLORATION +extraen I-EXPLORATION +varios I-EXPLORATION +coágulos I-EXPLORATION +con I-EXPLORATION +balón, I-EXPLORATION +persistiendo I-EXPLORATION +algunos I-EXPLORATION +defectos I-EXPLORATION +de I-EXPLORATION +repleción, I-EXPLORATION +planteando I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +entre I-EXPLORATION +colangiocarcinoma I-EXPLORATION +y I-EXPLORATION +colangitis I-EXPLORATION +esclerosante. I-EXPLORATION +Se I-EXPLORATION +completa I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +DPPI I-EXPLORATION +no I-EXPLORATION +permeable I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hipertensión I-EXPLORATION +portal. I-EXPLORATION +Al I-EXPLORATION +alta I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +ecoendoscopia I-EXPLORATION +objetivándose I-EXPLORATION +varices I-EXPLORATION +esofagogástricas, I-EXPLORATION +circulación I-EXPLORATION +colateral I-EXPLORATION +periesplénica I-EXPLORATION +y I-EXPLORATION +periportal, I-EXPLORATION +cavernomatosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +mesentérica I-EXPLORATION +superior I-EXPLORATION +y I-EXPLORATION +circulación I-EXPLORATION +colateral I-EXPLORATION +en I-EXPLORATION +torno I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +VB, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +prominente I-EXPLORATION +ovillo I-EXPLORATION +vascular I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +VB I-EXPLORATION +extrahepática I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +cístico, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +varices I-EXPLORATION +coledocianas. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +abdominal I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +anemia I-DERIVED_FROM/TO +(Hb I-DERIVED_FROM/TO +11, I-DERIVED_FROM/TO +4 I-DERIVED_FROM/TO +mg/dl I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +hierro I-DERIVED_FROM/TO +sérico I-DERIVED_FROM/TO +15 I-DERIVED_FROM/TO +µg/dl) I-DERIVED_FROM/TO +asociada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +hiperferritinemia I-DERIVED_FROM/TO +(707 I-DERIVED_FROM/TO +ng/ml). I-DERIVED_FROM/TO +La B-EXPLORATION +gastroscopia, I-EXPLORATION +colonoscopia, I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +tránsito I-EXPLORATION +gastrointestinal I-EXPLORATION +descartaron I-EXPLORATION +afectación I-EXPLORATION +inflamatoria. I-EXPLORATION +A I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +presentar I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +transferrina I-EXPLORATION +bajo I-EXPLORATION +(3, I-EXPLORATION +7 I-EXPLORATION +%) I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +de I-EXPLORATION +hemocromatosis I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +la I-EXPLORATION +ceruloplasmina I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +metabolismo I-EXPLORATION +del I-EXPLORATION +cobre, I-EXPLORATION +que I-EXPLORATION +confirmaron I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +aceruloplasminemia: I-EXPLORATION +ceruloplasmina I-EXPLORATION +inferior I-EXPLORATION +a I-EXPLORATION +7 I-EXPLORATION +mg/dl I-EXPLORATION +(rango I-EXPLORATION +normal, I-EXPLORATION +22-61 I-EXPLORATION +mg/dl), I-EXPLORATION +cobre I-EXPLORATION +sérico I-EXPLORATION +13 I-EXPLORATION +µg/dl I-EXPLORATION +(rango I-EXPLORATION +normal, I-EXPLORATION +70-150 I-EXPLORATION +µg/dl) I-EXPLORATION +y I-EXPLORATION +cobre I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +normal. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +test I-EXPLORATION +genético I-EXPLORATION +por I-EXPLORATION +no I-EXPLORATION +encontrarse I-EXPLORATION +disponible I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +centro. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +abdominal I-EXPLORATION +identificó I-EXPLORATION +baja I-EXPLORATION +intensidad I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +en I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +T2 I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +depósito I-EXPLORATION +hepático I-EXPLORATION +de I-EXPLORATION +hierro I-EXPLORATION +sin I-EXPLORATION +observar I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +RM I-EXPLORATION +cerebral I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +oftalmológico. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +lista I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +espera I-PRESENT_ILLNESS +quirúrgica I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +colecistectomía I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +litiasis I-PRESENT_ILLNESS +biliar I-PRESENT_ILLNESS +sintomática I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +resección I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +adenoma I-PRESENT_ILLNESS +hepático I-PRESENT_ILLNESS +(de I-PRESENT_ILLNESS +6, I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +x I-PRESENT_ILLNESS +5, I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +x I-PRESENT_ILLNESS +6, I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +segmento I-PRESENT_ILLNESS +II-III). I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +hipocondrios, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +amilasa I-EXPLORATION +de I-EXPLORATION +3315 I-EXPLORATION +UI/L I-EXPLORATION +(rango I-EXPLORATION +de I-EXPLORATION +normalidad: I-EXPLORATION +25-115 I-EXPLORATION +UI/L), I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos; I-EXPLORATION +ingresándose I-EXPLORATION +con I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +aguda I-EXPLORATION +biliar, I-EXPLORATION +sin I-EXPLORATION +criterios I-EXPLORATION +de I-EXPLORATION +Ranson. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +litiasis, I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intra I-EXPLORATION +y I-EXPLORATION +extrahepática, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +páncreas I-EXPLORATION +aumentado I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa. I-EXPLORATION + I-EXPLORATION +Requirió B-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Medicina I-EVOLUTION +Intensiva I-EVOLUTION +por I-EVOLUTION +mala I-EVOLUTION +evolución I-EVOLUTION +con I-EVOLUTION +oligoanuria I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +ingreso; I-EVOLUTION +realizándose B-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +abdomen, I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +pancreatitis I-EXPLORATION +grado I-EXPLORATION +E I-EXPLORATION +de I-EXPLORATION +Balthazar. I-EXPLORATION +Durante B-EVOLUTION +su I-EVOLUTION +estancia I-EVOLUTION +prolongada I-EVOLUTION +en I-EVOLUTION +planta I-EVOLUTION +presentó I-EVOLUTION +numerosas I-EVOLUTION +complicaciones: I-EVOLUTION +condensación I-EVOLUTION +pulmonar I-EVOLUTION +con I-EVOLUTION +derrame I-EVOLUTION +pleural I-EVOLUTION +asociado I-EVOLUTION +(Klebsiella I-EVOLUTION +pneumoniae I-EVOLUTION +en I-EVOLUTION +esputo), I-EVOLUTION +infección I-EVOLUTION +del I-EVOLUTION +tracto I-EVOLUTION +urinario I-EVOLUTION +(Candida I-EVOLUTION +albicans), I-EVOLUTION +sepsis I-EVOLUTION +por I-EVOLUTION +catéter I-EVOLUTION +(Stafilococo I-EVOLUTION +haemolyticus), I-EVOLUTION +trombosis I-EVOLUTION +venosa I-EVOLUTION +profunda I-EVOLUTION +de I-EVOLUTION +yugular I-EVOLUTION +interna I-EVOLUTION +y I-EVOLUTION +subclavia I-EVOLUTION +derecha I-EVOLUTION +por I-EVOLUTION +catéter I-EVOLUTION +central, I-EVOLUTION +desnutrición I-EVOLUTION +proteica I-EVOLUTION +severa, I-EVOLUTION +e I-EVOLUTION +imposibilidad I-EVOLUTION +de I-EVOLUTION +reintroducir I-EVOLUTION +alimentación I-EVOLUTION +por I-EVOLUTION +vía I-EVOLUTION +enteral I-EVOLUTION +por I-EVOLUTION +cuadros I-EVOLUTION +suboclusivos I-EVOLUTION +con I-EVOLUTION +vómitos I-EVOLUTION +y I-EVOLUTION +distensión I-EVOLUTION +abdominal. I-EVOLUTION +En B-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +estenosis I-EXPLORATION +severa I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +hepático I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +pliegues I-EXPLORATION +y I-EXPLORATION +varios I-EXPLORATION +trayectos I-EXPLORATION +fistulosos, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmaron I-EXPLORATION +con I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +; I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +colecciones I-EXPLORATION +multiloculadas I-EXPLORATION +en I-EXPLORATION +psoas-iliaco I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +falta I-TREATMENT +de I-TREATMENT +respuesta I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +conservador I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +para I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +realizándose I-TREATMENT +bypass I-TREATMENT +íleo-cólico, I-TREATMENT +colecistectomía I-TREATMENT +y I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +adenoma I-TREATMENT +hepático. I-TREATMENT + I-TREATMENT +Actualmente B-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática, I-EVOLUTION +con I-EVOLUTION +TAC I-EVOLUTION +abdomen I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +espasmo I-PAST_MEDICAL_HISTORY +hemifacial I-PAST_MEDICAL_HISTORY +izquierdo, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +epigastrio I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +coluria I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +Murphy I-EXPLORATION +negativo I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +transaminasas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +analítica. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +hilio I-EXPLORATION +hepático. I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +manifiesta I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +hipodensa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hilio I-EXPLORATION +hepático. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +RMN I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +hilio I-EXPLORATION +hepático I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +polilobulada I-EXPLORATION +con I-EXPLORATION +compresión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +sin I-EXPLORATION +realce I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION + I-EXPLORATION +Dados I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +colangitis I-EXPLORATION +se I-EXPLORATION +diagnostica I-EXPLORATION +como I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Caroli I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +laparotomía I-EXPLORATION +exploradora, I-EXPLORATION +apreciándose I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +quística I-EXPLORATION +intrahepática I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +IV-III I-EXPLORATION +que, I-EXPLORATION +tras I-EXPLORATION +una I-EXPLORATION +colangiografía I-EXPLORATION +intraoperatoria, I-EXPLORATION +presenta I-EXPLORATION +comunicación I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +principal. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +colecistectomía I-TREATMENT +y I-TREATMENT +hepatectomía I-TREATMENT +izquierda I-TREATMENT +reglada, I-TREATMENT +siendo B-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +favorable. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +histología I-EXPLORATION +describe I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +múltiples I-EXPLORATION +quistes I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +fibrosa, I-EXPLORATION +revestidas I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +mucosecretor I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +planas, I-EXPLORATION +proyecciones I-EXPLORATION +papilares, I-EXPLORATION +atipia I-EXPLORATION +citológica I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +sólido I-EXPLORATION +con I-EXPLORATION +infiltración I-EXPLORATION +focal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +del I-EXPLORATION +quiste, I-EXPLORATION +sin I-EXPLORATION +alcanzar I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +hepático I-EXPLORATION +ni I-EXPLORATION +bordes I-EXPLORATION +quirúrgicos. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +estroma I-EXPLORATION +ovárico. I-EXPLORATION +Todo I-EXPLORATION +ello I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnostico I-EXPLORATION +de I-EXPLORATION +cistoadenocarcinoma I-EXPLORATION +hepático. I-EXPLORATION + I-EXPLORATION +Cinco B-EVOLUTION +años I-EVOLUTION +después, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +asintomático I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +radiológicos I-EVOLUTION +de I-EVOLUTION +recidiva. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +hábito I-PAST_MEDICAL_HISTORY +tabáquico, I-PAST_MEDICAL_HISTORY +alcoholismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pancreatitis I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +en I-EXPLORATION +urgencias I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +izquierdo I-EXPLORATION +masivo. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +toracocentesis I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +negativo, I-EXPLORATION +con I-EXPLORATION +criterios I-EXPLORATION +de I-EXPLORATION +exudado I-EXPLORATION +con I-EXPLORATION +60 I-EXPLORATION +% I-EXPLORATION +de I-EXPLORATION +polimorfonucleares, I-EXPLORATION +destacando I-EXPLORATION +12.400 I-EXPLORATION +UI/L I-EXPLORATION +de I-EXPLORATION +amilasa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +líquido I-EXPLORATION +pleural. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +torácico, I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +infiltrado I-EXPLORATION +en I-EXPLORATION +LII I-EXPLORATION +y I-EXPLORATION +pequeñas I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +vidrio I-EXPLORATION +deslustrado. I-EXPLORATION +Con B-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +derrame I-TREATMENT +paraneumónico I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +médico. I-TREATMENT +Sin B-EXPLORATION +embargo, I-EXPLORATION +el I-EXPLORATION +derrame I-EXPLORATION +empeoró, I-EXPLORATION +realizándose I-EXPLORATION +nueva I-EXPLORATION +toracocentesis I-EXPLORATION +diagnóstica I-EXPLORATION +y I-EXPLORATION +evacuadora, I-EXPLORATION +con I-EXPLORATION +citología I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +células I-EXPLORATION +malignas, I-EXPLORATION +cultivo I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +biopsia I-EXPLORATION +pleural I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +tumor, I-EXPLORATION +destacando I-EXPLORATION +nuevamente I-EXPLORATION +amilasa I-EXPLORATION +elevada, I-EXPLORATION +con I-EXPLORATION +10.156 I-EXPLORATION +UL/L. I-EXPLORATION +Ante I-EXPLORATION +el I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +recidivante I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +toraco-abdominal, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +evidenciaba I-EXPLORATION +un I-EXPLORATION +pseudoquiste I-EXPLORATION +pancreático I-EXPLORATION +de I-EXPLORATION +28 I-EXPLORATION +mm I-EXPLORATION +comunicado I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +x I-EXPLORATION +5, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +páncreas I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +espacio I-EXPLORATION +subfrénico, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +izquierdo I-EXPLORATION +masivo, I-EXPLORATION +siendo I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +fístula I-EXPLORATION +pleuropancreática. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +con I-TREATMENT +dieta I-TREATMENT +absoluta, I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +total, I-TREATMENT +drenaje I-TREATMENT +torácico I-TREATMENT +con I-TREATMENT +tubo I-TREATMENT +y I-TREATMENT +octeótrido I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +100 I-TREATMENT +µg I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +subcutáneo, I-TREATMENT +duplicando I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +ante I-TREATMENT +el I-TREATMENT +alto I-TREATMENT +débito. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +CPRE I-TREATMENT +con I-TREATMENT +intento I-TREATMENT +de I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +stent I-TREATMENT +en I-TREATMENT +el I-TREATMENT +conducto I-TREATMENT +pancreático I-TREATMENT +principal, I-TREATMENT +que I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +posible I-TREATMENT +técnicamente I-TREATMENT +al I-TREATMENT +encontrarse I-TREATMENT +el I-TREATMENT +origen I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +en I-TREATMENT +pseudoquiste I-TREATMENT +pancreático I-TREATMENT +situado I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cola I-TREATMENT +del I-TREATMENT +páncreas. I-TREATMENT +Pese I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +inicial, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +presentó I-TREATMENT +mejoría, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +finalmente I-TREATMENT +fue I-TREATMENT +intervenido I-TREATMENT +tras I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +iniciado I-TREATMENT +el I-TREATMENT +tratamiento, I-TREATMENT +evidenciando I-TREATMENT +un I-TREATMENT +orifico I-TREATMENT +en I-TREATMENT +el I-TREATMENT +diafragma I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +cm I-TREATMENT +que I-TREATMENT +comunicaba I-TREATMENT +el I-TREATMENT +pseudoquiste I-TREATMENT +con I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +pleural I-TREATMENT +y I-TREATMENT +que I-TREATMENT +determinaba I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +pleuropancreática. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +pancreatectomía I-TREATMENT +distal, I-TREATMENT +no I-TREATMENT +pudiendo I-TREATMENT +respetar I-TREATMENT +el I-TREATMENT +bazo I-TREATMENT +por I-TREATMENT +la I-TREATMENT +gran I-TREATMENT +inflamación I-TREATMENT +presente, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +cierre I-TREATMENT +del I-TREATMENT +orificio I-TREATMENT +diafragmático I-TREATMENT +y I-TREATMENT +drenaje I-TREATMENT +pleural I-TREATMENT +izquierdo, I-TREATMENT +con I-TREATMENT +derivación I-TREATMENT +de I-TREATMENT +conducto I-TREATMENT +de I-TREATMENT +Wirsung I-TREATMENT +distal I-TREATMENT +término-lateral I-TREATMENT +en I-TREATMENT +Y I-TREATMENT +de I-TREATMENT +Roux I-TREATMENT +retrocólica-transmesocólica I-TREATMENT +tras I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +cálculos. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +satisfactoria, I-EVOLUTION +siendo I-EVOLUTION +retirado I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +pleural I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +sin I-EVOLUTION +recidiva I-EVOLUTION +del I-EVOLUTION +derrame I-EVOLUTION +y I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +post-operatorio. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +asintomático I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +embarazada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +semanas, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cavernomatosis I-PRESENT_ILLNESS +portal I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +7años. I-PRESENT_ILLNESS +Durante B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +adolescencia I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemorragia I-PAST_MEDICAL_HISTORY +digestiva I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +secundarios I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +varices I-PAST_MEDICAL_HISTORY +esofágicas I-PAST_MEDICAL_HISTORY +(VE). I-PAST_MEDICAL_HISTORY +Anticoagulada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +trombosis I-PAST_MEDICAL_HISTORY +venosa I-PAST_MEDICAL_HISTORY +mesentérica I-PAST_MEDICAL_HISTORY +aguda. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +trimestre I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +retiraron I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +beta-bloqueantes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +anticoagulantes I-PAST_MEDICAL_HISTORY +orales, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +pasó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +heparina I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bajo I-PAST_MEDICAL_HISTORY +peso. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +gastroscopia I-EXPLORATION +realizada I-EXPLORATION +para I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +varices I-EXPLORATION +esofágicas I-EXPLORATION +6 I-EXPLORATION +días I-EXPLORATION +antes I-EXPLORATION +del I-EXPLORATION +evento, I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +VE I-EXPLORATION +grado I-EXPLORATION +I I-EXPLORATION +y I-EXPLORATION +II I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +rojos. I-EXPLORATION + I-EXPLORATION +Acudió I-EXPLORATION +a I-EXPLORATION +urgencias I-EXPLORATION +por I-EXPLORATION +melenas I-EXPLORATION +e I-EXPLORATION +hipotensión I-EXPLORATION +arterial. I-EXPLORATION +En I-EXPLORATION +analítica I-EXPLORATION +destacaba I-EXPLORATION +hemoglobina I-EXPLORATION +7, I-EXPLORATION +1 I-EXPLORATION +g/dl. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +gastroscopia I-TREATMENT +urgente I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +observaron I-TREATMENT +VE I-TREATMENT +grado I-TREATMENT +II I-TREATMENT +con I-TREATMENT +puntos I-TREATMENT +rojos I-TREATMENT +y I-TREATMENT +sangrado I-TREATMENT +activo, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +ligadura I-TREATMENT +con I-TREATMENT +bandas I-TREATMENT +elásticas. I-TREATMENT +Se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +cesárea I-TREATMENT +urgente I-TREATMENT +para I-TREATMENT +extracción I-TREATMENT +fetal I-TREATMENT +por I-TREATMENT +shock I-TREATMENT +hipovolémico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +a I-TREATMENT +continuación I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +somatostatina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +revisó I-TREATMENT +endoscópicamente, I-TREATMENT +objetivando I-TREATMENT +el I-TREATMENT +cese I-TREATMENT +del I-TREATMENT +sangrado. I-TREATMENT +La B-EVOLUTION +recién I-EVOLUTION +nacida I-EVOLUTION +requirió I-EVOLUTION +cuidados I-EVOLUTION +en I-EVOLUTION +incubadora I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +unos I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +ambas I-EVOLUTION +fueron I-EVOLUTION +dadas I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +fallecida I-FAMILY_HISTORY +por I-FAMILY_HISTORY +hepatopatía I-FAMILY_HISTORY +crónica I-FAMILY_HISTORY +inespecífica I-FAMILY_HISTORY +evolucionada I-FAMILY_HISTORY +hacia I-FAMILY_HISTORY +cirrosis I-FAMILY_HISTORY +hepática I-FAMILY_HISTORY +y I-FAMILY_HISTORY +hermana I-FAMILY_HISTORY +con I-FAMILY_HISTORY +hepatopatía I-FAMILY_HISTORY +no I-FAMILY_HISTORY +filiada. I-FAMILY_HISTORY +En B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +(VHC) I-PAST_MEDICAL_HISTORY +genotipo I-PAST_MEDICAL_HISTORY +1b I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +nula I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +peginterferón I-PAST_MEDICAL_HISTORY +α-2a I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ribavirina I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ocasiones. I-PAST_MEDICAL_HISTORY +Además, I-PAST_MEDICAL_HISTORY +cólicos I-PAST_MEDICAL_HISTORY +nefríticos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +febrero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +intensa, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +epigastralgia I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS +Los B-EXPLORATION +valores I-EXPLORATION +analíticos I-EXPLORATION +más I-EXPLORATION +destacables I-EXPLORATION +fueron: I-EXPLORATION +AST I-EXPLORATION +145 I-EXPLORATION +U/L I-EXPLORATION +(0-37 I-EXPLORATION +U/L), I-EXPLORATION +ALT I-EXPLORATION +121 I-EXPLORATION +U/L I-EXPLORATION +(0-37 I-EXPLORATION +U/L), I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +116 I-EXPLORATION +U/L I-EXPLORATION +(50-190 I-EXPLORATION +U/L), I-EXPLORATION +GGT I-EXPLORATION +167 I-EXPLORATION +U/L I-EXPLORATION +(6-50 I-EXPLORATION +U/L), I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +14, I-EXPLORATION +6 I-EXPLORATION +mg/dl I-EXPLORATION +(0-1, I-EXPLORATION +8 I-EXPLORATION +mg/dl), I-EXPLORATION +y I-EXPLORATION +alfa-feto I-EXPLORATION +proteína I-EXPLORATION +19, I-EXPLORATION +14 I-EXPLORATION +ng/ml I-EXPLORATION +(0-5 I-EXPLORATION +ng/ml), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +VHC I-EXPLORATION +de I-EXPLORATION +14.600.000 I-EXPLORATION +UI I-EXPLORATION +ml. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +pruebas I-EXPLORATION +diagnósticas: I-EXPLORATION +ecografía I-EXPLORATION +digestiva, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +lesiones I-EXPLORATION +ocupantes I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +ni I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +vías I-EXPLORATION +biliares I-EXPLORATION +y I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +bilis I-EXPLORATION +espesa I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +concluyentes I-EXPLORATION +de I-EXPLORATION +colelitiasis; I-EXPLORATION +colangio-RM I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +coledocolitiasis I-EXPLORATION +y I-EXPLORATION +litiasis I-EXPLORATION +intrahepática; I-EXPLORATION +endoscopia I-EXPLORATION +oral I-EXPLORATION +normal; I-EXPLORATION +angio-TAC I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +hepatomegalia I-EXPLORATION +homogénea I-EXPLORATION +y I-EXPLORATION +ecoendoscopia I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +páncreas I-EXPLORATION +o I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +fibrosis I-EXPLORATION +grado I-EXPLORATION +3 I-EXPLORATION +según I-EXPLORATION +METAVIR I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +hepatitis I-EXPLORATION +C, I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +alteraciones I-EXPLORATION +valorables. I-EXPLORATION + I-EXPLORATION +Un B-EVOLUTION +año I-EVOLUTION +después I-EVOLUTION +(febrero I-EVOLUTION +2012) I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +consulta I-EVOLUTION +presentando I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +similares I-EVOLUTION +características I-EVOLUTION +(ictericia, I-EVOLUTION +prurito I-EVOLUTION +y I-EVOLUTION +epigastralgia); I-EVOLUTION +ante B-TREATMENT +la I-TREATMENT +recurrencia I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +se I-TREATMENT +prescribió I-TREATMENT +AUDC, I-TREATMENT +con B-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +rápida I-EVOLUTION +del I-EVOLUTION +cuadro. I-EVOLUTION + I-EVOLUTION +Ante B-EXPLORATION +la I-EXPLORATION +clínica I-EXPLORATION +recidivante I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +causa I-EXPLORATION +etiológica, I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +LPAC. I-EXPLORATION +Se I-EXPLORATION +envió I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +al I-EXPLORATION +Hospital I-EXPLORATION +Universitario I-EXPLORATION +La I-EXPLORATION +Paz I-EXPLORATION +(Madrid) I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +hepática, I-EXPLORATION +apreciándose I-EXPLORATION +una I-EXPLORATION +expresión I-EXPLORATION +canicular I-EXPLORATION +normal I-EXPLORATION +de I-EXPLORATION +MRD3. I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +estudió I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +codificante I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +ABCB4 I-EXPLORATION +(muestra I-EXPLORATION +de I-EXPLORATION +ADN I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +periférica) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Hospital I-EXPLORATION +Universitario I-EXPLORATION +Saint-Antoine I-EXPLORATION +(París) I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +tecnología I-EXPLORATION +Roche I-EXPLORATION +454 I-EXPLORATION +GS I-EXPLORATION +Junior I-EXPLORATION +sequencing, I-EXPLORATION +siendo I-EXPLORATION +esta I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +generación I-EXPLORATION +de I-EXPLORATION +secuenciación I-EXPLORATION +del I-EXPLORATION +ADN I-EXPLORATION +por I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +secuenciación I-EXPLORATION +ultraprofunda I-EXPLORATION +de I-EXPLORATION +productos I-EXPLORATION +PCR, I-EXPLORATION +no I-EXPLORATION +encontrándose I-EXPLORATION +tampoco I-EXPLORATION +ninguna I-EXPLORATION +mutación. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +clínica, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Hospital I-EXPLORATION +Universitario I-EXPLORATION +La I-EXPLORATION +Paz I-EXPLORATION +se I-EXPLORATION +analizó I-EXPLORATION +nuevamente I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +ABCB4 I-EXPLORATION +esta I-EXPLORATION +vez I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +MLPA® I-EXPLORATION +(Multiplex I-EXPLORATION +Ligation-dependent I-EXPLORATION +Probe I-EXPLORATION +Amplification) I-EXPLORATION +(9), I-EXPLORATION +tratándose I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +técnica I-EXPLORATION +complementaria I-EXPLORATION +que I-EXPLORATION +detecta I-EXPLORATION +cambios I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +copias I-EXPLORATION +genómicas, I-EXPLORATION +inserciones I-EXPLORATION +o I-EXPLORATION +deleciones I-EXPLORATION +no I-EXPLORATION +detectados I-EXPLORATION +por I-EXPLORATION +los I-EXPLORATION +métodos I-EXPLORATION +convencionales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +secuenciación. I-EXPLORATION +Se I-EXPLORATION +comparó I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +hermana I-EXPLORATION +(control I-EXPLORATION +1) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +individuo I-EXPLORATION +sano I-EXPLORATION +(control I-EXPLORATION +2). I-EXPLORATION +Se I-EXPLORATION +identificó I-EXPLORATION +una I-EXPLORATION +mutación I-EXPLORATION +en I-EXPLORATION +heterocigosis I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +deleción I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +de I-EXPLORATION +gen I-EXPLORATION +que I-EXPLORATION +contiene I-EXPLORATION +el I-EXPLORATION +exón I-EXPLORATION +4 I-EXPLORATION +completo, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +deficiencia I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +MDR3 I-EXPLORATION +(10), I-EXPLORATION +confirmándose I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +LPAC. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +19 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +intermitente, I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +progresiva. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +evidencian I-EXPLORATION +hepatomegalia I-EXPLORATION +y I-EXPLORATION +onda I-EXPLORATION +ascítica I-EXPLORATION +positiva. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destaca: I-EXPLORATION +Mantoux I-EXPLORATION ++, I-EXPLORATION +CA I-EXPLORATION +125 I-EXPLORATION +797.7, I-EXPLORATION +leucocitos I-EXPLORATION +4.000, I-EXPLORATION +Hb I-EXPLORATION +9.7. I-EXPLORATION +TC I-EXPLORATION +toracoabdominal: I-EXPLORATION +ascitis, I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +serosa I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +nodulares I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +implantes I-EXPLORATION +peritoneales, I-EXPLORATION +principalmente I-EXPLORATION +en I-EXPLORATION +epiplón. I-EXPLORATION +Leve I-EXPLORATION +esplenomegalia. I-EXPLORATION +Múltiples I-EXPLORATION +adenopatías I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +patológico, I-EXPLORATION +mesentéricas, I-EXPLORATION +en I-EXPLORATION +eje I-EXPLORATION +aortoilíaco, I-EXPLORATION +retrocurales I-EXPLORATION +y I-EXPLORATION +periceliacas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +biopsia I-EXPLORATION +peritoneal I-EXPLORATION +ecoguiada I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +mayor I-EXPLORATION +engrosamiento I-EXPLORATION +peritoneal I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +toman I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +cultivo, I-EXPLORATION +con I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +Mycobacterium I-EXPLORATION +tuberculosis. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tuberculostáticos I-TREATMENT +con B-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +clínica, I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ascitis I-EVOLUTION +y I-EVOLUTION +del I-EVOLUTION +engrosamiento I-EVOLUTION +peritoneal. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +octubre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2012 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +ingresada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico-analítico I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +hepatitis I-PRESENT_ILLNESS +aguda I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +grave. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +tatuaje I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +toma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Inneov I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +capilar® I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +resumen I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +I. I-EXPLORATION +La I-EXPLORATION +inmunología I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +viral I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +Al B-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +suspender I-EVOLUTION +Inneov I-EVOLUTION +masa I-EVOLUTION +capilar® I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +mejoría I-EVOLUTION +clínica, I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +del I-EVOLUTION +prurito, I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +analítica, I-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +pruebas I-EVOLUTION +de I-EVOLUTION +función I-EVOLUTION +hepática I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +más I-EVOLUTION +tarde. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +causalidad I-EVOLUTION +utilizando I-EVOLUTION +la I-EVOLUTION +escala I-EVOLUTION +de I-EVOLUTION +CIOMS/RUCAM I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +caso I-EVOLUTION +2 I-EVOLUTION +y I-EVOLUTION +3 I-EVOLUTION +fue I-EVOLUTION +altamente I-EVOLUTION +probable. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +niño I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +citopatía I-PAST_MEDICAL_HISTORY +mitocondrial I-PAST_MEDICAL_HISTORY +(déficit I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +complejos I-PAST_MEDICAL_HISTORY +I-III-IV I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cadena I-PAST_MEDICAL_HISTORY +respiratoria) I-PAST_MEDICAL_HISTORY +en B-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +vitaminas I-PRESENT_ILLNESS +B1 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +B6, I-PRESENT_ILLNESS +carnitina, I-PRESENT_ILLNESS +coenzima I-PRESENT_ILLNESS +Q, I-PRESENT_ILLNESS +clobazam I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fenobarbital. I-PRESENT_ILLNESS +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Gastroenterología I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Nutrición I-DERIVED_FROM/TO +Infantil I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +episodios I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +atragantamiento I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +comidas I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +varios I-DERIVED_FROM/TO +ingresos I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +neumonía. I-DERIVED_FROM/TO +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +padres I-PRESENT_ILLNESS +referían I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +alimentado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +purés, I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +accesos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +carraspeo I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tragar. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +tenía I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +deshidratación I-EXPLORATION +ni I-EXPLORATION +de I-EXPLORATION +desnutrición, I-EXPLORATION +con I-EXPLORATION +datos I-EXPLORATION +antropométricos I-EXPLORATION +en I-EXPLORATION +percentiles I-EXPLORATION +adecuados I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +sexo. I-EXPLORATION +Como I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +presentaba I-EXPLORATION +hipotonía I-EXPLORATION +generalizada, I-EXPLORATION +apraxia I-EXPLORATION +fonoarticulatoria I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +deglución, I-EXPLORATION +e I-EXPLORATION +hipotonía I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +oral I-EXPLORATION +con I-EXPLORATION +babeo I-EXPLORATION +constante. I-EXPLORATION +Resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +previos I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +disfagia I-EXPLORATION +orofaríngea, I-EXPLORATION +y I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +videofluoroscopia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +centro, I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +fibroendoscopia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +deglución I-EXPLORATION +(FEES) I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +deglución I-EXPLORATION +con I-EXPLORATION +diferentes I-EXPLORATION +volúmenes/texturas. I-EXPLORATION +En I-EXPLORATION +reposo I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +secreciones I-EXPLORATION +en I-EXPLORATION +vallécula, I-EXPLORATION +faringe I-EXPLORATION +y I-EXPLORATION +senos I-EXPLORATION +piriformes; I-EXPLORATION +tras I-EXPLORATION +administrar I-EXPLORATION +distintas I-EXPLORATION +consistencias I-EXPLORATION +y I-EXPLORATION +volúmenes I-EXPLORATION +teñidos I-EXPLORATION +con I-EXPLORATION +azul I-EXPLORATION +de I-EXPLORATION +metileno I-EXPLORATION +se I-EXPLORATION +concluyó I-EXPLORATION +que I-EXPLORATION +con I-EXPLORATION +5 I-EXPLORATION +cc I-EXPLORATION +de I-EXPLORATION +textura I-EXPLORATION +néctar I-EXPLORATION +había I-EXPLORATION +reflejo I-EXPLORATION +deglutorio I-EXPLORATION +enlentecido I-EXPLORATION +y I-EXPLORATION +muy I-EXPLORATION +fraccionado I-EXPLORATION +sin I-EXPLORATION +reflejo I-EXPLORATION +tusígeno; I-EXPLORATION +el I-EXPLORATION +alimento I-EXPLORATION +se I-EXPLORATION +quedaba I-EXPLORATION +inicialmente I-EXPLORATION +en I-EXPLORATION +vallécula, I-EXPLORATION +faringe I-EXPLORATION +y I-EXPLORATION +senos I-EXPLORATION +piriformes I-EXPLORATION +(pasando I-EXPLORATION +posteriormente I-EXPLORATION +a I-EXPLORATION +esófago I-EXPLORATION +por I-EXPLORATION +gravedad). I-EXPLORATION +Con I-EXPLORATION +5 I-EXPLORATION +cc I-EXPLORATION +de I-EXPLORATION +pudding I-EXPLORATION +(más I-EXPLORATION +espeso) I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +penetración I-EXPLORATION +sin I-EXPLORATION +reflejo I-EXPLORATION +tusígeno; I-EXPLORATION +deglución I-EXPLORATION +fraccionada I-EXPLORATION +con I-EXPLORATION +acumulación I-EXPLORATION +en I-EXPLORATION +vallécula, I-EXPLORATION +faringe I-EXPLORATION +y I-EXPLORATION +senos I-EXPLORATION +piriformes; I-EXPLORATION +enlentecimiento I-EXPLORATION +del I-EXPLORATION +paso I-EXPLORATION +a I-EXPLORATION +esófago I-EXPLORATION +y I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +apertura I-EXPLORATION +del I-EXPLORATION +esfínter I-EXPLORATION +esofágico I-EXPLORATION +superior. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +paciente, I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +patología I-EXPLORATION +neurológica I-EXPLORATION +de I-EXPLORATION +base, I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +manometría I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +resolución I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +esofágica. I-EXPLORATION +Con I-EXPLORATION +dicha I-EXPLORATION +prueba I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +hallazgos I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +esfínter I-EXPLORATION +esofágico I-EXPLORATION +superior I-EXPLORATION +hipertenso I-EXPLORATION +con I-EXPLORATION +pobre I-EXPLORATION +bomba I-EXPLORATION +faríngea I-EXPLORATION +y I-EXPLORATION +ondas I-EXPLORATION +peristálticas I-EXPLORATION +normales I-EXPLORATION +alternando I-EXPLORATION +con I-EXPLORATION +contracciones I-EXPLORATION +de I-EXPLORATION +muy I-EXPLORATION +baja I-EXPLORATION +amplitud. I-EXPLORATION +La I-EXPLORATION +presión I-EXPLORATION +de I-EXPLORATION +reposo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuerpo I-EXPLORATION +esofágico I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +del I-EXPLORATION +esfínter I-EXPLORATION +esofágico I-EXPLORATION +inferior I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +límite I-EXPLORATION +bajo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +estableció I-EXPLORATION +el I-EXPLORATION +diagnostico I-EXPLORATION +de I-EXPLORATION +disfagia I-EXPLORATION +orofaríngea I-EXPLORATION +de I-EXPLORATION +etiología I-EXPLORATION +neurógena I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +abordaje I-EXPLORATION +multidisciplinar. I-EXPLORATION +Se B-TREATMENT +prescribió I-TREATMENT +espesante I-TREATMENT +para I-TREATMENT +líquidos I-TREATMENT +y I-TREATMENT +dieta I-TREATMENT +hipercalórica I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +de I-TREATMENT +textura I-TREATMENT +néctar, I-TREATMENT +administrándolos I-TREATMENT +en I-TREATMENT +pequeños I-TREATMENT +volúmenes, I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +mostró I-TREATMENT +menor I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +aspiración I-TREATMENT +en I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +de I-TREATMENT +deglución I-TREATMENT +realizadas. I-TREATMENT +Se I-TREATMENT +recomendaron I-TREATMENT +medidas I-TREATMENT +generales I-TREATMENT +como I-TREATMENT +evitar I-TREATMENT +dobles I-TREATMENT +texturas I-TREATMENT +y I-TREATMENT +posturar I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +durante I-TREATMENT +las I-TREATMENT +comidas I-TREATMENT +(tronco I-TREATMENT +erguido, I-TREATMENT +hombros I-TREATMENT +simétricos, I-TREATMENT +cabeza I-TREATMENT +ligeramente I-TREATMENT +flexionada), I-TREATMENT +y I-TREATMENT +también I-TREATMENT +se I-TREATMENT +solicitó I-TREATMENT +interconsulta I-TREATMENT +a I-TREATMENT +Logopedia I-TREATMENT +para I-TREATMENT +ejercicios I-TREATMENT +de I-TREATMENT +rehabilitación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +deglución. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +en I-EVOLUTION +años I-EVOLUTION +posteriores I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +favorable; I-EVOLUTION +presenta I-EVOLUTION +atragantamientos I-EVOLUTION +leves I-EVOLUTION +pero I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +vuelto I-EVOLUTION +a I-EVOLUTION +ingresar I-EVOLUTION +por I-EVOLUTION +neumonía I-EVOLUTION +aspirativa I-EVOLUTION +ni I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +otras I-EVOLUTION +complicaciones I-EVOLUTION +como I-EVOLUTION +deshidratación I-EVOLUTION +o I-EVOLUTION +desnutrición, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +considerado I-EVOLUTION +la I-EVOLUTION +realización I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +gastrostomía. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +endometriosis, I-PAST_MEDICAL_HISTORY +mioma I-PAST_MEDICAL_HISTORY +uterino I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +embolización I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +miomectomía, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +alcoholismo. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +hijos; I-PAST_MEDICAL_HISTORY +padres I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hermanos I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +perímetro I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +epigastrio I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pirosis, I-PRESENT_ILLNESS +pesadez I-PRESENT_ILLNESS +posprandial I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +continuo, I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +distendido, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +epigastrio I-EXPLORATION +y I-EXPLORATION +mesogastrio, I-EXPLORATION +indurada I-EXPLORATION +y I-EXPLORATION +dolorosa. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +esplenomegalia I-EXPLORATION +ni I-EXPLORATION +existe I-EXPLORATION +semiología I-EXPLORATION +de I-EXPLORATION +ascitis. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +GGT, I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +(hemograma, I-EXPLORATION +sistemático I-EXPLORATION +de I-EXPLORATION +orina, I-EXPLORATION +bioquímica I-EXPLORATION +general, I-EXPLORATION +proteinograma, I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +coagulación, I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +hepatotropos I-EXPLORATION +y I-EXPLORATION +tumorales), I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +abdominal I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +hepatomegalia I-EXPLORATION +con I-EXPLORATION +incontables I-EXPLORATION +lesiones I-EXPLORATION +quísticas; I-EXPLORATION +destaca I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +derecho I-EXPLORATION +(LHD) I-EXPLORATION +un I-EXPLORATION +quiste I-EXPLORATION +de I-EXPLORATION +18 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +vía I-EXPLORATION +biliar, I-EXPLORATION +páncreas I-EXPLORATION +y I-EXPLORATION +bazo I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +Riñón I-EXPLORATION +derecho I-EXPLORATION +pélvico I-EXPLORATION +por I-EXPLORATION +desplazamiento I-EXPLORATION +hepático. I-EXPLORATION +Sendos I-EXPLORATION +quistes I-EXPLORATION +renales I-EXPLORATION +bilaterales I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño. I-EXPLORATION +Miomas I-EXPLORATION +uterinos I-EXPLORATION +calcificados. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +hepática I-EXPLORATION +poliquística, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +quiste I-EXPLORATION +gigante I-EXPLORATION +en I-EXPLORATION +LHD. I-EXPLORATION +La I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +quistes I-EXPLORATION +renales I-EXPLORATION +significativos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +criterios I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +poliquística I-EXPLORATION +renal I-EXPLORATION +permite I-EXPLORATION +establecer I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +EHPA. I-EXPLORATION +Posteriormente B-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +ingresa I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +programada I-TREATMENT +a I-TREATMENT +la I-TREATMENT +planta I-TREATMENT +del I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Digestivo, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +percutáneo I-TREATMENT +con I-TREATMENT +catéter I-TREATMENT +8F I-TREATMENT +pig-tail, I-TREATMENT +con I-TREATMENT +control I-TREATMENT +ecográfico I-TREATMENT +del I-TREATMENT +quiste I-TREATMENT +hepático I-TREATMENT +gigante, I-TREATMENT +evacuándose I-TREATMENT +un I-TREATMENT +líquido I-TREATMENT +transparente, I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +inmediatas. I-TREATMENT +En I-TREATMENT +un I-TREATMENT +segundo I-TREATMENT +tiempo, I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +día, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +en I-TREATMENT +el I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Radiología I-TREATMENT +una I-TREATMENT +quistografía I-TREATMENT +transcatéter, I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +no I-TREATMENT +se I-TREATMENT +advierten I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +fugas I-TREATMENT +de I-TREATMENT +contraste I-TREATMENT +y I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +instilación I-TREATMENT +de I-TREATMENT +270 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +alcohol I-TREATMENT +puro I-TREATMENT +durante I-TREATMENT +treinta I-TREATMENT +minutos, I-TREATMENT +y I-TREATMENT +que I-TREATMENT +se I-TREATMENT +aspira I-TREATMENT +posteriormente. I-TREATMENT +Más B-EVOLUTION +tarde I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +analítica, I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +inmediatas. I-EVOLUTION +Continúa I-EVOLUTION +en I-EVOLUTION +seguimiento I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +consultas, I-EVOLUTION +permaneciendo I-EVOLUTION +asintomática, I-EVOLUTION +sin I-EVOLUTION +requerir I-EVOLUTION +más I-EVOLUTION +sesiones I-EVOLUTION +de I-EVOLUTION +escleroterapia. I-EVOLUTION +Tras I-EVOLUTION +4 I-EVOLUTION +años I-EVOLUTION +del I-EVOLUTION +procedimiento, I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +realizó I-EVOLUTION +un I-EVOLUTION +TAC I-EVOLUTION +abdominal, I-EVOLUTION +observándose I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +tamaño I-EVOLUTION +del I-EVOLUTION +quiste I-EVOLUTION +hepático I-EVOLUTION +tratado I-EVOLUTION +(8, I-EVOLUTION +4 I-EVOLUTION +cm). I-EVOLUTION + I-EVOLUTION + +En B-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +trabajo I-PRESENT_ILLNESS +presentamos I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +catorce I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esteatohepatitis I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +alcohólica I-PAST_MEDICAL_HISTORY +-confirmada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +biopsia, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +indicar I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +misma-, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +periodo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +recomendaciones I-PAST_MEDICAL_HISTORY +generales I-PAST_MEDICAL_HISTORY +dietéticas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +práctica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ejercicio I-PAST_MEDICAL_HISTORY +físico I-PAST_MEDICAL_HISTORY +recreativo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +aeróbico. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sujeto I-PRESENT_ILLNESS +participó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +programa I-PRESENT_ILLNESS +individualizado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +prescripción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ejercicio I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +supervisión, I-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seguir I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +habitual. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +incorporación I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +programa, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sujeto I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +antropométricas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fisiológicas I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +resumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tabla I-PRESENT_ILLNESS +I. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +sujeto I-PRESENT_ILLNESS +declaró: I-PRESENT_ILLNESS +a) I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +físicamente I-PRESENT_ILLNESS +activo I-PRESENT_ILLNESS +-realizando I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +sesiones I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +semana, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pádel, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +rutas I-PRESENT_ILLNESS +cicloturistas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +larga I-PRESENT_ILLNESS +duración I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fines I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +semana, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +controlar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ninguna I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ellas-; I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +b) I-PRESENT_ILLNESS +seguir I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +dieta I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +lípidos, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alcohol I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +fármacos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manera I-PRESENT_ILLNESS +habitual. I-PRESENT_ILLNESS +A B-EXPLORATION +su I-EXPLORATION +incorporación I-EXPLORATION +al I-EXPLORATION +programa I-EXPLORATION +se I-EXPLORATION +estudió I-EXPLORATION +su I-EXPLORATION +condición I-EXPLORATION +física I-EXPLORATION +cardiorrespiratoria I-EXPLORATION +-mediante I-EXPLORATION +una I-EXPLORATION +ergometría I-EXPLORATION +submáxima I-EXPLORATION +(conforme I-EXPLORATION +al I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +YMCA) I-EXPLORATION +(8) I-EXPLORATION +- I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +fuerza I-EXPLORATION +muscular I-EXPLORATION +(conforme I-EXPLORATION +al I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +Brzycki) I-EXPLORATION +(9), I-EXPLORATION +estimándose I-EXPLORATION +con I-EXPLORATION +ello I-EXPLORATION +la I-EXPLORATION +intensidad I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +prescribir I-EXPLORATION +el I-EXPLORATION +entrenamiento, I-EXPLORATION +tanto I-EXPLORATION +de I-EXPLORATION +resistencia I-EXPLORATION +aeróbica I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +fuerza, I-EXPLORATION +respectivamente. I-EXPLORATION +Se B-TREATMENT +animó I-TREATMENT +al I-TREATMENT +sujeto I-TREATMENT +a I-TREATMENT +seguir I-TREATMENT +manteniendo I-TREATMENT +su I-TREATMENT +práctica I-TREATMENT +autónoma I-TREATMENT +de I-TREATMENT +ejercicio I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +instruyó I-TREATMENT +para I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +un I-TREATMENT +pulsómetro I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +misma, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +para I-TREATMENT +recoger I-TREATMENT +los I-TREATMENT +datos I-TREATMENT +de I-TREATMENT +cada I-TREATMENT +sesión I-TREATMENT +en I-TREATMENT +un I-TREATMENT +"diario I-TREATMENT +de I-TREATMENT +entrenamiento" I-TREATMENT +digital. I-TREATMENT +Se I-TREATMENT +diseñó I-TREATMENT +un I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +entrenamiento I-TREATMENT +-complementario I-TREATMENT +al I-TREATMENT +ejercicio I-TREATMENT +auto-reportado I-TREATMENT +por I-TREATMENT +el I-TREATMENT +paciente-, I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +una I-TREATMENT +hora I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +no I-TREATMENT +consecutivos, I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +en I-TREATMENT +gimnasio I-TREATMENT +bajo I-TREATMENT +supervisión I-TREATMENT +de I-TREATMENT +un I-TREATMENT +instructor. I-TREATMENT +Se I-TREATMENT +intentó I-TREATMENT +con I-TREATMENT +estas I-TREATMENT +sesiones I-TREATMENT +complementarias I-TREATMENT +ajustar I-TREATMENT +la I-TREATMENT +carga I-TREATMENT +de I-TREATMENT +entrenamiento I-TREATMENT +del I-TREATMENT +sujeto I-TREATMENT +para I-TREATMENT +que, I-TREATMENT +sumada I-TREATMENT +a I-TREATMENT +la I-TREATMENT +realizada I-TREATMENT +espontáneamente I-TREATMENT +por I-TREATMENT +él, I-TREATMENT +se I-TREATMENT +cumplieran I-TREATMENT +las I-TREATMENT +recomendaciones I-TREATMENT +del I-TREATMENT +American I-TREATMENT +College I-TREATMENT +of I-TREATMENT +Sports I-TREATMENT +Medicine I-TREATMENT +(10). I-TREATMENT +Periódicamente I-TREATMENT +se I-TREATMENT +reevaluaba I-TREATMENT +la I-TREATMENT +condición I-TREATMENT +física I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +reajustar I-TREATMENT +las I-TREATMENT +intensidades I-TREATMENT +de I-TREATMENT +entrenamiento I-TREATMENT +a I-TREATMENT +las I-TREATMENT +mejoras I-TREATMENT +funcionales I-TREATMENT +que I-TREATMENT +se I-TREATMENT +iban I-TREATMENT +consiguiendo I-TREATMENT +progresivamente I-TREATMENT +con I-TREATMENT +el I-TREATMENT +mismo. I-TREATMENT +En B-EXPLORATION +un I-EXPLORATION +análisis I-EXPLORATION +post I-EXPLORATION +hoc I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +cuatro I-EXPLORATION +grandes I-EXPLORATION +periodos I-EXPLORATION +según I-EXPLORATION +el I-EXPLORATION +porcentaje I-EXPLORATION +promedio I-EXPLORATION +de I-EXPLORATION +carga I-EXPLORATION +de I-EXPLORATION +trabajo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sesión I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +dedicaba I-EXPLORATION +a I-EXPLORATION +mejorar I-EXPLORATION +la I-EXPLORATION +resistencia I-EXPLORATION +cardiorrespiratoria I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +fuerza I-EXPLORATION +muscular. I-EXPLORATION +Durante B-TREATMENT +el I-TREATMENT +periodo I-TREATMENT +de I-TREATMENT +intervención I-TREATMENT +no I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +ajustes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +dieta, I-TREATMENT +sino I-TREATMENT +que I-TREATMENT +el I-TREATMENT +sujeto I-TREATMENT +siguió I-TREATMENT +manteniendo I-TREATMENT +las I-TREATMENT +pautas I-TREATMENT +nutricionales I-TREATMENT +que I-TREATMENT +le I-TREATMENT +eran I-TREATMENT +indicadas I-TREATMENT +en I-TREATMENT +sus I-TREATMENT +controles I-TREATMENT +médicos I-TREATMENT +periódicos. I-TREATMENT + I-TREATMENT +Tras B-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +entrenamiento I-EVOLUTION +complementario I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +objetivar I-EVOLUTION +un I-EVOLUTION +incremento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +cardiorrespiratoria I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fuerza I-EVOLUTION +muscular I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +indica I-EVOLUTION +que I-EVOLUTION +tanto I-EVOLUTION +la I-EVOLUTION +intensidad, I-EVOLUTION +como I-EVOLUTION +la I-EVOLUTION +periodización I-EVOLUTION +y I-EVOLUTION +planificación I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +sesiones I-EVOLUTION +complementarias I-EVOLUTION +de I-EVOLUTION +ejercicio I-EVOLUTION +fueron I-EVOLUTION +los I-EVOLUTION +correctos I-EVOLUTION +como I-EVOLUTION +para I-EVOLUTION +desencadenar I-EVOLUTION +y I-EVOLUTION +mantener I-EVOLUTION +las I-EVOLUTION +adaptaciones I-EVOLUTION +fisiológicas I-EVOLUTION +buscadas. I-EVOLUTION +Los I-EVOLUTION +parámetros I-EVOLUTION +analíticos I-EVOLUTION +registrados I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +revisiones I-EVOLUTION +periódicas I-EVOLUTION +realizadas I-EVOLUTION +mostraron I-EVOLUTION +un I-EVOLUTION +importante I-EVOLUTION +cambio I-EVOLUTION +de I-EVOLUTION +tendencia I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +de I-EVOLUTION +colesterolemia I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +trigliceridemia I-EVOLUTION +-datos I-EVOLUTION +no I-EVOLUTION +mostrados- I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +periodo I-EVOLUTION +de I-EVOLUTION +intervención. I-EVOLUTION +Del I-EVOLUTION +mismo I-EVOLUTION +modo, I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +plasmáticos I-EVOLUTION +de I-EVOLUTION +transaminasas, I-EVOLUTION +aunque I-EVOLUTION +siguieron I-EVOLUTION +elevados, I-EVOLUTION +mostraron I-EVOLUTION +una I-EVOLUTION +tendencia I-EVOLUTION +a I-EVOLUTION +ser I-EVOLUTION +inferiores I-EVOLUTION +al I-EVOLUTION +periodo I-EVOLUTION +anterior I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +entrada I-EVOLUTION +del I-EVOLUTION +sujeto I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +programa, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +a I-EVOLUTION +mostrar I-EVOLUTION +menor I-EVOLUTION +dispersión. I-EVOLUTION +No I-EVOLUTION +se I-EVOLUTION +observó, I-EVOLUTION +sin I-EVOLUTION +embargo, I-EVOLUTION +ninguna I-EVOLUTION +reducción I-EVOLUTION +del I-EVOLUTION +peso I-EVOLUTION +corporal I-EVOLUTION +o I-EVOLUTION +del I-EVOLUTION +porcentaje I-EVOLUTION +de I-EVOLUTION +masa I-EVOLUTION +grasa I-EVOLUTION +que, I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +contrario, I-EVOLUTION +tendieron I-EVOLUTION +a I-EVOLUTION +elevarse. I-EVOLUTION +De I-EVOLUTION +todo I-EVOLUTION +ello I-EVOLUTION +se I-EVOLUTION +puede I-EVOLUTION +concluir I-EVOLUTION +que I-EVOLUTION +con I-EVOLUTION +las I-EVOLUTION +adaptaciones I-EVOLUTION +fisiológicas I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +logran I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +ejercicio I-EVOLUTION +adecuadamente I-EVOLUTION +"dosificado", I-EVOLUTION +puede I-EVOLUTION +alterarse I-EVOLUTION +el I-EVOLUTION +curso I-EVOLUTION +natural I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION +Por I-EVOLUTION +el I-EVOLUTION +contrario, I-EVOLUTION +la I-EVOLUTION +realización I-EVOLUTION +autónoma I-EVOLUTION +y I-EVOLUTION +recreativa I-EVOLUTION +de I-EVOLUTION +ejercicio I-EVOLUTION +no I-EVOLUTION +lograría I-EVOLUTION +dichas I-EVOLUTION +adaptaciones, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +resultaría I-EVOLUTION +ineficaz I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +anal, I-PRESENT_ILLNESS +sangrado I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cambio I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +heces, I-PRESENT_ILLNESS +estudiado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +centro, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +han I-PRESENT_ILLNESS +realizado I-PRESENT_ILLNESS +colonoscopia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +resonancia I-PRESENT_ILLNESS +magnética I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +ano-rectal, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +ecoendoscopia I-PRESENT_ILLNESS +diagnosticándose I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +anillo I-PRESENT_ILLNESS +estenótico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +importantes I-PRESENT_ILLNESS +cambios I-PRESENT_ILLNESS +inflamatorios I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +desestructuran I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pared, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +poder I-PRESENT_ILLNESS +definir I-PRESENT_ILLNESS +infiltración, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +biospias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +displasia I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +úlcera I-PRESENT_ILLNESS +rectal I-PRESENT_ILLNESS +solitaria. I-PRESENT_ILLNESS +Se B-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +han I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dicho I-PAST_MEDICAL_HISTORY +centro I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +anorrectoplastias, I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +colgajo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Z I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +posteriormente I-PAST_MEDICAL_HISTORY +dilataciones, I-PAST_MEDICAL_HISTORY +persistiendo I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +crónico. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +nuestro I-EXPLORATION +centro I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +importante I-EXPLORATION +dolor I-EXPLORATION +mal I-EXPLORATION +controlado I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +altas I-EXPLORATION +dosis I-EXPLORATION +de I-EXPLORATION +mórficos, I-EXPLORATION +incontinencia I-EXPLORATION +rectal I-EXPLORATION +severa I-EXPLORATION +y I-EXPLORATION +exploración I-EXPLORATION +rectal I-EXPLORATION +con I-EXPLORATION +estenosis I-EXPLORATION +a I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +línea I-EXPLORATION +pectínea I-EXPLORATION +que I-EXPLORATION +permite I-EXPLORATION +malamente I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +dedo. I-EXPLORATION +Ante B-TREATMENT +este I-TREATMENT +cuadro, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +resección I-TREATMENT +anterior I-TREATMENT +laparoscópica I-TREATMENT +ultrabaja. I-TREATMENT +Intraoperatoriamente I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +pulltrough I-TREATMENT +endoanal, I-TREATMENT +a I-TREATMENT +expensas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +anatomía I-TREATMENT +patológica I-TREATMENT +definitiva, I-TREATMENT +siendo I-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +adenocarcinoma I-TREATMENT +de I-TREATMENT +glándulas I-TREATMENT +anales I-TREATMENT +sin I-TREATMENT +áreas I-TREATMENT +mucinosas, I-TREATMENT +CD7 I-TREATMENT +(+) I-TREATMENT +/CD20 I-TREATMENT +(-) I-TREATMENT +/PSA I-TREATMENT +(-), I-TREATMENT +T3 I-TREATMENT +N0, I-TREATMENT +con I-TREATMENT +márgenes I-TREATMENT +radial I-TREATMENT +y I-TREATMENT +distal I-TREATMENT +afectos, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +completar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +mediante I-TREATMENT +amputación I-TREATMENT +abdómino-perineal I-TREATMENT +cilíndrica I-TREATMENT +laparoscópica. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +supervivencia I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +a I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticada B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EW I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +portal, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +afectación I-PAST_MEDICAL_HISTORY +neuropsiquiátrica. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +D-penicilamina I-PAST_MEDICAL_HISTORY +(350 I-PAST_MEDICAL_HISTORY +mg/8 I-PAST_MEDICAL_HISTORY +horas I-PAST_MEDICAL_HISTORY +v.o.) I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico. I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +flexibilidad I-PRESENT_ILLNESS +cutánea, I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pápulas I-PRESENT_ILLNESS +blanquecinas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +redundante I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +axilar. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +pseudo-pseudoxantoma I-EXPLORATION +elástico I-EXPLORATION +(PPXE) I-EXPLORATION +secundario I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +D-penicilamina. I-EXPLORATION +Ante B-TREATMENT +este I-TREATMENT +hallazgo I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +D-penicilamina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +acetato I-TREATMENT +de I-TREATMENT +zinc I-TREATMENT +(50 I-TREATMENT +mg/8 I-TREATMENT +horas I-TREATMENT +v.o.). I-TREATMENT +Así B-EXPLORATION +mismo, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +examen I-EXPLORATION +oftalmológico I-EXPLORATION +y I-EXPLORATION +ecocardiográfico I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +elástico I-EXPLORATION +a I-EXPLORATION +otro I-EXPLORATION +nivel, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatopatía I-PAST_MEDICAL_HISTORY +previa, I-PAST_MEDICAL_HISTORY +consumidora B-PRESENT_ILLNESS +habitual I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Herbalife I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +zumo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Noni. I-PRESENT_ILLNESS +Acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +inespecífico, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +mucocutánea. I-PRESENT_ILLNESS +No B-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +deterioro I-EXPLORATION +neurológico. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +destacaba: I-EXPLORATION +ALT I-EXPLORATION +940 I-EXPLORATION +U/l, I-EXPLORATION +AST I-EXPLORATION +1300 I-EXPLORATION +U/l, I-EXPLORATION +GGT I-EXPLORATION +173U/l, I-EXPLORATION +FA I-EXPLORATION +187 I-EXPLORATION +U/l, I-EXPLORATION +LDH I-EXPLORATION +431 I-EXPLORATION +U/l, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +21, I-EXPLORATION +45 I-EXPLORATION +mg/dl, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +del I-EXPLORATION +41% I-EXPLORATION +(INR I-EXPLORATION +2.03). I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +etiología I-EXPLORATION +incluyó I-EXPLORATION +serologías I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +hepatotropos: I-EXPLORATION +VHA, I-EXPLORATION +VHB, I-EXPLORATION +VHC, I-EXPLORATION +VHE, I-EXPLORATION +CMV, I-EXPLORATION +EB, I-EXPLORATION +VVZ, I-EXPLORATION +HHV I-EXPLORATION +6-8 I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +IgG I-EXPLORATION +e I-EXPLORATION +IgM I-EXPLORATION +negativas. I-EXPLORATION +Serología I-EXPLORATION +VIH I-EXPLORATION +negativa. I-EXPLORATION +ARN-VHC I-EXPLORATION +y I-EXPLORATION +ADN-VHB I-EXPLORATION +negativos. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +Coxiella, I-EXPLORATION +T. I-EXPLORATION +Cruzi, I-EXPLORATION +Treponema I-EXPLORATION +y I-EXPLORATION +Brucella, I-EXPLORATION +fueron I-EXPLORATION +negativas I-EXPLORATION +para I-EXPLORATION +IgG I-EXPLORATION +e I-EXPLORATION +IgM. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +además I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Wilson, I-EXPLORATION +deficiencia I-EXPLORATION +de I-EXPLORATION +alfa I-EXPLORATION +1 I-EXPLORATION +antitripsina I-EXPLORATION +y I-EXPLORATION +hepatitis I-EXPLORATION +autoinmune. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +colangio-hepato I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +descartaron I-EXPLORATION +patología I-EXPLORATION +biliopancreática. I-EXPLORATION +La I-EXPLORATION +evolución I-EXPLORATION +analítica I-EXPLORATION +fue I-EXPLORATION +tórpida I-EXPLORATION +como I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +I. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +transyugular I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +hepatitis I-EXPLORATION +lobulillar I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +confluente I-EXPLORATION +que I-EXPLORATION +iniciaba I-EXPLORATION +transformación I-EXPLORATION +nodular. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +tercera I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +desarrolló I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +encefalopatía I-EVOLUTION +hepática I-EVOLUTION +grado I-EVOLUTION +II I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +clínico I-EVOLUTION +con I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +ascitis. I-EVOLUTION +El B-TREATMENT +cuadro I-TREATMENT +clínico I-TREATMENT +progresó I-TREATMENT +hacia I-TREATMENT +fallo I-TREATMENT +hepático I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +trasplante I-TREATMENT +hepático I-TREATMENT +urgente, I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +posterior. I-TREATMENT + I-TREATMENT + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +abdominalgia I-PRESENT_ILLNESS +generalizada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +predominio I-PRESENT_ILLNESS +horario I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +incluso I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +despierta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +noche. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +asocia I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +cambios I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hábito I-PRESENT_ILLNESS +deposicional. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realiza I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +hemoglobina I-EXPLORATION +12, I-EXPLORATION +6 I-EXPLORATION +g/dl, I-EXPLORATION +volumen I-EXPLORATION +corpuscular I-EXPLORATION +medio I-EXPLORATION +79, I-EXPLORATION +6 I-EXPLORATION +fl. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +hemograma I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION +Además, I-EXPLORATION +presenta I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +con I-EXPLORATION +AST, I-EXPLORATION +ALT I-EXPLORATION +y I-EXPLORATION +GGT I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +Destaca I-EXPLORATION +ferropenia I-EXPLORATION +con I-EXPLORATION +ferritina I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +ng/ml I-EXPLORATION +(20-200 I-EXPLORATION +ng/ml) I-EXPLORATION +sin I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda I-EXPLORATION +(proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +y I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular). I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +despistaje I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +celiaca I-EXPLORATION +con I-EXPLORATION +IgA I-EXPLORATION +total, I-EXPLORATION +anticuerpos I-EXPLORATION +antitransglutaminasa I-EXPLORATION +(IgA-AAT), I-EXPLORATION +anticuerpos I-EXPLORATION +antipéptido I-EXPLORATION +deaminado I-EXPLORATION +de I-EXPLORATION +gliadina I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +HLA I-EXPLORATION +DQ2-DQ8 I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +enfermedad I-EXPLORATION +celiaca. I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +sensibilización I-EXPLORATION +alimentaria I-EXPLORATION +con I-EXPLORATION +IgE I-EXPLORATION +total I-EXPLORATION +y I-EXPLORATION +específica I-EXPLORATION +a I-EXPLORATION +proteínas I-EXPLORATION +de I-EXPLORATION +leche I-EXPLORATION +de I-EXPLORATION +vaca I-EXPLORATION +(PLV) I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +huevo I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Tras I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +normales, I-EXPLORATION +se I-EXPLORATION +había I-EXPLORATION +realizado I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +en I-EXPLORATION +otro I-EXPLORATION +centro I-EXPLORATION +hospitalario I-EXPLORATION +con I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +gastritis, I-EXPLORATION +con I-EXPLORATION +test I-EXPLORATION +rápido I-EXPLORATION +de I-EXPLORATION +ureasa I-EXPLORATION +en I-EXPLORATION +biopsia I-EXPLORATION +antral I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +Helicobacter I-EXPLORATION +pylori. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +otras I-EXPLORATION +muestras I-EXPLORATION +gástricas I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico. I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +IBP I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +altas I-TREATMENT +(2 I-TREATMENT +mg/ I-TREATMENT +kg/día) I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +inicial I-TREATMENT +presentando I-TREATMENT +recaída I-TREATMENT +al I-TREATMENT +suspender I-TREATMENT +IBP I-TREATMENT +a I-TREATMENT +los I-TREATMENT +2 I-TREATMENT +meses. I-TREATMENT + I-TREATMENT +Reconsulta B-EVOLUTION +en I-EVOLUTION +nuestro I-EVOLUTION +centro I-EVOLUTION +por I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +sintomatología, I-EVOLUTION +dolor I-EVOLUTION +más I-EVOLUTION +localizado I-EVOLUTION +e I-EVOLUTION +intensificado I-EVOLUTION +en I-EVOLUTION +epigastrio I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +último I-EVOLUTION +mes. I-EVOLUTION +Se B-EXPLORATION +decide I-EXPLORATION +nueva I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +únicamente I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +en I-EXPLORATION +antro I-EXPLORATION +gástrico. I-EXPLORATION +Se I-EXPLORATION +toman I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +antro I-EXPLORATION +gástrico I-EXPLORATION +para I-EXPLORATION +test I-EXPLORATION +rápido I-EXPLORATION +de I-EXPLORATION +ureasa I-EXPLORATION +para I-EXPLORATION +Helicobacter I-EXPLORATION +pylori I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +descripción I-EXPLORATION +histológica I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +gástrica I-EXPLORATION +con I-EXPLORATION +moderado I-EXPLORATION +componente I-EXPLORATION +inflamatorio I-EXPLORATION +linfoplasmocitario I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +colágena I-EXPLORATION +subepitelial I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +parcheada I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +que I-EXPLORATION +superan I-EXPLORATION +las I-EXPLORATION +10 I-EXPLORATION +micras I-EXPLORATION +de I-EXPLORATION +espesor I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +distribuyen I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +glándulas. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +linfocitosis I-EXPLORATION +intraepitelial I-EXPLORATION +significativa, I-EXPLORATION +ni I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +Helicobacter I-EXPLORATION +pylori. I-EXPLORATION +Las I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +esófago I-EXPLORATION +y I-EXPLORATION +duodeno I-EXPLORATION +no I-EXPLORATION +presentan I-EXPLORATION +alteraciones I-EXPLORATION +histológicas. I-EXPLORATION + I-EXPLORATION +Orientada I-EXPLORATION +como I-EXPLORATION +GC I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +colonoscopia I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +colitis I-EXPLORATION +colágena I-EXPLORATION +asociada I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +normal I-EXPLORATION +tanto I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +como I-EXPLORATION +histológicamente. I-EXPLORATION +Se B-TREATMENT +reinicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +esomeprazol I-TREATMENT +oral I-TREATMENT +40 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +horas, I-TREATMENT +desapareciendo I-TREATMENT +la I-TREATMENT +sintomatología I-TREATMENT +a I-TREATMENT +los I-TREATMENT +pocos I-TREATMENT +días I-TREATMENT +junto I-TREATMENT +suplemento I-TREATMENT +de I-TREATMENT +hierro I-TREATMENT +oral. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +3 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +inicio I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +puede I-TREATMENT +disminuir I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +IBP I-TREATMENT +a I-TREATMENT +la I-TREATMENT +mitad I-TREATMENT +permaneciendo B-EVOLUTION +asintomática I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +relevantes, I-PAST_MEDICAL_HISTORY +con B-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +esofágica I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Dos B-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +impactación I-PAST_MEDICAL_HISTORY +alimentaria. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +gastroduodenal I-EXPLORATION +baritado I-EXPLORATION +(EGD) I-EXPLORATION +detectó I-EXPLORATION +en I-EXPLORATION +tercio I-EXPLORATION +esofágico I-EXPLORATION +inferior I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +sacular I-EXPLORATION +con I-EXPLORATION +nivel I-EXPLORATION +hidroaéreo, I-EXPLORATION +bien I-EXPLORATION +delimitada I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +tóraco-abdominal I-EXPLORATION +corroboró I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +descritos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +EGD. I-EXPLORATION +La I-EXPLORATION +gastroscopia I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +doble I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +con I-EXPLORATION +contenido I-EXPLORATION +alimentario I-EXPLORATION +semisólido I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +reseñables, I-PAST_MEDICAL_HISTORY +remitido B-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +otorrinolaringología I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +sensación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cuerpo I-DERIVED_FROM/TO +extraño I-DERIVED_FROM/TO +faringo-laríngeo I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +descartar I-DERIVED_FROM/TO +reflujo I-DERIVED_FROM/TO +gastroesofágico. I-DERIVED_FROM/TO +El B-EXPLORATION +EGD I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +sacular I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +epifrénica, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +endoscópicamente. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +77 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +virus I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hiato, I-PAST_MEDICAL_HISTORY +con B-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +esofágica I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pirosis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +ocasionales I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +regurgitación I-PRESENT_ILLNESS +alimentaria. I-PRESENT_ILLNESS +El B-EXPLORATION +EGD I-EXPLORATION +identificó I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +sacular I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +boca I-EXPLORATION +ancha I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +situado I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +distales I-EXPLORATION +del I-EXPLORATION +esófago I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +hernia I-EXPLORATION +hiatal I-EXPLORATION +por I-EXPLORATION +deslizamiento. I-EXPLORATION +La I-EXPLORATION +endoscopia I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +divertículo, I-EXPLORATION +con I-EXPLORATION +contenido I-EXPLORATION +alimentario I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +a I-EXPLORATION +30 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arcada I-EXPLORATION +dentaria. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +con B-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sólidos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +líquidos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +broncoaspiración. I-PRESENT_ILLNESS +El B-EXPLORATION +EGD I-EXPLORATION +sugería I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +contracciones I-EXPLORATION +terciarias I-EXPLORATION +en I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +inferior, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +divertículo I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +posterior I-EXPLORATION +derecha I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +9x2, I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +diámetro I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +endoscópico. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +86 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tiroidectomía I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +bocio I-PAST_MEDICAL_HISTORY +multinodular I-PAST_MEDICAL_HISTORY +endotorácico, I-PAST_MEDICAL_HISTORY +esofagitis I-PAST_MEDICAL_HISTORY +denudativa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2011 I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +amoxicilina, I-PAST_MEDICAL_HISTORY +divertículo I-PAST_MEDICAL_HISTORY +esofágico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pequeña I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hiato. I-PAST_MEDICAL_HISTORY +Presentaba B-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +predominio I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +líquidos I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +motivó I-PRESENT_ILLNESS +ingresos I-PRESENT_ILLNESS +hospitalarios I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +broncoaspiración I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +ocasiones. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +último I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +divertículo I-EXPLORATION +ya I-EXPLORATION +conocido I-EXPLORATION +situado I-EXPLORATION +a I-EXPLORATION +unos I-EXPLORATION +28 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +arcada I-EXPLORATION +dentaria I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +endoscopia. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +seis I-EXPLORATION +pacientes I-EXPLORATION +descritos I-EXPLORATION +se I-EXPLORATION +les I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +manometría I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +resolución I-EXPLORATION +(MAR), I-EXPLORATION +identificándose I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +un I-EXPLORATION +trastorno I-EXPLORATION +motor I-EXPLORATION +esofágico I-EXPLORATION +(TME) I-EXPLORATION +concomitante. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +obtenidos I-EXPLORATION +con I-EXPLORATION +MAR I-EXPLORATION +en I-EXPLORATION +cada I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pacientes I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +I. I-EXPLORATION +Se I-EXPLORATION +utilizaron I-EXPLORATION +como I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +descritos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +clasificación I-EXPLORATION +de I-EXPLORATION +Chicago I-EXPLORATION +vigente I-EXPLORATION +(7). I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +caso I-EXPLORATION +presentaba I-EXPLORATION +ondas I-EXPLORATION +hipercontráctiles I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +S2 I-EXPLORATION +y I-EXPLORATION +S3, I-EXPLORATION +siendo I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +manométrico I-EXPLORATION +de I-EXPLORATION +TME I-EXPLORATION +hipercontráctil I-EXPLORATION +("jackhammer"). I-EXPLORATION +La I-EXPLORATION +MAR I-EXPLORATION +del I-EXPLORATION +segundo I-EXPLORATION +paciente I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +un I-EXPLORATION +TME I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +espasmo I-EXPLORATION +esofágico I-EXPLORATION +distal, I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +S3. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +tercer I-EXPLORATION +caso, I-EXPLORATION +la I-EXPLORATION +MAR I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +TME I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +peristalsis I-EXPLORATION +débil I-EXPLORATION +por I-EXPLORATION +defecto I-EXPLORATION +peristáltico I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contorno I-EXPLORATION +isobárico I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +mmHg I-EXPLORATION +(en I-EXPLORATION +el I-EXPLORATION +50% I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +degluciones), I-EXPLORATION +con I-EXPLORATION +ondas I-EXPLORATION +de I-EXPLORATION +duración I-EXPLORATION +prolongada I-EXPLORATION +y I-EXPLORATION +morfología I-EXPLORATION +de I-EXPLORATION +doble I-EXPLORATION +y I-EXPLORATION +triple I-EXPLORATION +pico I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +56% I-EXPLORATION +y I-EXPLORATION +11% I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +degluciones I-EXPLORATION +respectivamente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +S3. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +del I-EXPLORATION +caso I-EXPLORATION +4 I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +obstrucción I-EXPLORATION +al I-EXPLORATION +tracto I-EXPLORATION +de I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +gastroesofágica I-EXPLORATION +(UGE) I-EXPLORATION +y I-EXPLORATION +simultáneamente I-EXPLORATION +un I-EXPLORATION +TME I-EXPLORATION +con I-EXPLORATION +rasgos I-EXPLORATION +de I-EXPLORATION +acalasia I-EXPLORATION +tipo I-EXPLORATION +III I-EXPLORATION +(espástica) I-EXPLORATION +de I-EXPLORATION +probable I-EXPLORATION +origen I-EXPLORATION +secundario, I-EXPLORATION +observándose I-EXPLORATION +gran I-EXPLORATION +duración I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +ondas I-EXPLORATION +peristálticas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +S2 I-EXPLORATION +(a I-EXPLORATION +unos I-EXPLORATION +30 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +orificio I-EXPLORATION +nasal). I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +5 I-EXPLORATION +presentó I-EXPLORATION +también I-EXPLORATION +un I-EXPLORATION +TME I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +hipercontráctil I-EXPLORATION +("jackhammer") I-EXPLORATION +con I-EXPLORATION +ondas I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +S2 I-EXPLORATION +y I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +en I-EXPLORATION +S3. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +del I-EXPLORATION +caso I-EXPLORATION +6 I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +TME I-EXPLORATION +consistente I-EXPLORATION +en I-EXPLORATION +obstrucción I-EXPLORATION +al I-EXPLORATION +flujo I-EXPLORATION +de I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +UGE, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +contráctil I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +del I-EXPLORATION +divertículo I-EXPLORATION +esofágico I-EXPLORATION +consistente I-EXPLORATION +en I-EXPLORATION +ensanchamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +de I-EXPLORATION +contracción I-EXPLORATION +(entre I-EXPLORATION +segmentos I-EXPLORATION +S2-S3). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +predominantemente I-EXPLORATION +afectado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +MAR, I-EXPLORATION +coincidió I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +localización I-EXPLORATION +del I-EXPLORATION +DE I-EXPLORATION +objetivada I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +radiológicos I-EXPLORATION +y I-EXPLORATION +endoscópicos. I-EXPLORATION + I-EXPLORATION +Cinco B-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +pacientes I-DERIVED_FROM/TO +fueron I-DERIVED_FROM/TO +remitidos I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +quirúrgico. I-DERIVED_FROM/TO +El B-TREATMENT +paciente I-TREATMENT +del I-TREATMENT +primer I-TREATMENT +caso I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +mediante I-TREATMENT +diverticulectomía I-TREATMENT +que I-TREATMENT +se I-TREATMENT +complicó I-TREATMENT +con I-TREATMENT +fístula I-TREATMENT +esófago-pleural I-TREATMENT +y I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +esofágica I-TREATMENT +metálica I-TREATMENT +cubierta I-TREATMENT +(Wallflex®). I-TREATMENT +Los I-TREATMENT +pacientes I-TREATMENT +del I-TREATMENT +segundo I-TREATMENT +y I-TREATMENT +tercer I-TREATMENT +caso I-TREATMENT +decidieron I-TREATMENT +continuar I-TREATMENT +un I-TREATMENT +manejo I-TREATMENT +conservador, I-TREATMENT +tras I-TREATMENT +desestimar I-TREATMENT +la I-TREATMENT +opción I-TREATMENT +de I-TREATMENT +cirugía I-TREATMENT +debido I-TREATMENT +al I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +morbi-mortalidad I-TREATMENT +asociado I-TREATMENT +al I-TREATMENT +mismo. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +del I-EVOLUTION +cuarto I-EVOLUTION +caso I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +alta, I-EVOLUTION +identificándose B-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +endoscópico I-EXPLORATION +urgente I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +coágulo I-EXPLORATION +adherido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +del I-EXPLORATION +divertículo. I-EXPLORATION +Ello B-EVOLUTION +aceleró I-EVOLUTION +la I-EVOLUTION +decisión I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +quirúrgico I-EVOLUTION +del I-EVOLUTION +DE, I-EVOLUTION +una I-EVOLUTION +vez I-EVOLUTION +superado I-EVOLUTION +el I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +sangrado I-EVOLUTION +digestivo. I-EVOLUTION +No I-EVOLUTION +obstante, I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posteriores I-EVOLUTION +al I-EVOLUTION +evento I-EVOLUTION +hemorrágico, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +desarrolló I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +séptico I-EVOLUTION +secundario I-EVOLUTION +a I-EVOLUTION +neumonía I-EVOLUTION +de I-EVOLUTION +origen I-EVOLUTION +espirativo, I-EVOLUTION +falleciendo I-EVOLUTION +finalmente. I-EVOLUTION +La B-TREATMENT +paciente I-TREATMENT +del I-TREATMENT +quinto I-TREATMENT +caso I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +quirúrgicamente I-TREATMENT +realizándose I-TREATMENT +diverticulectomía I-TREATMENT +y I-TREATMENT +miotomía I-TREATMENT +mediante I-TREATMENT +toracoscopia. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +tórpida I-EVOLUTION +al I-EVOLUTION +presentar I-EVOLUTION +mediastinitis I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +fístula I-EVOLUTION +esófago-pleural. I-EVOLUTION +Se B-TREATMENT +trató I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +prótesis I-TREATMENT +esofágica I-TREATMENT +metálica I-TREATMENT +cubierta I-TREATMENT +(Wallflex®). I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +número I-TREATMENT +seis I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +mediante I-TREATMENT +inyección I-TREATMENT +de I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +UGE I-TREATMENT +para I-TREATMENT +resolver I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +de I-TREATMENT +obstrucción I-TREATMENT +funcional. I-TREATMENT +Se I-TREATMENT +consideró I-TREATMENT +el I-TREATMENT +mejor I-TREATMENT +tratamiento I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +edad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +mejorando I-TREATMENT +la I-TREATMENT +sintomatología. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +español, B-PAST_MEDICAL_HISTORY +ingeniero I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +caminos I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +residido I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Costa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Marfil I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +motivos I-PAST_MEDICAL_HISTORY +laborales. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +actualidad I-PRESENT_ILLNESS +regresa I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +España I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +perianal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +asocia I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +última I-PRESENT_ILLNESS +deposición I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +diarreica, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deja I-PRESENT_ILLNESS +entrever I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +gusano I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +tamaño. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destaca I-EXPLORATION +dolor I-EXPLORATION +leve I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +derecha. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +resalta I-EXPLORATION +discreta I-EXPLORATION +eosinofilia I-EXPLORATION +(750 I-EXPLORATION +eosinófilos I-EXPLORATION +por I-EXPLORATION +microlitro). I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +visualización I-EXPLORATION +macroscópica I-EXPLORATION +del I-EXPLORATION +parásito I-EXPLORATION +impresiona I-EXPLORATION +de I-EXPLORATION +Taenia. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +diferido I-EXPLORATION +microbiológico I-EXPLORATION +lo I-EXPLORATION +describe I-EXPLORATION +como I-EXPLORATION +Taenia I-EXPLORATION +saginata I-EXPLORATION +(T. I-EXPLORATION +saginata). I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +85 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +hipertensiva, I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +isquémico I-PAST_MEDICAL_HISTORY +transitorio I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +secuelas I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +infecciones I-PAST_MEDICAL_HISTORY +respiratorias I-PAST_MEDICAL_HISTORY +recurrentes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +broncoaspiración. I-PAST_MEDICAL_HISTORY +Intervenido B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +subcapital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fémur I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +corrección I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +coagulación I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +horas. I-PRESENT_ILLNESS +A B-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +presenta I-EXPLORATION +dificultad I-EXPLORATION +respiratoria I-EXPLORATION +y I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +consciencia I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +pulmonar, I-EXPLORATION +con I-EXPLORATION +mejoría I-EXPLORATION +tras I-EXPLORATION +antibioterapia. I-EXPLORATION +A I-EXPLORATION +las I-EXPLORATION +96 I-EXPLORATION +horas I-EXPLORATION +postoperatorias I-EXPLORATION +presenta I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +brusco, I-EXPLORATION +vómitos I-EXPLORATION +y I-EXPLORATION +distensión. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +abdomen: I-EXPLORATION +aire I-EXPLORATION +en I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +curvatura I-EXPLORATION +mayor I-EXPLORATION +gástrica. I-EXPLORATION +Tomografía I-EXPLORATION +computarizada I-EXPLORATION +abdominal I-EXPLORATION +urgente: I-EXPLORATION +gas I-EXPLORATION +intramural I-EXPLORATION +circunferencial I-EXPLORATION +gástrico I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +difusa I-EXPLORATION +y I-EXPLORATION +hacia I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +esofágico, I-EXPLORATION +con I-EXPLORATION +pequeña I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +neumoperitoneo I-EXPLORATION +adyacente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +curvatura I-EXPLORATION +menor, I-EXPLORATION +gas I-EXPLORATION +venoso I-EXPLORATION +portal I-EXPLORATION +y I-EXPLORATION +neumomediastino I-EXPLORATION +adyacente I-EXPLORATION +a I-EXPLORATION +esófago; I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +gastritis I-EXPLORATION +enfisematosa. I-EXPLORATION +Tratamiento B-TREATMENT +con I-TREATMENT +antibioterapia I-TREATMENT +intravenosa I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro, I-TREATMENT +nutrición I-TREATMENT +parenteral, I-TREATMENT +inhibidores I-TREATMENT +de I-TREATMENT +la I-TREATMENT +bomba I-TREATMENT +de I-TREATMENT +protones I-TREATMENT +y I-TREATMENT +sonda I-TREATMENT +nasogástrica. I-TREATMENT +Se B-EXPLORATION +descarta I-EXPLORATION +etiología I-EXPLORATION +isquémica I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +angiotomografía I-EXPLORATION +computarizada: I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +defectos I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +arterial. I-EXPLORATION +Tomografía I-EXPLORATION +computarizada I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +11 I-EXPLORATION +días: I-EXPLORATION +desaparición I-EXPLORATION +de I-EXPLORATION +neumatosis I-EXPLORATION +gastroesofágica I-EXPLORATION +; I-EXPLORATION +colapso I-EXPLORATION +completo I-EXPLORATION +del I-EXPLORATION +pulmón I-EXPLORATION +izquierdo. I-EXPLORATION +Broncoscopia I-EXPLORATION +urgente I-EXPLORATION +resolutiva: I-EXPLORATION +aspiración I-EXPLORATION +de I-EXPLORATION +tapones I-EXPLORATION +de I-EXPLORATION +moco. I-EXPLORATION +Se B-TREATMENT +suspende I-TREATMENT +la I-TREATMENT +antibioterapia I-TREATMENT +tras I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +iniciando I-TREATMENT +tolerancia I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +satisfactoriamente. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +96 I-EVOLUTION +horas, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +broncoaspiración, I-EVOLUTION +empeoramiento I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +respiratorio, I-EVOLUTION +falleciendo I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cólicos I-PAST_MEDICAL_HISTORY +biliares I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +colelitiasis I-PAST_MEDICAL_HISTORY +conocida, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +destacaban I-EXPLORATION +dolor I-EXPLORATION +y I-EXPLORATION +defensa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Murphy I-EXPLORATION +positivo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +solicitada, I-EXPLORATION +el I-EXPLORATION +rango I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +7x103/µL I-EXPLORATION +(referencia: I-EXPLORATION +4-10, I-EXPLORATION +5 I-EXPLORATION +103/µL), I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +asociada. I-EXPLORATION +Bilirrubina I-EXPLORATION +total I-EXPLORATION +0, I-EXPLORATION +6 I-EXPLORATION +mg/dl I-EXPLORATION +(referencia: I-EXPLORATION +0, I-EXPLORATION +2-1, I-EXPLORATION +10 I-EXPLORATION +mg/dl), I-EXPLORATION +AST I-EXPLORATION +66 I-EXPLORATION +mg/dl I-EXPLORATION +(referencia I-EXPLORATION +8-40 I-EXPLORATION +mg/dl), I-EXPLORATION +amilasa I-EXPLORATION +43 I-EXPLORATION +mg/dl I-EXPLORATION +(referencia: I-EXPLORATION +25-115 I-EXPLORATION +mg/dl), I-EXPLORATION +PCR I-EXPLORATION +15, I-EXPLORATION +84 I-EXPLORATION +mg/dl I-EXPLORATION +(referencia I-EXPLORATION +inferior I-EXPLORATION +a I-EXPLORATION +5 I-EXPLORATION +mg/dl). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +urgente I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +distendida, I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +pared I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +colelitiasis. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +colecistitis I-TREATMENT +aguda, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +una I-TREATMENT +colecistectomía I-TREATMENT +laparoscópica I-TREATMENT +urgente I-TREATMENT +tras B-EVOLUTION +la I-EVOLUTION +cual I-EVOLUTION +tuvo I-EVOLUTION +una I-EVOLUTION +recuperación I-EVOLUTION +postoperatoria I-EVOLUTION +favorable I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +El B-EXPLORATION +resultado I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +colecistitis I-EXPLORATION +crónica I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +pancreático I-EXPLORATION +ectópico I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula I-EXPLORATION +biliar. I-EXPLORATION + I-EXPLORATION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +estenosis I-PRESENT_ILLNESS +esofágica I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +caústicos I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +respondió I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +dilataciones I-PRESENT_ILLNESS +consecutivas I-PRESENT_ILLNESS +realizadas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +balón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dilatación I-PRESENT_ILLNESS +esofágico. I-PRESENT_ILLNESS +La B-EXPLORATION +estenosis I-EXPLORATION +tenía I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +calibre I-EXPLORATION +inicial I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +mm. I-EXPLORATION +Se B-TREATMENT +realizaron I-TREATMENT +2 I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +inyección I-TREATMENT +intralesional I-TREATMENT +de I-TREATMENT +mitomicina I-TREATMENT +C I-TREATMENT +(1, I-TREATMENT +6 I-TREATMENT +ml I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +ocasión) I-TREATMENT +y I-TREATMENT +dilatación I-TREATMENT +con I-TREATMENT +balones I-TREATMENT +de I-TREATMENT +10-11-12 I-TREATMENT +mm I-TREATMENT +con I-TREATMENT +40 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +separación I-TREATMENT +entre I-TREATMENT +sesiones, I-TREATMENT +obteniendo B-EVOLUTION +la I-EVOLUTION +resolución I-EVOLUTION +completa I-EVOLUTION +del I-EVOLUTION +cuadro. I-EVOLUTION +Han I-EVOLUTION +transcurrido I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +5 I-EVOLUTION +meses I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +ingesta I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +precisado I-EVOLUTION +nuevas I-EVOLUTION +dilataciones I-EVOLUTION +esofágicas I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +19 I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +intervenida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +atresia I-PRESENT_ILLNESS +esofágica I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +long-gap, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +realización I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gastrostomía I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mismo I-PRESENT_ILLNESS +acto I-PRESENT_ILLNESS +quirúrgico. I-PRESENT_ILLNESS +A B-TREATMENT +los I-TREATMENT +2 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +(4 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +vida) I-TREATMENT +requiere I-TREATMENT +dilatación I-TREATMENT +esofágica I-TREATMENT +con I-TREATMENT +balón I-TREATMENT +hidroneumático I-TREATMENT +por I-TREATMENT +estenosis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +anastomótica. I-TREATMENT +Tras I-TREATMENT +una I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +inicial I-TREATMENT +se I-TREATMENT +produjo I-TREATMENT +una I-TREATMENT +reestenosis I-TREATMENT +a I-TREATMENT +las I-TREATMENT +4 I-TREATMENT +semanas I-TREATMENT +motivo I-TREATMENT +por I-TREATMENT +el I-TREATMENT +que I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +una I-TREATMENT +segunda I-TREATMENT +dilatación. I-TREATMENT +Desde I-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +hicieron I-TREATMENT +dilataciones I-TREATMENT +sucesivas I-TREATMENT +con I-TREATMENT +una I-TREATMENT +periodicidad I-TREATMENT +que I-TREATMENT +oscila I-TREATMENT +entre I-TREATMENT +4 I-TREATMENT +y I-TREATMENT +8 I-TREATMENT +semanas I-TREATMENT +(excepto I-TREATMENT +en I-TREATMENT +una I-TREATMENT +ocasión I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +dilatación I-TREATMENT +a I-TREATMENT +las I-TREATMENT +2 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +previa I-TREATMENT +y I-TREATMENT +otra I-TREATMENT +ocasión I-TREATMENT +en I-TREATMENT +que I-TREATMENT +no I-TREATMENT +precisó I-TREATMENT +dilataciones I-TREATMENT +por I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +reestenosis I-TREATMENT +en I-TREATMENT +un I-TREATMENT +periodo I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +meses). I-TREATMENT +Además B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +marcada I-PAST_MEDICAL_HISTORY +traqueomalacia I-PAST_MEDICAL_HISTORY +asociada, I-PAST_MEDICAL_HISTORY +lo B-TREATMENT +que I-TREATMENT +condicionaba I-TREATMENT +una I-TREATMENT +intubación I-TREATMENT +nasotraqueal I-TREATMENT +compleja I-TREATMENT +y I-TREATMENT +ciertos I-TREATMENT +problemas I-TREATMENT +en I-TREATMENT +la I-TREATMENT +extubación I-TREATMENT +tras I-TREATMENT +cada I-TREATMENT +proceso I-TREATMENT +de I-TREATMENT +dilatación I-TREATMENT +esofágica. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +14 I-TREATMENT +dilataciones I-TREATMENT +hidroneumáticas I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +sesión I-TREATMENT +de I-TREATMENT +MC I-TREATMENT +(con I-TREATMENT +2 I-TREATMENT +años I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +vida). I-TREATMENT +Se B-EVOLUTION +produjo I-EVOLUTION +una I-EVOLUTION +respuesta I-EVOLUTION +muy I-EVOLUTION +favorable I-EVOLUTION +pues I-EVOLUTION +tras I-EVOLUTION +una I-EVOLUTION +sesión, I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +precisado I-EVOLUTION +nuevas I-EVOLUTION +dilataciones I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +19 I-EVOLUTION +meses I-EVOLUTION +ni I-EVOLUTION +ha I-EVOLUTION +mostrado I-EVOLUTION +ningún I-EVOLUTION +tipo I-EVOLUTION +de I-EVOLUTION +clínica I-EVOLUTION +digestiva I-EVOLUTION +ni I-EVOLUTION +respiratoria I-EVOLUTION +en I-EVOLUTION +este I-EVOLUTION +periodo. I-EVOLUTION + I-EVOLUTION +Análisis B-TREATMENT +de I-TREATMENT +la I-TREATMENT +serie I-TREATMENT + I-TREATMENT +En I-TREATMENT +total I-TREATMENT +se I-TREATMENT +han I-TREATMENT +puesto I-TREATMENT +5 I-TREATMENT +prótesis I-TREATMENT +en I-TREATMENT +4 I-TREATMENT +pacientes I-TREATMENT +(en I-TREATMENT +1 I-TREATMENT +caso I-TREATMENT +se I-TREATMENT +han I-TREATMENT +usado I-TREATMENT +2 I-TREATMENT +prótesis). I-TREATMENT +Se B-EVOLUTION +ha I-EVOLUTION +conseguido I-EVOLUTION +el I-EVOLUTION +objetivo I-EVOLUTION +de I-EVOLUTION +solucionar I-EVOLUTION +la I-EVOLUTION +estenosis I-EVOLUTION +en I-EVOLUTION +2 I-EVOLUTION +casos, I-EVOLUTION +ha I-EVOLUTION +habido I-EVOLUTION +respuesta I-EVOLUTION +parcial I-EVOLUTION +temporal I-EVOLUTION +en I-EVOLUTION +3 I-EVOLUTION +casos I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +paciente I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +clínico I-EVOLUTION +(por I-EVOLUTION +presentar I-EVOLUTION +una I-EVOLUTION +úlcera I-EVOLUTION +esofágica). I-EVOLUTION +Tres I-EVOLUTION +han I-EVOLUTION +sido I-EVOLUTION +customizadas I-EVOLUTION +y I-EVOLUTION +2 I-EVOLUTION +comercializadas I-EVOLUTION +(todas I-EVOLUTION +del I-EVOLUTION +menor I-EVOLUTION +calibre I-EVOLUTION +23/18/23). I-EVOLUTION +Tres I-EVOLUTION +han I-EVOLUTION +sido I-EVOLUTION +no I-EVOLUTION +recubiertas, I-EVOLUTION +una I-EVOLUTION +parcialmente I-EVOLUTION +cubierta I-EVOLUTION +y I-EVOLUTION +otra I-EVOLUTION +completamente I-EVOLUTION +cubierta. I-EVOLUTION +De I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +fístulas I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +efectiva I-EVOLUTION +la I-EVOLUTION +de I-EVOLUTION +prótesis I-EVOLUTION +cubierta I-EVOLUTION +y I-EVOLUTION +falló I-EVOLUTION +la I-EVOLUTION +parcialmente I-EVOLUTION +cubierta. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +analizar I-EVOLUTION +las I-EVOLUTION +complicaciones I-EVOLUTION +observadas I-EVOLUTION +con I-EVOLUTION +las I-EVOLUTION +PD I-EVOLUTION +hemos I-EVOLUTION +visto I-EVOLUTION +como I-EVOLUTION +la I-EVOLUTION +más I-EVOLUTION +frecuente I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +significativo I-EVOLUTION +(necesidad I-EVOLUTION +de I-EVOLUTION +analgesia I-EVOLUTION +mantenida I-EVOLUTION +más I-EVOLUTION +de I-EVOLUTION +5 I-EVOLUTION +días) I-EVOLUTION +en I-EVOLUTION +2 I-EVOLUTION +casos I-EVOLUTION +(2/5, I-EVOLUTION +40%), I-EVOLUTION +hiperplasia I-EVOLUTION +grave I-EVOLUTION +(que I-EVOLUTION +ha I-EVOLUTION +requerido I-EVOLUTION +dilatación I-EVOLUTION +específica I-EVOLUTION +en I-EVOLUTION +2 I-EVOLUTION +casos I-EVOLUTION +(2/5, I-EVOLUTION +40%), I-EVOLUTION +hiperplasia I-EVOLUTION +leve I-EVOLUTION +(no I-EVOLUTION +precisa I-EVOLUTION +dilatación) I-EVOLUTION +en I-EVOLUTION +2 I-EVOLUTION +casos I-EVOLUTION +(2/5, I-EVOLUTION +40%), I-EVOLUTION +migración I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +prótesis I-EVOLUTION +en I-EVOLUTION +1 I-EVOLUTION +caso I-EVOLUTION +(1/5, I-EVOLUTION +20%), I-EVOLUTION +aunque I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +recolocar I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +úlcera I-EVOLUTION +penetrante I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +borde I-EVOLUTION +superior I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +prótesis I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +paciente I-EVOLUTION +(1/5, I-EVOLUTION +20%). I-EVOLUTION +Todas I-EVOLUTION +han I-EVOLUTION +podido I-EVOLUTION +ser I-EVOLUTION +resueltas I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +conservadora. I-EVOLUTION + I-EVOLUTION +Con I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +MC I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +hecho I-EVOLUTION +5 I-EVOLUTION +terapias I-EVOLUTION +en I-EVOLUTION +6 I-EVOLUTION +enfermos, I-EVOLUTION +con I-EVOLUTION +2 I-EVOLUTION +en I-EVOLUTION +4 I-EVOLUTION +enfermos I-EVOLUTION +y I-EVOLUTION +1 I-EVOLUTION +sesión I-EVOLUTION +en I-EVOLUTION +uno. I-EVOLUTION +Se I-EVOLUTION +ha I-EVOLUTION +solucionado I-EVOLUTION +la I-EVOLUTION +estenosis I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +definitiva I-EVOLUTION +en I-EVOLUTION +3 I-EVOLUTION +casos I-EVOLUTION +(60%) I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +otros I-EVOLUTION +dos I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +efectiva I-EVOLUTION +(40%). I-EVOLUTION + I-EVOLUTION +No I-EVOLUTION +hemos I-EVOLUTION +detectado I-EVOLUTION +efectos I-EVOLUTION +secundarios I-EVOLUTION +al I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +MC. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +tiempo I-EVOLUTION +medio I-EVOLUTION +dedicado I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +técnica I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +MC I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +de I-EVOLUTION +28, I-EVOLUTION +7 I-EVOLUTION +minutos I-EVOLUTION +(16-75). I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +cuanto I-EVOLUTION +al I-EVOLUTION +cómputo I-EVOLUTION +total I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +serie I-EVOLUTION +manejando I-EVOLUTION +ambas I-EVOLUTION +técnicas, I-EVOLUTION +podemos I-EVOLUTION +decir I-EVOLUTION +que I-EVOLUTION +hemos I-EVOLUTION +solucionado I-EVOLUTION +las I-EVOLUTION +estenosis I-EVOLUTION +en I-EVOLUTION +5 I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +casos I-EVOLUTION +de I-EVOLUTION +EER I-EVOLUTION +(83,3%) I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +1 I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +fístulas I-EVOLUTION +(50%); I-EVOLUTION +la I-EVOLUTION +fístula I-EVOLUTION +que I-EVOLUTION +fracasó I-EVOLUTION +tuvo I-EVOLUTION +que I-EVOLUTION +reintervenirse. I-EVOLUTION +De I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +fracasos I-EVOLUTION +uno I-EVOLUTION +presenta I-EVOLUTION +un I-EVOLUTION +cierre I-EVOLUTION +completo I-EVOLUTION +esofágico I-EVOLUTION +que I-EVOLUTION +ha I-EVOLUTION +obligado I-EVOLUTION +a I-EVOLUTION +replantear I-EVOLUTION +cirugía I-EVOLUTION +reparadora I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +otro I-EVOLUTION +persiste I-EVOLUTION +con I-EVOLUTION +dieta I-EVOLUTION +oral I-EVOLUTION +mediante I-EVOLUTION +dilataciones I-EVOLUTION +quincenales. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +casos I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +prótesis I-EVOLUTION +o I-EVOLUTION +mitomicina I-EVOLUTION +final I-EVOLUTION +(último I-EVOLUTION +caso I-EVOLUTION +incluido) I-EVOLUTION +osciló I-EVOLUTION +entre I-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +y I-EVOLUTION +2 I-EVOLUTION +años. I-EVOLUTION + I-EVOLUTION + +Lactante B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipotonía I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +respiratoria, I-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +origen. I-PRESENT_ILLNESS +Durante B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +fiebre, I-EXPLORATION +deposiciones I-EXPLORATION +líquidas, I-EXPLORATION +hipoglucemia I-EXPLORATION +sintomática I-EXPLORATION +con I-EXPLORATION +clonias I-EXPLORATION +de I-EXPLORATION +extremidades I-EXPLORATION +de I-EXPLORATION +menos I-EXPLORATION +de I-EXPLORATION +30 I-EXPLORATION +segundos I-EXPLORATION +de I-EXPLORATION +duración I-EXPLORATION +y I-EXPLORATION +nistagmo, I-EXPLORATION +acidosis I-EXPLORATION +metabólica, I-EXPLORATION +hiperlactacidemia I-EXPLORATION +y I-EXPLORATION +coagulopatía I-EXPLORATION +moderada I-EXPLORATION +con I-EXPLORATION +sangrado I-EXPLORATION +digestivo. I-EXPLORATION +Sufrió B-EVOLUTION +deterioro I-EVOLUTION +hemodinámico I-EVOLUTION +progresivo I-EVOLUTION +hasta I-EVOLUTION +situación I-EVOLUTION +de I-EVOLUTION +shock, I-EVOLUTION +precisando I-EVOLUTION +expansión I-EVOLUTION +volumétrica I-EVOLUTION +y I-EVOLUTION +administración I-EVOLUTION +de I-EVOLUTION +dopamina, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +cefotaxima I-EVOLUTION +y I-EVOLUTION +clindamicina I-EVOLUTION +tras I-EVOLUTION +objetivar I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +procalcitonina I-EVOLUTION +(59, I-EVOLUTION +1 I-EVOLUTION +ng/ml). I-EVOLUTION +Ante B-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +shock I-DERIVED_FROM/TO +séptico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +origen I-DERIVED_FROM/TO +entérico, I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +trasladado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +primeras I-DERIVED_FROM/TO +24 I-DERIVED_FROM/TO +horas I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro, I-DERIVED_FROM/TO +ingresando I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cuidados I-DERIVED_FROM/TO +Críticos I-DERIVED_FROM/TO +Pediátricos. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +prematuridad I-PAST_MEDICAL_HISTORY +tardía I-PAST_MEDICAL_HISTORY +(34 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +gestacional), I-PAST_MEDICAL_HISTORY +alimentación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fórmula I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +ganancia I-PAST_MEDICAL_HISTORY +ponderoestatural, I-PAST_MEDICAL_HISTORY +refiriendo I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +frecuentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +llanto, I-PAST_MEDICAL_HISTORY +considerados I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cólico. I-PAST_MEDICAL_HISTORY +Recibía I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +producto I-PAST_MEDICAL_HISTORY +homeopático I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +contenía I-PAST_MEDICAL_HISTORY +Argentum I-PAST_MEDICAL_HISTORY +nitricum I-PAST_MEDICAL_HISTORY +D5, I-PAST_MEDICAL_HISTORY +Chamomilla I-PAST_MEDICAL_HISTORY +D1, I-PAST_MEDICAL_HISTORY +China I-PAST_MEDICAL_HISTORY +D3 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Cuprum I-PAST_MEDICAL_HISTORY +aceticum I-PAST_MEDICAL_HISTORY +D4, I-PAST_MEDICAL_HISTORY +infusiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +manzanilla I-PAST_MEDICAL_HISTORY +adquiridas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +farmacia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +paracetamol I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +puntual, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +adecuada. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +palidez I-EXPLORATION +cutánea, I-EXPLORATION +sangrado I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +puntos I-EXPLORATION +de I-EXPLORATION +punción I-EXPLORATION +y I-EXPLORATION +capilaritis, I-EXPLORATION +distensión I-EXPLORATION +abdominal, I-EXPLORATION +hepatomegalia I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm, I-EXPLORATION +irritabilidad, I-EXPLORATION +hiperexcitabilidad I-EXPLORATION +y I-EXPLORATION +discreto I-EXPLORATION +nistagmo I-EXPLORATION +horizontal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +fallo I-EXPLORATION +hepático I-EXPLORATION +agudo I-EXPLORATION +con I-EXPLORATION +hipertransaminasemia I-EXPLORATION +(aspartato I-EXPLORATION +aminotransferasa I-EXPLORATION +[AST] I-EXPLORATION +812 I-EXPLORATION +U/l, I-EXPLORATION +alanino I-EXPLORATION +aminotransferasa I-EXPLORATION +[ALT] I-EXPLORATION +1002 I-EXPLORATION +U/l), I-EXPLORATION +coagulopatía I-EXPLORATION +grave I-EXPLORATION +(actividad I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +22%, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +tromboplastina I-EXPLORATION +parcial I-EXPLORATION +activada I-EXPLORATION +[TTPa] I-EXPLORATION +59 I-EXPLORATION +segundos, I-EXPLORATION +factor I-EXPLORATION +V I-EXPLORATION +Leiden I-EXPLORATION +34%, I-EXPLORATION +plaquetas I-EXPLORATION +86.000/μl), I-EXPLORATION +administrándose I-EXPLORATION +vitamina I-EXPLORATION +K I-EXPLORATION +y I-EXPLORATION +plasma. I-EXPLORATION +Presentó I-EXPLORATION +hipoglucemia I-EXPLORATION +(27 I-EXPLORATION +mg/dl) I-EXPLORATION +con I-EXPLORATION +cetonemia I-EXPLORATION +negativa, I-EXPLORATION +acidosis I-EXPLORATION +metabólica I-EXPLORATION +moderada I-EXPLORATION +(pH I-EXPLORATION +7, I-EXPLORATION +25, I-EXPLORATION +bicarbonato I-EXPLORATION +13 I-EXPLORATION +mmol/l, I-EXPLORATION +exceso I-EXPLORATION +de I-EXPLORATION +bases I-EXPLORATION +-12, I-EXPLORATION +7 I-EXPLORATION +mmol/l), I-EXPLORATION +precisando I-EXPLORATION +elevado I-EXPLORATION +aporte I-EXPLORATION +endovenoso I-EXPLORATION +de I-EXPLORATION +glucosa I-EXPLORATION +(14 I-EXPLORATION +mg/kg/min) I-EXPLORATION +y I-EXPLORATION +bicarbonato. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +y I-EXPLORATION +directa, I-EXPLORATION +amonio I-EXPLORATION +y I-EXPLORATION +albúmina I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Presentó B-TREATMENT +febrícula I-TREATMENT +las I-TREATMENT +primeras I-TREATMENT +72 I-TREATMENT +horas, I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +proteína I-TREATMENT +C I-TREATMENT +reactiva I-TREATMENT +(56 I-TREATMENT +mg/l) I-TREATMENT +y I-TREATMENT +procalcitonina I-TREATMENT +(88 I-TREATMENT +ng/ml), I-TREATMENT +sustituyéndose I-TREATMENT +la I-TREATMENT +antibioterapia I-TREATMENT +por I-TREATMENT +piperacilina-tazobactam I-TREATMENT +ante I-TREATMENT +probable I-TREATMENT +clínica I-TREATMENT +infecciosa I-TREATMENT +entérica, I-TREATMENT +ampliándose I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +etiológico I-TREATMENT +infeccioso. I-TREATMENT +La B-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +mostró I-EXPLORATION +ascitis I-EXPLORATION +y I-EXPLORATION +peristaltismo I-EXPLORATION +aumentado I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +intestinales, I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +hepáticas. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +insuficiencia I-TREATMENT +hepática I-TREATMENT +aguda I-TREATMENT +grave I-TREATMENT +con I-TREATMENT +sospecha I-TREATMENT +inicial I-TREATMENT +de I-TREATMENT +enfermedad I-TREATMENT +metabólica I-TREATMENT +descompensada, I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +despistaje I-TREATMENT +metabólico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +N-acetilcisteina, I-TREATMENT +y I-TREATMENT +NTBC I-TREATMENT +(2-[2-nitro-4-trifluorometibenzoil]-1-3-ciclohexanediona) I-TREATMENT +así I-TREATMENT +como I-TREATMENT +dieta I-TREATMENT +exenta I-TREATMENT +de I-TREATMENT +tirosina I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +presunción I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +tirosinemia. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +objetivó I-EVOLUTION +mejoría I-EVOLUTION +neurológica, I-EVOLUTION +hemodinámica, I-EVOLUTION +infecciosa I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +función I-EVOLUTION +hepática I-EVOLUTION +progresivas, I-EVOLUTION +presentando I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +60 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +actividad I-EVOLUTION +de I-EVOLUTION +protrombina I-EVOLUTION +del I-EVOLUTION +82%, I-EVOLUTION +AST I-EVOLUTION +148 I-EVOLUTION +U/l I-EVOLUTION +y I-EVOLUTION +ALT I-EVOLUTION +684 I-EVOLUTION +U/l. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +infeccioso I-EXPLORATION +ampliado I-EXPLORATION +resultó I-EXPLORATION +negativo, I-EXPLORATION +incluidos I-EXPLORATION +virus I-EXPLORATION +hepatotropos I-EXPLORATION +(VHA, I-EXPLORATION +VHB I-EXPLORATION +y I-EXPLORATION +VHC), I-EXPLORATION +influenzae I-EXPLORATION +(A, I-EXPLORATION +B), I-EXPLORATION +perfil I-EXPLORATION +TORCH, I-EXPLORATION +citoquímica I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +virales I-EXPLORATION +en I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo I-EXPLORATION +(LCR), I-EXPLORATION +y I-EXPLORATION +cultivos I-EXPLORATION +(sangre, I-EXPLORATION +LCR, I-EXPLORATION +orina, I-EXPLORATION +heces). I-EXPLORATION +También I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +hepático I-EXPLORATION +autoinmune. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +metabólico I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +excreción I-EXPLORATION +elevada I-EXPLORATION +de I-EXPLORATION +ácido I-EXPLORATION +homovanílico, I-EXPLORATION +ligeramente I-EXPLORATION +elevada I-EXPLORATION +de I-EXPLORATION +vanilmandélico I-EXPLORATION +y I-EXPLORATION +4-hidroxifenilpirúvico I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +hipoaminoacidemia. I-EXPLORATION +La I-EXPLORATION +espectometría I-EXPLORATION +de I-EXPLORATION +masas I-EXPLORATION +en I-EXPLORATION +tándem, I-EXPLORATION +alfafetoproteína I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +succinilacetona I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +reevaluó I-EXPLORATION +la I-EXPLORATION +anamnesis, I-EXPLORATION +registrándose I-EXPLORATION +la I-EXPLORATION +ingesta I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +mantenida I-EXPLORATION +durante I-EXPLORATION +los I-EXPLORATION +últimos I-EXPLORATION +dos I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +infusión I-EXPLORATION +elaborada I-EXPLORATION +con I-EXPLORATION +dos I-EXPLORATION +cucharadas I-EXPLORATION +de I-EXPLORATION +manzanilla, I-EXPLORATION +una I-EXPLORATION +estrella I-EXPLORATION +de I-EXPLORATION +anís I-EXPLORATION +estrellado I-EXPLORATION +(Illicium I-EXPLORATION +verum) I-EXPLORATION +y I-EXPLORATION +dos I-EXPLORATION +granos I-EXPLORATION +de I-EXPLORATION +matalahúva I-EXPLORATION +(anís I-EXPLORATION +verde I-EXPLORATION +o I-EXPLORATION +Pimpinella I-EXPLORATION +anisum) I-EXPLORATION +en I-EXPLORATION +500 I-EXPLORATION +ml I-EXPLORATION +de I-EXPLORATION +agua, I-EXPLORATION +con I-EXPLORATION +ingesta I-EXPLORATION +diaria I-EXPLORATION +de I-EXPLORATION +250 I-EXPLORATION +ml. I-EXPLORATION +Se B-EVOLUTION +contactó I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Información I-EVOLUTION +Toxicológica, I-EVOLUTION +que I-EVOLUTION +recomendó I-EVOLUTION +determinar I-EVOLUTION +la I-EVOLUTION +posible I-EVOLUTION +existencia I-EVOLUTION +de I-EVOLUTION +contaminación I-EVOLUTION +con I-EVOLUTION +Illicium I-EVOLUTION +anisatum, I-EVOLUTION +de I-EVOLUTION +conocido I-EVOLUTION +efecto I-EVOLUTION +tóxico, I-EVOLUTION +que I-EVOLUTION +justificara I-EVOLUTION +el I-EVOLUTION +cuadro I-EVOLUTION +clínico I-EVOLUTION +mediante I-EVOLUTION +un I-EVOLUTION +sencillo I-EVOLUTION +procedimiento I-EVOLUTION +que I-EVOLUTION +sugiere I-EVOLUTION +su I-EVOLUTION +presencia: I-EVOLUTION +a B-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +de I-EXPLORATION +estrella I-EXPLORATION +de I-EXPLORATION +anís I-EXPLORATION +estrellado I-EXPLORATION +se I-EXPLORATION +añadieron I-EXPLORATION +3 I-EXPLORATION +ml I-EXPLORATION +de I-EXPLORATION +alcohol I-EXPLORATION +96o I-EXPLORATION +y, I-EXPLORATION +tras I-EXPLORATION +hervir I-EXPLORATION +y I-EXPLORATION +filtrar, I-EXPLORATION +se I-EXPLORATION +añadieron I-EXPLORATION +al I-EXPLORATION +líquido I-EXPLORATION +obtenido I-EXPLORATION +cinco I-EXPLORATION +gotas I-EXPLORATION +de I-EXPLORATION +agua. I-EXPLORATION +La I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +turbidez I-EXPLORATION +sugirió I-EXPLORATION +la I-EXPLORATION +contaminación I-EXPLORATION +con I-EXPLORATION +Illicium I-EXPLORATION +anisatum. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +fue I-EVOLUTION +satisfactoria I-EVOLUTION +con I-EVOLUTION +recuperación I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +analítica I-EVOLUTION +completa I-EVOLUTION +del I-EVOLUTION +paciente. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +boliviana B-PAST_MEDICAL_HISTORY +de B-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Fue B-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Chagas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Madrid, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +serología I-PRESENT_ILLNESS +positiva I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +IgG I-PRESENT_ILLNESS +Trypanosoma I-PRESENT_ILLNESS +cruzi, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +seguimiento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Málaga. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +abdominales I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +estreñimiento, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +empeora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +refractario I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +uso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +laxantes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +enemas, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +recurriendo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +desimpactaciones I-PRESENT_ILLNESS +manuales. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +prolapso I-PRESENT_ILLNESS +rectal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +maniobra I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Valsalva I-PRESENT_ILLNESS +intensa, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +reducido I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +cirujanos I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +complicaciones I-PRESENT_ILLNESS +inmediatas. I-PRESENT_ILLNESS +Tras I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +agudo, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +enema I-PRESENT_ILLNESS +opaco I-PRESENT_ILLNESS +objetivándose I-PRESENT_ILLNESS +dilatación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +colon I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +recto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +cm. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +difuso, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +asociados. I-PRESENT_ILLNESS +Se B-EXPLORATION +objetiva I-EXPLORATION +mediante I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +un I-EXPLORATION +vólvulo I-EXPLORATION +colónico, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +resolvió I-EXPLORATION +sin I-EXPLORATION +incidencias I-EXPLORATION +con I-EXPLORATION +endoscopia I-EXPLORATION +descompresiva. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +ambulatoria I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +epigastralgia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +esofagogastroduodenoscopia I-EXPLORATION +evidenció I-EXPLORATION +gastritis I-EXPLORATION +nodular I-EXPLORATION +antral. I-EXPLORATION +Las I-EXPLORATION +biopsias I-EXPLORATION +de I-EXPLORATION +antro I-EXPLORATION +reportaron I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +difusa I-EXPLORATION +no I-EXPLORATION +atrófica, I-EXPLORATION +activa I-EXPLORATION +grave, I-EXPLORATION +con I-EXPLORATION +plasmocitos I-EXPLORATION +y I-EXPLORATION +cuerpos I-EXPLORATION +de I-EXPLORATION +Russell I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +bacilos I-EXPLORATION +Helicobacter I-EXPLORATION +pylori I-EXPLORATION +(HP) I-EXPLORATION ++++/+++. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +inmunohistoquímica I-EXPLORATION +con I-EXPLORATION +CD138 I-EXPLORATION +demostraron I-EXPLORATION +reactividad I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +citoplasmáticas I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +cadenas I-EXPLORATION +livianas I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +Kappa I-EXPLORATION +y I-EXPLORATION +Lambda, I-EXPLORATION +confirmando I-EXPLORATION +el I-EXPLORATION +diagnostico I-EXPLORATION +de I-EXPLORATION +GCR. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +suministró I-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +HP, I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +presentó I-TREATMENT +resolución I-TREATMENT +de I-TREATMENT +su I-TREATMENT +sintomatología. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +realizó I-EVOLUTION +control I-EVOLUTION +endoscópico I-EVOLUTION +e I-EVOLUTION +histopatológico I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +nueve I-EVOLUTION +meses I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +se I-EVOLUTION +evidenció I-EVOLUTION +marcada I-EVOLUTION +mejoría I-EVOLUTION +con I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +estudio I-EVOLUTION +previo. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +2007 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +presentación I-PRESENT_ILLNESS +episódica. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +crónico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cannabis I-PAST_MEDICAL_HISTORY +inhalado I-PAST_MEDICAL_HISTORY +(10-15 I-PAST_MEDICAL_HISTORY +porros I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día). I-PAST_MEDICAL_HISTORY +Mediante B-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +es I-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +pinza I-EXPLORATION +aortomesentérica I-EXPLORATION +tanto I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +tercera I-EXPLORATION +porción I-EXPLORATION +duodenal I-EXPLORATION +como I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +renal I-EXPLORATION +izquierda I-EXPLORATION +que B-TREATMENT +no I-TREATMENT +mejora I-TREATMENT +con I-TREATMENT +la I-TREATMENT +ganancia I-TREATMENT +ponderal, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +(duodeno-yeyunostomía I-TREATMENT +en I-TREATMENT +septiembre I-TREATMENT +de I-TREATMENT +2009). I-TREATMENT +Posteriormente B-EVOLUTION +los I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +continúan I-EVOLUTION +sin I-EVOLUTION +cambios I-EVOLUTION +pese I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +resolución I-EVOLUTION +radiológica I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +alteraciones I-EVOLUTION +anatómicas. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +crisis I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +con I-EXPLORATION +asistencia I-EXPLORATION +a I-EXPLORATION +Urgencias I-EXPLORATION +se I-EXPLORATION +objetivan I-EXPLORATION +ecográficamente I-EXPLORATION +varias I-EXPLORATION +invaginaciones I-EXPLORATION +intestinales I-EXPLORATION +en I-EXPLORATION +diferentes I-EXPLORATION +localizaciones I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +resuelven I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +conservadora. I-EXPLORATION +En I-EXPLORATION +otras I-EXPLORATION +múltiples I-EXPLORATION +exploraciones I-EXPLORATION +realizadas I-EXPLORATION +en I-EXPLORATION +periodos I-EXPLORATION +asintomáticos I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +patología I-EXPLORATION +intestinal I-EXPLORATION +que I-EXPLORATION +justifique I-EXPLORATION +el I-EXPLORATION +cuadro. I-EXPLORATION +Durante B-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +en I-EVOLUTION +consultas, I-EVOLUTION +y I-EVOLUTION +coincidiendo I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +abandono I-EVOLUTION +del I-EVOLUTION +consumo I-EVOLUTION +de I-EVOLUTION +cannabis, I-EVOLUTION +los I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +vómitos I-EVOLUTION +desaparecen I-EVOLUTION +por I-EVOLUTION +completo, I-EVOLUTION +pudiendo I-EVOLUTION +ser I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +completamente I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +adenocarcinoma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vejiga, I-PRESENT_ILLNESS +tratado I-PRESENT_ILLNESS +mediante I-PRESENT_ILLNESS +derivación I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +Mainz I-PRESENT_ILLNESS +II. I-PRESENT_ILLNESS +Durante B-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +una I-TREATMENT +colonoscopia I-TREATMENT +posterior, I-TREATMENT +se I-TREATMENT +extirparon I-TREATMENT +dos I-TREATMENT +lesiones I-TREATMENT +polipoides I-TREATMENT +sesiles, I-TREATMENT +que I-TREATMENT +resultaron I-TREATMENT +ser I-TREATMENT +granulomas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ureterosigmoidostomía. I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +apareció I-EVOLUTION +una I-EVOLUTION +dilatación I-EVOLUTION +ureteral I-EVOLUTION +y I-EVOLUTION +estenosis I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +anastomosis I-EVOLUTION +del I-EVOLUTION +uréter I-EVOLUTION +izquierdo I-EVOLUTION +a I-EVOLUTION +consecuencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cicatrización I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +"polipectomía". I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +combinado I-TREATMENT +uro-endoscópico I-TREATMENT +en I-TREATMENT +quirófano I-TREATMENT +y I-TREATMENT +radioguiado: I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +nefrostomía I-TREATMENT +izquierda, I-TREATMENT +se I-TREATMENT +pasó I-TREATMENT +una I-TREATMENT +guía I-TREATMENT +radio-opaca I-TREATMENT +que I-TREATMENT +atravesó I-TREATMENT +el I-TREATMENT +estoma I-TREATMENT +estenosado I-TREATMENT +y I-TREATMENT +apareció I-TREATMENT +en I-TREATMENT +sigma. I-TREATMENT +Por I-TREATMENT +endoscopia, I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +guía, I-TREATMENT +se I-TREATMENT +aplicó I-TREATMENT +un I-TREATMENT +balón I-TREATMENT +de I-TREATMENT +dilatación I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +mm I-TREATMENT +Ø, I-TREATMENT +sin I-TREATMENT +conseguir I-TREATMENT +un I-TREATMENT +aumento I-TREATMENT +significativo I-TREATMENT +del I-TREATMENT +calibre I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT +Finalmente, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +ampliar I-TREATMENT +la I-TREATMENT +estenosis I-TREATMENT +utilizando I-TREATMENT +un I-TREATMENT +esfinterótomo I-TREATMENT +convencional, I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +consiguió I-TREATMENT +una I-TREATMENT +apertura I-TREATMENT +significativa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +anastomosis I-TREATMENT +comprobando I-TREATMENT +débito I-TREATMENT +de I-TREATMENT +suero I-TREATMENT +salino. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +muy I-EVOLUTION +satisfactoria. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diaforesis I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +g I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hachís I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +transporte I-PRESENT_ILLNESS +ilegal, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +custodiado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Policía I-PRESENT_ILLNESS +Nacional I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +toda I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +estancia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hospital. I-PRESENT_ILLNESS +En B-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +dos I-EXPLORATION +cuerpos I-EXPLORATION +extraños I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +íleon, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +obstrucción I-EXPLORATION +mecánica I-EXPLORATION +sin I-EXPLORATION +perforación, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +expulsaron I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +espontánea I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +horas, I-EXPLORATION +confirmándose I-EXPLORATION +su I-EXPLORATION +naturaleza I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +específico. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +horas I-EXPLORATION +se I-EXPLORATION +describía I-EXPLORATION +otro I-EXPLORATION +cuerpo I-EXPLORATION +extraño I-EXPLORATION +en I-EXPLORATION +antro I-EXPLORATION +gástrico, I-EXPLORATION +no I-EXPLORATION +objetivado I-EXPLORATION +previamente, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +endoscopia I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +extracción I-TREATMENT +mediante I-TREATMENT +cesta I-TREATMENT +de I-TREATMENT +Dormia I-TREATMENT +de I-TREATMENT +un I-TREATMENT +tercer I-TREATMENT +paquete I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +cm, I-TREATMENT +morfología I-TREATMENT +redondeada I-TREATMENT +y I-TREATMENT +consistencia I-TREATMENT +semidura. I-TREATMENT +El B-EVOLUTION +procedimiento I-EVOLUTION +se I-EVOLUTION +llevó I-EVOLUTION +a I-EVOLUTION +cabo I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +bajo I-EVOLUTION +sedación I-EVOLUTION +profunda I-EVOLUTION +por I-EVOLUTION +anestesista. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +trasplantado B-PAST_MEDICAL_HISTORY +hepático, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +inmunosupresor I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +esteroides I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tacrolimus, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +trasplante I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +intervenido I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +neoplasia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +colon I-PRESENT_ILLNESS +obstructiva I-PRESENT_ILLNESS +realizándose B-TREATMENT +resección. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +bien I-EXPLORATION +diferenciado I-EXPLORATION +con I-EXPLORATION +infiltración I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +perirrectal, I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +márgenes I-EXPLORATION +quirúrgicos I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +ganglios I-EXPLORATION +linfáticos. I-EXPLORATION +Tras B-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +modificó I-TREATMENT +la I-TREATMENT +inmunosupresión I-TREATMENT +introduciendo I-TREATMENT +everolimus. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +se I-EVOLUTION +detectaron I-EVOLUTION +metástasis I-EVOLUTION +hepáticas I-EVOLUTION +en I-EVOLUTION +segmentos I-EVOLUTION +IV I-EVOLUTION +y I-EVOLUTION +VII. I-EVOLUTION +Se B-TREATMENT +intervino I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +realizando I-TREATMENT +una I-TREATMENT +hepatectomía I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +una I-TREATMENT +ablación I-TREATMENT +por I-TREATMENT +microondas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +metástasis I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +VII. I-TREATMENT +Tras B-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +está I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +controlada. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +intervenida B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colon, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +recidiva I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carcinomatosis I-PAST_MEDICAL_HISTORY +peritoneal, I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +quimioterapia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cirugía, I-PAST_MEDICAL_HISTORY +utilizando I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cierre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +pared I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +malla I-PAST_MEDICAL_HISTORY +biológica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Permacol™. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +2015, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +nueva I-PRESENT_ILLNESS +recidiva I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fondo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +saco I-PRESENT_ILLNESS +recto-vesical I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +infiltración I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +recto, I-PRESENT_ILLNESS +vejiga I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cúpula I-PRESENT_ILLNESS +vaginal, I-PRESENT_ILLNESS +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +exenteración I-TREATMENT +pélvica I-TREATMENT +con I-TREATMENT +reconstrucción I-TREATMENT +vaginal I-TREATMENT +y I-TREATMENT +derivación I-TREATMENT +urinaria I-TREATMENT +tipo I-TREATMENT +Bricker I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +malla. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +se I-EVOLUTION +objetivó I-EVOLUTION +fístula I-EVOLUTION +urinaria I-EVOLUTION +del I-EVOLUTION +asa I-EVOLUTION +ileal, I-EVOLUTION +secundaria I-EVOLUTION +al I-EVOLUTION +decúbito I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +malla. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +endoscopia I-EXPLORATION +del I-EXPLORATION +asa I-EXPLORATION +del I-EXPLORATION +Bricker, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +orificio I-EXPLORATION +fistuloso I-EXPLORATION +con I-EXPLORATION +fondo I-EXPLORATION +blanquecino I-EXPLORATION +a I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ileostomía I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +malla, I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +el I-EXPLORATION +50% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +circunferencia. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +colocación I-TREATMENT +endoscópica I-TREATMENT +de I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +metálica I-TREATMENT +cubierta I-TREATMENT +(Hanarostent® I-TREATMENT +Colon/Rectum) I-TREATMENT +de I-TREATMENT +100 I-TREATMENT +mm I-TREATMENT +x I-TREATMENT +20 I-TREATMENT +mm, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +sin I-TREATMENT +incidencias I-TREATMENT +tras I-TREATMENT +12 I-TREATMENT +semanas, I-TREATMENT +objetivándose I-TREATMENT +resolución I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fístula. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +permanencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +prótesis I-EVOLUTION +fue I-EVOLUTION +más I-EVOLUTION +prolongada I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +recomendada, I-EVOLUTION +dada I-EVOLUTION +nuestra I-EVOLUTION +experiencia I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fístula. I-EVOLUTION +A I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +posibilidad I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +malla, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +sin I-EVOLUTION +recurrencia, I-EVOLUTION +probablemente I-EVOLUTION +por I-EVOLUTION +formación I-EVOLUTION +de I-EVOLUTION +tejido I-EVOLUTION +fibroso I-EVOLUTION +perifístula. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +dislipemia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +suprarrenalectomía I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +hipertrofia I-PAST_MEDICAL_HISTORY +macronodular I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +glándulas I-PAST_MEDICAL_HISTORY +suprarrenales. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +losartán I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hidroclorotiazida, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +sustitutivo I-PAST_MEDICAL_HISTORY +hormonal, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hidrocortisona I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +mg/24 I-PAST_MEDICAL_HISTORY +horas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fludrocortisona I-PAST_MEDICAL_HISTORY +0, I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +mg/24 I-PAST_MEDICAL_HISTORY +horas. I-PAST_MEDICAL_HISTORY +Presenta B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nueve I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pancreatitis I-PRESENT_ILLNESS +aguda I-PRESENT_ILLNESS +recidivante, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +manifiesta I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +agudos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +autolimitan I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +4-5 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dieta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +analgésico. I-PRESENT_ILLNESS +Durante B-EXPLORATION +su I-EXPLORATION +primer I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +perfil I-EXPLORATION +hepático I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +lipídico I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +elevación I-EXPLORATION +del I-EXPLORATION +colesterol I-EXPLORATION +(225 I-EXPLORATION +mg/dL) I-EXPLORATION +y I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +TG I-EXPLORATION +normales, I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +colangio-RMN, I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +objetivan I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar, I-EXPLORATION +colelitiasis I-EXPLORATION +ni I-EXPLORATION +lesiones I-EXPLORATION +pancreáticas I-EXPLORATION +o I-EXPLORATION +biliares, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +cataloga I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +aguda I-EXPLORATION +idiopática. I-EXPLORATION +Posteriormente I-EXPLORATION +presenta I-EXPLORATION +nuevos I-EXPLORATION +episodios I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +periodicidad I-EXPLORATION +de I-EXPLORATION +entre I-EXPLORATION +siete I-EXPLORATION +meses I-EXPLORATION +y I-EXPLORATION +tres I-EXPLORATION +años, I-EXPLORATION +realizándose I-EXPLORATION +en I-EXPLORATION +este I-EXPLORATION +tiempo I-EXPLORATION +estudios I-EXPLORATION +analíticos I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +que I-EXPLORATION +incluyen I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +colangio-RMN, I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +ecoendoscopia I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +identifica I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pancreatitis. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +últimos I-EXPLORATION +dos I-EXPLORATION +años I-EXPLORATION +la I-EXPLORATION +periodicidad I-EXPLORATION +se I-EXPLORATION +reduce, I-EXPLORATION +con I-EXPLORATION +episodios I-EXPLORATION +cada I-EXPLORATION +6-7 I-EXPLORATION +meses, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +repite I-EXPLORATION +nuevamente I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +estudio, I-EXPLORATION +objetivándose I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +colangio-RMN I-EXPLORATION +realizada I-EXPLORATION +un I-EXPLORATION +remanente I-EXPLORATION +de I-EXPLORATION +glándula I-EXPLORATION +suprarrenal I-EXPLORATION +que I-EXPLORATION +plantea I-EXPLORATION +el I-EXPLORATION +posible I-EXPLORATION +origen I-EXPLORATION +tóxico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pancreatitis, I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +corticoterapia I-EXPLORATION +crónica I-EXPLORATION +e I-EXPLORATION +hiperproducción I-EXPLORATION +endógena I-EXPLORATION +de I-EXPLORATION +corticoides. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +estudio I-EXPLORATION +hormonal I-EXPLORATION +con I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +cortisol I-EXPLORATION +de I-EXPLORATION +25, I-EXPLORATION +7 I-EXPLORATION +mcg/dL, I-EXPLORATION +ACTH I-EXPLORATION +y I-EXPLORATION +cortisol I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +normales, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +reduce I-EXPLORATION +la I-EXPLORATION +dosis I-EXPLORATION +de I-EXPLORATION +corticoterapia I-EXPLORATION +sustitutiva I-EXPLORATION +a I-EXPLORATION +hidrocortisona I-EXPLORATION +10 I-EXPLORATION +mg I-EXPLORATION +al I-EXPLORATION +día, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +van I-EXPLORATION +reduciendo I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +progresiva I-EXPLORATION +hasta I-EXPLORATION +su I-EXPLORATION +suspensión. I-EXPLORATION +Además, B-TREATMENT +ante I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +origen I-TREATMENT +farmacológico I-TREATMENT +se I-TREATMENT +cambia I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antihipertensivo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +asociación I-TREATMENT +de I-TREATMENT +losartán I-TREATMENT +e I-TREATMENT +hidroclorotiazida I-TREATMENT +a I-TREATMENT +ramipril I-TREATMENT +en I-TREATMENT +monoterapia. I-TREATMENT +Se B-EXPLORATION +completa I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +con I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +IG4 I-EXPLORATION +y I-EXPLORATION +ANA I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +normales, I-EXPLORATION +test I-EXPLORATION +del I-EXPLORATION +sudor I-EXPLORATION +y I-EXPLORATION +test I-EXPLORATION +genético I-EXPLORATION +para I-EXPLORATION +fibrosis I-EXPLORATION +quística I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +negativos. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +modificación I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +ingresar I-EVOLUTION +por I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +pancreatitis I-EVOLUTION +aguda I-EVOLUTION +leve. I-EVOLUTION +Se I-EVOLUTION +interroga I-EVOLUTION +nuevamente I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +paciente, I-EVOLUTION +quien I-EVOLUTION +finalmente I-EVOLUTION +refiere I-EVOLUTION +consumir I-EVOLUTION +infusiones I-EVOLUTION +de I-EVOLUTION +cola I-EVOLUTION +de I-EVOLUTION +caballo I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +habitual. I-EVOLUTION +Ante I-EVOLUTION +la I-EVOLUTION +posibilidad I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +pancreatitis I-EVOLUTION +recidivante I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +toma I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +infusión, I-EVOLUTION +se I-EVOLUTION +suspende I-EVOLUTION +por I-EVOLUTION +completo I-EVOLUTION +la I-EVOLUTION +misma. I-EVOLUTION +Desde I-EVOLUTION +entonces, I-EVOLUTION +14 I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +asintomática I-EVOLUTION +con I-EVOLUTION +controles I-EVOLUTION +ecográficos I-EVOLUTION +normales. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +casos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pseudodiverticulosis I-PRESENT_ILLNESS +yeyunal I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +debutaron I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +abdomen I-PRESENT_ILLNESS +agudo. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +primero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ellos, I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +obstrucción I-PRESENT_ILLNESS +intestinal. I-PRESENT_ILLNESS +El B-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +sugiere I-EXPLORATION +brida I-EXPLORATION +o I-EXPLORATION +hernia I-EXPLORATION +interna, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +cirugía. I-EXPLORATION +En B-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +lugar, I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +90 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +El B-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +objetiva I-EXPLORATION +causa I-EXPLORATION +obstructiva. I-EXPLORATION +Tras B-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +de I-TREATMENT +manejo I-TREATMENT +conservador I-TREATMENT +sufre I-TREATMENT +empeoramiento. I-TREATMENT +Se I-TREATMENT +objetiva I-TREATMENT +neumoperitoneo I-TREATMENT +en I-TREATMENT +TC I-TREATMENT +abdominal, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +cirugía. I-TREATMENT +Por B-PRESENT_ILLNESS +último, I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +El B-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +informa I-EXPLORATION +perforación I-EXPLORATION +de I-EXPLORATION +divertículo I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +es I-TREATMENT +llevado I-TREATMENT +a I-TREATMENT +quirófano. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +primeros I-EXPLORATION +casos I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +causa I-EXPLORATION +obstructiva I-EXPLORATION +en I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +pseudodivertículos I-EXPLORATION +yeyunales I-EXPLORATION +proximalmente; I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segundo I-EXPLORATION +y I-EXPLORATION +tercer I-EXPLORATION +caso, I-EXPLORATION +con I-EXPLORATION +perforación I-EXPLORATION +de I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +estos. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +resección I-TREATMENT +intestinal I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +afecto I-TREATMENT +y I-TREATMENT +anastomosis I-TREATMENT +primaria. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +cursó I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +falsos I-EXPLORATION +divertículos I-EXPLORATION +en I-EXPLORATION +yeyuno, I-EXPLORATION +en I-EXPLORATION +dos I-EXPLORATION +casos I-EXPLORATION +perforados, I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +malignidad. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cirrosis I-PRESENT_ILLNESS +hepática I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +VHC I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +seguimiento I-PRESENT_ILLNESS +estrecho I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Hepatología I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +2000. I-PRESENT_ILLNESS +Estaba B-PAST_MEDICAL_HISTORY +infectado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +genotipo I-PAST_MEDICAL_HISTORY +1b I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antiviral I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +pasado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +rechazo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +parte I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +recibir I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +interferón. I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +relevantes I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +intervención I-PAST_MEDICAL_HISTORY +quirúrgica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ductus I-PAST_MEDICAL_HISTORY +arterioso I-PAST_MEDICAL_HISTORY +persistente, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +paroxística, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +colocación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +stents I-PAST_MEDICAL_HISTORY +coronarios I-PAST_MEDICAL_HISTORY +convencionales I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2004 I-PAST_MEDICAL_HISTORY +indicados I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +recambio I-PAST_MEDICAL_HISTORY +valvular I-PAST_MEDICAL_HISTORY +aórtico I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2013 I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +prótesis I-PAST_MEDICAL_HISTORY +metálica, I-PAST_MEDICAL_HISTORY +requiriendo I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +anticoagulación I-PAST_MEDICAL_HISTORY +oral I-PAST_MEDICAL_HISTORY +(Eliquis®). I-PAST_MEDICAL_HISTORY +Además, I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2007 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +2013 I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +accidentes I-PAST_MEDICAL_HISTORY +cerebrovasculares I-PAST_MEDICAL_HISTORY +agudos I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +secuelas I-PAST_MEDICAL_HISTORY +posteriores I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +afectación I-PAST_MEDICAL_HISTORY +moderada. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +mayo I-EXPLORATION +de I-EXPLORATION +2014, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +cribado I-EXPLORATION +de I-EXPLORATION +hepatocarcinoma, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +hepática I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +25 I-EXPLORATION +x I-EXPLORATION +17 I-EXPLORATION +milímetros I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +VI I-EXPLORATION +hepático I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +hepatocelular. I-EXPLORATION +Se B-TREATMENT +optó I-TREATMENT +por I-TREATMENT +realizar I-TREATMENT +ablación I-TREATMENT +mediante I-TREATMENT +radiofrecuencia I-TREATMENT +como I-TREATMENT +tratamiento, I-TREATMENT +lográndose I-TREATMENT +respuesta I-TREATMENT +completa I-TREATMENT +radiológica I-TREATMENT +en I-TREATMENT +la I-TREATMENT +resonancia I-TREATMENT +magnética I-TREATMENT +realizada I-TREATMENT +cuatro I-TREATMENT +semanas I-TREATMENT +tras I-TREATMENT +el I-TREATMENT +tratamiento. I-TREATMENT +Se B-EVOLUTION +sometió I-EVOLUTION +al I-EVOLUTION +paciente I-EVOLUTION +a I-EVOLUTION +continuación I-EVOLUTION +a I-EVOLUTION +seguimiento I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +radiológico I-EVOLUTION +realizando I-EVOLUTION +pruebas I-EVOLUTION +de I-EVOLUTION +imagen I-EVOLUTION +cada I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +sin I-EVOLUTION +objetivarse I-EVOLUTION +recidiva I-EVOLUTION +tumoral. I-EVOLUTION +En B-TREATMENT +mayo I-TREATMENT +de I-TREATMENT +2015, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +antiviral I-TREATMENT +con I-TREATMENT +ledipasvir/sofosbuvir I-TREATMENT +90/400 I-TREATMENT +mg I-TREATMENT +(Harvoni®) I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +12 I-TREATMENT +semanas, I-TREATMENT +tras I-TREATMENT +documentarse I-TREATMENT +la I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +enfermedad I-TREATMENT +tumoral I-TREATMENT +mediante I-TREATMENT +una I-TREATMENT +resonancia I-TREATMENT +magnética I-TREATMENT +hepática I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +empezar I-TREATMENT +el I-TREATMENT +tratamiento. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +finalizó I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +eventos I-EVOLUTION +adversos I-EVOLUTION +ni I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +logrando I-EVOLUTION +alcanzar I-EVOLUTION +respuesta I-EVOLUTION +virológica I-EVOLUTION +sostenida I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +12 I-EVOLUTION +y I-EVOLUTION +24 I-EVOLUTION +semanas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +finalizar I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +octubre I-EXPLORATION +de I-EXPLORATION +2015 I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +hepática I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +hepático I-EXPLORATION +tratado I-EXPLORATION +con I-EXPLORATION +radiofrecuencia I-EXPLORATION +sin I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +datos I-EXPLORATION +que I-EXPLORATION +orientaran I-EXPLORATION +a I-EXPLORATION +recidiva I-EXPLORATION +tumoral. I-EXPLORATION +No I-EXPLORATION +obstante, I-EXPLORATION +tres I-EXPLORATION +meses I-EXPLORATION +después I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +resonancia I-EXPLORATION +magnética, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +aparecieron I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +hipointensas I-EXPLORATION +en I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +ligeramente I-EXPLORATION +hiperintensas I-EXPLORATION +en I-EXPLORATION +T2 I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +hepático, I-EXPLORATION +algunas I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cuales I-EXPLORATION +presentaban I-EXPLORATION +realce I-EXPLORATION +periférico I-EXPLORATION +en I-EXPLORATION +anillo, I-EXPLORATION +siendo I-EXPLORATION +sugerentes I-EXPLORATION +como I-EXPLORATION +primera I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +hepáticas. I-EXPLORATION +La I-EXPLORATION +zona I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +VI I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +había I-EXPLORATION +aplicado I-EXPLORATION +radiofrecuencia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pasado I-EXPLORATION +se I-EXPLORATION +mantenía I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +radiológicos I-EXPLORATION +de I-EXPLORATION +recidiva I-EXPLORATION +tumoral. I-EXPLORATION +En I-EXPLORATION +ese I-EXPLORATION +momento, I-EXPLORATION +la I-EXPLORATION +hipótesis I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +posible I-EXPLORATION +recidiva I-EXPLORATION +tumoral I-EXPLORATION +de I-EXPLORATION +comportamiento I-EXPLORATION +agresivo I-EXPLORATION +del I-EXPLORATION +hepatocarcinoma I-EXPLORATION +previo I-EXPLORATION +era I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +diagnósticos I-EXPLORATION +más I-EXPLORATION +probables, I-EXPLORATION +aunque I-EXPLORATION +el I-EXPLORATION +comportamiento I-EXPLORATION +radiológico I-EXPLORATION +también I-EXPLORATION +hacía I-EXPLORATION +sospechar I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +tratara I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +primario I-EXPLORATION +no I-EXPLORATION +conocido I-EXPLORATION +y I-EXPLORATION +originado I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +extrahepático. I-EXPLORATION +Por I-EXPLORATION +ello, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +punción-aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +hepáticas I-EXPLORATION +para I-EXPLORATION +análisis I-EXPLORATION +citológico, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +mostró I-EXPLORATION +células I-EXPLORATION +metastásicas I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +neuroendocrino I-EXPLORATION +de I-EXPLORATION +célula I-EXPLORATION +pequeña I-EXPLORATION +(CD56+; I-EXPLORATION +sinaptofisina+ I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +a I-EXPLORATION +continuación I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +cérvico-tóraco-abdominal I-EXPLORATION +para I-EXPLORATION +completar I-EXPLORATION +el I-EXPLORATION +estudio, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +lesiones I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +dorsales I-EXPLORATION +y I-EXPLORATION +lumbosacros, I-EXPLORATION +siendo I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +metastásica. I-EXPLORATION +La I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +realizadas I-EXPLORATION +posteriormente I-EXPLORATION +confirmaron I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tomografía. I-EXPLORATION + I-EXPLORATION +Hasta I-EXPLORATION +la I-EXPLORATION +fecha, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +logrado I-EXPLORATION +encontrar I-EXPLORATION +la I-EXPLORATION +localización I-EXPLORATION +primaria I-EXPLORATION +del I-EXPLORATION +tumor, I-EXPLORATION +si I-EXPLORATION +bien I-EXPLORATION +la I-EXPLORATION +hipótesis I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +microcítico I-EXPLORATION +de I-EXPLORATION +pulmón I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +metastásica I-EXPLORATION +es I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +más I-EXPLORATION +probable. I-EXPLORATION +En B-TREATMENT +el I-TREATMENT +momento I-TREATMENT +actual I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +está I-TREATMENT +recibiendo I-TREATMENT +quimioterapia I-TREATMENT +basada I-TREATMENT +en I-TREATMENT +un I-TREATMENT +régimen I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +carboplatino I-TREATMENT +y I-TREATMENT +etopósido I-TREATMENT +y I-TREATMENT +ha I-TREATMENT +recibido I-TREATMENT +radioterapia I-TREATMENT +paliativa I-TREATMENT +para I-TREATMENT +control I-TREATMENT +del I-TREATMENT +dolor I-TREATMENT +secundario I-TREATMENT +a I-TREATMENT +las I-TREATMENT +metástasis I-TREATMENT +óseas I-TREATMENT +de I-TREATMENT +columna, I-TREATMENT +presentando I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínica. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +tóraco-abdominal I-EXPLORATION +realizada I-EXPLORATION +seis I-EXPLORATION +meses I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +comenzar I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +quimioterápico I-EXPLORATION +han I-EXPLORATION +desaparecido I-EXPLORATION +la I-EXPLORATION +mayoría I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +hepáticas I-EXPLORATION +y I-EXPLORATION +óseas I-EXPLORATION +metastásicas, I-EXPLORATION +persistiendo I-EXPLORATION +solo I-EXPLORATION +algunos I-EXPLORATION +nódulos I-EXPLORATION +milimétricos I-EXPLORATION +hepáticos. I-EXPLORATION +Dada B-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +respuesta, I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +reiniciado I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +ciclo I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +oncológico I-EVOLUTION +cuyos I-EVOLUTION +resultados I-EVOLUTION +serán I-EVOLUTION +evaluados I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +futuro I-EVOLUTION +próximo. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +85 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colelitiasis I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +espalda, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hematoquecia. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +leucocitosis I-EXPLORATION +(14.300, I-EXPLORATION +neutrófilos I-EXPLORATION +84, I-EXPLORATION +5%), I-EXPLORATION +hemoglobina I-EXPLORATION +7 I-EXPLORATION +g/dl, I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +179 I-EXPLORATION +mg/l, I-EXPLORATION +amilasa I-EXPLORATION +648 I-EXPLORATION +U/l, I-EXPLORATION +lipasa I-EXPLORATION +1.417 I-EXPLORATION +U/l I-EXPLORATION +y I-EXPLORATION +patrón I-EXPLORATION +colestático. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +vesicular, I-EXPLORATION +con I-EXPLORATION +colelitiasis I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cola I-EXPLORATION +pancreática. I-EXPLORATION +Dado I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +HDA I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +anemia I-EXPLORATION +continuaron, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +angio-TC I-EXPLORATION +abdominal, I-EXPLORATION +visualizándose I-EXPLORATION +una I-EXPLORATION +estructura I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +lobulados I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vesícula, I-EXPLORATION +hiperdensa I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +arterial, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +cambiaba I-EXPLORATION +su I-EXPLORATION +morfología I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +venoso, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +pseudoaneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +cística. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +final I-EXPLORATION +fue I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +pancreatitis I-EXPLORATION +aguda I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +hemobilia I-EXPLORATION +por I-EXPLORATION +sangrado I-EXPLORATION +de I-EXPLORATION +pseudoaneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +cística. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +embolización I-TREATMENT +con B-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente. I-EVOLUTION + I-EVOLUTION + +En B-PRESENT_ILLNESS +primer I-PRESENT_ILLNESS +lugar, I-PRESENT_ILLNESS +presentamos I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +retroesternal, I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +oC. I-PRESENT_ILLNESS +La B-EXPLORATION +endoscopia I-EXPLORATION +oral I-EXPLORATION +mostraba I-EXPLORATION +erosiones I-EXPLORATION +longitudinales I-EXPLORATION +profundas, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +irregulares I-EXPLORATION +y I-EXPLORATION +sobreelevados, I-EXPLORATION +desde I-EXPLORATION +esófago I-EXPLORATION +medio I-EXPLORATION +hasta I-EXPLORATION +distal. I-EXPLORATION +Se B-TREATMENT +pautó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +aciclovir I-TREATMENT +por I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +EH I-TREATMENT +que I-TREATMENT +se I-TREATMENT +confirmó I-TREATMENT +histológicamente. I-TREATMENT +Además, B-EXPLORATION +el I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +eosinófilos I-EXPLORATION +en I-EXPLORATION +esófago I-EXPLORATION +proximal I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +> I-EXPLORATION +15 I-EXPLORATION +por I-EXPLORATION +campo, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +EEo. I-EXPLORATION +La I-EXPLORATION +endoscopia I-EXPLORATION +de I-EXPLORATION +revisión I-EXPLORATION +al I-EXPLORATION +mes I-EXPLORATION +de I-EXPLORATION +finalizar I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +mantenía I-EXPLORATION +signos I-EXPLORATION +endoscópicos I-EXPLORATION +e I-EXPLORATION +histológicos I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +EEo I-EXPLORATION +sin I-EXPLORATION +aislarse I-EXPLORATION +VHS-I. I-EXPLORATION + I-EXPLORATION +Asimismo, B-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +asma, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +broncodilatador, I-PAST_MEDICAL_HISTORY +corticoideo I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +antibiótico, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +aguda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +oral I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +ulcerada I-EXPLORATION +longitudinal I-EXPLORATION +subcentimétrica I-EXPLORATION +en I-EXPLORATION +cardias, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +presentaba I-EXPLORATION +inclusiones I-EXPLORATION +de I-EXPLORATION +Cowdry I-EXPLORATION +tipo I-EXPLORATION +A I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +EH. I-EXPLORATION +Histológicamente, I-EXPLORATION +coexistían I-EXPLORATION +una I-EXPLORATION +candidiasis I-EXPLORATION +esofágica I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +EEo. I-EXPLORATION +A B-TREATMENT +las I-TREATMENT +ocho I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +finalizar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +fluconazol, I-TREATMENT +aciclovir I-TREATMENT +y I-TREATMENT +pantoprazol I-TREATMENT +habían B-EVOLUTION +desaparecido I-EVOLUTION +las I-EVOLUTION +alteraciones I-EVOLUTION +sugestivas I-EVOLUTION +de I-EVOLUTION +esofagitis I-EVOLUTION +infecciosa, I-EVOLUTION +persistiendo I-EVOLUTION +las I-EVOLUTION +compatibles I-EVOLUTION +con I-EVOLUTION +EEo. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +inmunológico I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +pacientes. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +sugerente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +colangitis. I-PRESENT_ILLNESS +Durante B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +colangio-RMN I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +litiasis I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +7 I-EXPLORATION +mm I-EXPLORATION +enclavada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +colédoco, I-EXPLORATION +a I-EXPLORATION +unos I-EXPLORATION +4, I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +papila, I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intra I-EXPLORATION +y I-EXPLORATION +extrahepática. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +CPRE I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +consiguió I-EXPLORATION +canular I-EXPLORATION +la I-EXPLORATION +papila I-EXPLORATION +de I-EXPLORATION +Vater. I-EXPLORATION +Dos I-EXPLORATION +días I-EXPLORATION +después, I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ictericia, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +CPRE I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +coágulo I-EXPLORATION +fresco I-EXPLORATION +cubriendo I-EXPLORATION +la I-EXPLORATION +papila. I-EXPLORATION +Tras I-EXPLORATION +retirarlo, I-EXPLORATION +se I-EXPLORATION +accedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar, I-EXPLORATION +observando I-EXPLORATION +el I-EXPLORATION +cálculo I-EXPLORATION +descrito I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +colangiorresonancia, I-EXPLORATION +que B-TREATMENT +fue I-TREATMENT +extraído I-TREATMENT +tras I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +esfinterotomía I-TREATMENT +biliar. I-TREATMENT +Finalmente, I-TREATMENT +se I-TREATMENT +inyectó I-TREATMENT +adrenalina I-TREATMENT +diluida I-TREATMENT +en I-TREATMENT +la I-TREATMENT +papila, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +continuaba I-TREATMENT +con I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +hemorragia I-TREATMENT +reciente. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +alta, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +acudió I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +al I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencias I-EVOLUTION +por I-EVOLUTION +fiebre, I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +astenia I-EVOLUTION +intensa. I-EVOLUTION +Analíticamente, B-EXPLORATION +destacaba I-EXPLORATION +Hb I-EXPLORATION +8, I-EXPLORATION +6 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +(Hto) I-EXPLORATION +27, I-EXPLORATION +2%, I-EXPLORATION +leucocitos I-EXPLORATION +10.000 I-EXPLORATION +U/ml I-EXPLORATION +con I-EXPLORATION +68% I-EXPLORATION +de I-EXPLORATION +polimorfonucleares, I-EXPLORATION +plaquetas I-EXPLORATION +627.000 I-EXPLORATION +U/ml, I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C-reactiva I-EXPLORATION +(PCR) I-EXPLORATION +187, I-EXPLORATION +4 I-EXPLORATION +mg/l. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +ocupante I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +(LOE) I-EXPLORATION +hepática I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +10 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +segmento I-EXPLORATION +III, I-EXPLORATION +con I-EXPLORATION +características I-EXPLORATION +ecográficas I-EXPLORATION +de I-EXPLORATION +absceso. I-EXPLORATION +Se I-EXPLORATION +intentó I-EXPLORATION +el I-EXPLORATION +drenaje I-EXPLORATION +percutáneo, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +posible I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +material I-EXPLORATION +obtenido I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +Enterobacter I-EXPLORATION +cloacae. I-EXPLORATION + I-EXPLORATION +Una I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +antibiótico I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +descrita I-EXPLORATION +previamente, I-EXPLORATION +que I-EXPLORATION +correspondía I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +hematoma I-EXPLORATION +hepático. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +fiebre I-TREATMENT +elevada I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +Fr. I-TREATMENT + I-TREATMENT +Tras B-EVOLUTION +el I-EVOLUTION +drenaje, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +asintomática, I-EVOLUTION +apirética I-EVOLUTION +y I-EVOLUTION +hemodinámicamente I-EVOLUTION +estable. I-EVOLUTION +Se B-EXPLORATION +realizaron I-EXPLORATION +ecografías I-EXPLORATION +abdominales I-EXPLORATION +semanales I-EXPLORATION +para I-EXPLORATION +control I-EXPLORATION +evolutivo I-EXPLORATION +del I-EXPLORATION +hematoma I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +la I-EXPLORATION +disminución I-EXPLORATION +progresiva I-EXPLORATION +del I-EXPLORATION +mismo. I-EXPLORATION +Tras B-EVOLUTION +seis I-EVOLUTION +semanas, I-EVOLUTION +se I-EVOLUTION +retiró I-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +sin I-EVOLUTION +observar I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pancreatitis I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +calcificante I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +reagudizaciones I-PAST_MEDICAL_HISTORY +frecuentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +enólico. I-PAST_MEDICAL_HISTORY +Tras B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +abundante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alcohol I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cinturón I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +aumenta I-PRESENT_ILLNESS +progresivamente. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +pálido, I-EXPLORATION +sudoroso I-EXPLORATION +y I-EXPLORATION +taquicárdico. I-EXPLORATION +Palpación I-EXPLORATION +abdominal I-EXPLORATION +dolorosa I-EXPLORATION +en I-EXPLORATION +epigastrio I-EXPLORATION +e I-EXPLORATION +hipocondrios. I-EXPLORATION +En I-EXPLORATION +estudio I-EXPLORATION +analítico I-EXPLORATION +destacan I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +8 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +del I-EXPLORATION +23, I-EXPLORATION +5% I-EXPLORATION +y I-EXPLORATION +amilasa I-EXPLORATION +aumentada I-EXPLORATION +(338 I-EXPLORATION +U/l). I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +intravenoso I-EXPLORATION +en I-EXPLORATION +fases I-EXPLORATION +arterial I-EXPLORATION +tardía I-EXPLORATION +y I-EXPLORATION +portal I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +páncreas I-EXPLORATION +atrófico I-EXPLORATION +con I-EXPLORATION +calcificaciones I-EXPLORATION +dispersas, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +pseudoquiste I-EXPLORATION +en I-EXPLORATION +hilio I-EXPLORATION +esplénico, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +cara I-EXPLORATION +visceral I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +del I-EXPLORATION +bazo. I-EXPLORATION +Produce I-EXPLORATION +una I-EXPLORATION +sección I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +que I-EXPLORATION +comunica I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +hematoma I-EXPLORATION +subcapsular. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +punción-drenaje I-TREATMENT +guiado I-TREATMENT +por I-TREATMENT +TC I-TREATMENT +del I-TREATMENT +hematoma I-TREATMENT +periesplénico, I-TREATMENT +evolucionando B-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +favorable. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +polivalvulopatía I-PAST_MEDICAL_HISTORY +reumática I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +epigastrio I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +hacia I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +espalda I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cinturón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +ictericia, I-PRESENT_ILLNESS +coluria, I-PRESENT_ILLNESS +acolia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +(38, I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +oC). I-PRESENT_ILLNESS +En B-EXPLORATION +analítica I-EXPLORATION +muestra I-EXPLORATION +amilasa I-EXPLORATION +2.126 I-EXPLORATION +U/l, I-EXPLORATION +ALT I-EXPLORATION +124 I-EXPLORATION +U/l, I-EXPLORATION +AST I-EXPLORATION +169 I-EXPLORATION +U/l, I-EXPLORATION +GGT I-EXPLORATION +3.548 I-EXPLORATION +U/l, I-EXPLORATION +FA I-EXPLORATION +1.516 I-EXPLORATION +U/l, I-EXPLORATION +BrT I-EXPLORATION +12, I-EXPLORATION +2 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +BrD I-EXPLORATION +9, I-EXPLORATION +1 I-EXPLORATION +mg/dl. I-EXPLORATION +En I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +colelitiasis I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +(DVB) I-EXPLORATION +extrahepática I-EXPLORATION +y I-EXPLORATION +cambios I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +PAL. I-EXPLORATION +Ingresa B-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +colangitis I-TREATMENT +aguda I-TREATMENT +y I-TREATMENT +PAL, I-TREATMENT +iniciándose I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +piperazilina-tazobactam. I-TREATMENT +Al B-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +aparecen I-EVOLUTION +en I-EVOLUTION +ambas I-EVOLUTION +piernas I-EVOLUTION +nódulos I-EVOLUTION +subcutáneos I-EVOLUTION +dolorosos I-EVOLUTION +y I-EVOLUTION +eritematosos, I-EVOLUTION +compatibles I-EVOLUTION +histológicamente I-EVOLUTION +con I-EVOLUTION +PP. I-EVOLUTION +Los B-EXPLORATION +hemocultivos I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +R. I-EXPLORATION +planticola I-EXPLORATION +sensible I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +instaurado. I-EXPLORATION +En I-EXPLORATION +colangio-resonancia I-EXPLORATION +magnética I-EXPLORATION +(RNM) I-EXPLORATION +se I-EXPLORATION +descartan I-EXPLORATION +DVB I-EXPLORATION +y I-EXPLORATION +coledocolitiasis. I-EXPLORATION +Ante B-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +colestasis I-EVOLUTION +y I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +patología I-EVOLUTION +obstructiva, I-EVOLUTION +y I-EVOLUTION +asumiendo I-EVOLUTION +la I-EVOLUTION +salida I-EVOLUTION +espontánea I-EVOLUTION +de I-EVOLUTION +coledocoliatiasis, I-EVOLUTION +se I-EVOLUTION +decide I-EVOLUTION +no I-EVOLUTION +realizar I-EVOLUTION +CPRE. I-EVOLUTION +Al I-EVOLUTION +decimoprimer I-EVOLUTION +día I-EVOLUTION +se I-EVOLUTION +da I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +por I-EVOLUTION +buena I-EVOLUTION +evolución. I-EVOLUTION + I-EVOLUTION + +En B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Crohn I-PAST_MEDICAL_HISTORY +colónica I-PAST_MEDICAL_HISTORY +se B-PRESENT_ILLNESS +sospechó I-PRESENT_ILLNESS +afectación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ID I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +indicó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +CE. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +síntomas I-EXPLORATION +que I-EXPLORATION +hicieron I-EXPLORATION +sospechar I-EXPLORATION +una I-EXPLORATION +estenosis, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +comprobar I-EXPLORATION +antes I-EXPLORATION +la I-EXPLORATION +permeabilidad I-EXPLORATION +intestinal I-EXPLORATION +mediante I-EXPLORATION +una I-EXPLORATION +cápsula I-EXPLORATION +Agile®. I-EXPLORATION +Aproximadamente B-EVOLUTION +30 I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +administración I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +intenso I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal, I-EVOLUTION +distensión I-EVOLUTION +y I-EVOLUTION +vómitos. I-EVOLUTION +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC), I-EXPLORATION +diagnosticándose I-EXPLORATION +una I-EXPLORATION +obstrucción I-EXPLORATION +intestinal I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +impactación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Agile® I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +ileal, I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +asas I-EXPLORATION +proximales I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +paredes. I-EXPLORATION +A B-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +mejoró I-TREATMENT +con I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +analgesia I-TREATMENT +y I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +sonda I-TREATMENT +nasogástrica, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +intervenirla, I-TREATMENT +objetivándose I-TREATMENT +la I-TREATMENT +estenosis I-TREATMENT +ileal I-TREATMENT +con I-TREATMENT +un I-TREATMENT +discreto I-TREATMENT +edema I-TREATMENT +de I-TREATMENT +asas I-TREATMENT +proximales, I-TREATMENT +ya I-TREATMENT +sin I-TREATMENT +dilatación I-TREATMENT +de I-TREATMENT +las I-TREATMENT +mismas. I-TREATMENT +Se I-TREATMENT +resecó I-TREATMENT +el I-TREATMENT +segmento I-TREATMENT +afecto I-TREATMENT +y I-TREATMENT +no I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +la I-TREATMENT +cápsula I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +intervención. I-TREATMENT + I-TREATMENT + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +diarreicas, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +kg. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +23.660 I-EXPLORATION +leucocitos I-EXPLORATION +y I-EXPLORATION +colonoscopia I-EXPLORATION +con I-EXPLORATION +pancolitis I-EXPLORATION +moderada I-EXPLORATION +por I-EXPLORATION +CU. I-EXPLORATION +Precozmente I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +hemorragia I-EXPLORATION +digestiva I-EXPLORATION +alta, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +gastroscopia I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +afectación I-EXPLORATION +continua I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +gástrica, I-EXPLORATION +pérdida I-EXPLORATION +del I-EXPLORATION +patrón I-EXPLORATION +vascular I-EXPLORATION +y I-EXPLORATION +pliegues, I-EXPLORATION +exudado I-EXPLORATION +mucoso, I-EXPLORATION +friabilidad I-EXPLORATION +y I-EXPLORATION +erosiones I-EXPLORATION +en I-EXPLORATION +duodeno. I-EXPLORATION +Lesiones I-EXPLORATION +que I-EXPLORATION +impresionaban I-EXPLORATION +de I-EXPLORATION +CU. I-EXPLORATION +La I-EXPLORATION +anatomía-patológica I-EXPLORATION +demostró I-EXPLORATION +criptitis I-EXPLORATION +aguda, I-EXPLORATION +abscesos I-EXPLORATION +crípticos I-EXPLORATION +e I-EXPLORATION +hiperplasia I-EXPLORATION +foveolar, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +CU. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +Helicobacter I-EXPLORATION +pylori I-EXPLORATION +y I-EXPLORATION +negatividad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +técnicas I-EXPLORATION +inmunohistoquímicas I-EXPLORATION +(ácido I-EXPLORATION +peryódico I-EXPLORATION +de I-EXPLORATION +Schiff I-EXPLORATION +[PAS], I-EXPLORATION +Gram I-EXPLORATION +y I-EXPLORATION +CMV). I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +afectación I-TREATMENT +proximal I-TREATMENT +de I-TREATMENT +la I-TREATMENT +CU I-TREATMENT +se I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +corticoides I-TREATMENT +intravenosos I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +resolución I-EVOLUTION +sintomática I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +semana. I-EVOLUTION +La I-EVOLUTION +gastroscopia I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +fue I-EVOLUTION +normal. I-EVOLUTION +Actualmente, B-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +asintomático, I-TREATMENT +con I-TREATMENT +azatioprina I-TREATMENT +150 I-TREATMENT +mg/24 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +mesalazina I-TREATMENT +4 I-TREATMENT +g/24 I-TREATMENT +h. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +64 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +estudiado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +unas I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +acompañante. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +solo I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +GGT I-EXPLORATION +discretamente I-EXPLORATION +elevada I-EXPLORATION +(70 I-EXPLORATION +U/l) I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +CA I-EXPLORATION +19.9 I-EXPLORATION +de I-EXPLORATION +170 I-EXPLORATION +U/ml. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +analíticos I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +ya I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +izquierda, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +vías I-EXPLORATION +biliares I-EXPLORATION +principal I-EXPLORATION +y I-EXPLORATION +derechas I-EXPLORATION +presentaban I-EXPLORATION +características I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +practica I-EXPLORATION +una I-EXPLORATION +colangio-RMN I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +apreciar I-EXPLORATION +una I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +árbol I-EXPLORATION +biliar I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +polipoidea I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +hepático I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos. I-EXPLORATION +Previo I-EXPLORATION +a I-EXPLORATION +plantear I-EXPLORATION +un I-EXPLORATION +tratamiento I-EXPLORATION +se I-EXPLORATION +practica I-EXPLORATION +CPRE, I-EXPLORATION +que I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +izquierda I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +polipoidea I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +hepático I-EXPLORATION +izquierdo, I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +biopsiado. I-EXPLORATION +Además, B-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +plástica. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +papilar I-EXPLORATION +con I-EXPLORATION +displasia I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado. I-EXPLORATION +Se B-TREATMENT +plantea I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +practican I-TREATMENT +colecistectomía, I-TREATMENT +hepatectomía I-TREATMENT +izquierda I-TREATMENT +anatómica I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +I I-TREATMENT +y I-TREATMENT +exéresis I-TREATMENT +del I-TREATMENT +árbol I-TREATMENT +biliar I-TREATMENT +izquierdo I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +confluencia I-TREATMENT +con I-TREATMENT +el I-TREATMENT +derecho. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +intraoperatorio I-EXPLORATION +del I-EXPLORATION +borde I-EXPLORATION +de I-EXPLORATION +sección I-EXPLORATION +biliar I-EXPLORATION +no I-EXPLORATION +demuestra I-EXPLORATION +afectación. I-EXPLORATION +El B-EVOLUTION +postoperatorio I-EVOLUTION +transcurre I-EVOLUTION +sin I-EVOLUTION +incidencias I-EVOLUTION +reseñables. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +papilar I-EXPLORATION +biliar I-EXPLORATION +intraductal I-EXPLORATION +con I-EXPLORATION +foco I-EXPLORATION +de I-EXPLORATION +colangiocarcinoma I-EXPLORATION +papilar I-EXPLORATION +e I-EXPLORATION +invasivo, I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +linfática. I-EXPLORATION +Los I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +estaban I-EXPLORATION +libres. I-EXPLORATION +No B-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +tratamiento I-TREATMENT +complementario I-TREATMENT +y B-EVOLUTION +tras I-EVOLUTION +cinco I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +ingresado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +subictericia I-PRESENT_ILLNESS +cutánea-mucosa. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destaca I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +GGT I-EXPLORATION +y I-EXPLORATION +discreta I-EXPLORATION +de I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +CA I-EXPLORATION +19.9 I-EXPLORATION +de I-EXPLORATION +1.973 I-EXPLORATION +U/ml. I-EXPLORATION +Al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +caso, I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +demuestra I-EXPLORATION +una I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +caso, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +colangio-RMN I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +ver I-EXPLORATION +gran I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +árbol I-EXPLORATION +biliar I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +ocupación I-EXPLORATION +por I-EXPLORATION +material I-EXPLORATION +velloso I-EXPLORATION +y I-EXPLORATION +mucina. I-EXPLORATION +La I-EXPLORATION +CPRE I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +mucina I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ocupación I-EXPLORATION +vellosa I-EXPLORATION +del I-EXPLORATION +árbol I-EXPLORATION +biliar I-EXPLORATION +izquierdo, I-EXPLORATION +del I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +toma I-EXPLORATION +una I-EXPLORATION +biopsia, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +coloca I-EXPLORATION +una I-EXPLORATION +prótesis I-EXPLORATION +plástica. I-EXPLORATION +La I-EXPLORATION +histología I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +papilar I-EXPLORATION +intraductal I-EXPLORATION +con I-EXPLORATION +displasia I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado. I-EXPLORATION +También B-TREATMENT +se I-TREATMENT +le I-TREATMENT +plantea I-TREATMENT +tratamiento I-TREATMENT +quirúrgico, I-TREATMENT +practicando I-TREATMENT +hepatectomía I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +I I-TREATMENT +y I-TREATMENT +del I-TREATMENT +árbol I-TREATMENT +biliar I-TREATMENT +izquierdo, I-TREATMENT +colecistectomía I-TREATMENT +y I-TREATMENT +linfadenectomía I-TREATMENT +del I-TREATMENT +hilio I-TREATMENT +hepático. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +intraoperatoria I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +borde I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +biliar. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +definitivo I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +colangiocarcinoma I-EXPLORATION +con I-EXPLORATION +componente I-EXPLORATION +microinfiltrante I-EXPLORATION +aislado I-EXPLORATION +y I-EXPLORATION +focal I-EXPLORATION +en I-EXPLORATION +rama I-EXPLORATION +distal I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +III I-EXPLORATION +hepático I-EXPLORATION +con I-EXPLORATION +producción I-EXPLORATION +de I-EXPLORATION +moco. I-EXPLORATION +Tampoco B-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +tratamiento I-TREATMENT +adyuvante I-TREATMENT +y B-EVOLUTION +el I-EVOLUTION +paciente, I-EVOLUTION +tras I-EVOLUTION +cuatro I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +no I-EVOLUTION +presenta I-EVOLUTION +recidiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +CEP I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2010. I-PAST_MEDICAL_HISTORY +Tras B-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +se I-EXPLORATION +estudió I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +asociación I-EXPLORATION +con I-EXPLORATION +CU I-EXPLORATION +mediante I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +baja I-EXPLORATION +completa I-EXPLORATION +sin I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +objetivaran I-EXPLORATION +alteraciones I-EXPLORATION +macroscópicas I-EXPLORATION +ni I-EXPLORATION +histológicas. I-EXPLORATION +En B-TREATMENT +2013 I-TREATMENT +fue I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +trasplante I-TREATMENT +hepático I-TREATMENT +cadavérico I-TREATMENT +por I-TREATMENT +insuficiencia I-TREATMENT +hepatocelular I-TREATMENT +y I-TREATMENT +colangitis I-TREATMENT +de I-TREATMENT +repetición. I-TREATMENT +No B-EVOLUTION +presentó I-EVOLUTION +complicaciones I-EVOLUTION +inmediatas I-EVOLUTION +postrasplante, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +función I-EVOLUTION +del I-EVOLUTION +injerto I-EVOLUTION +y I-EVOLUTION +régimen I-EVOLUTION +de I-EVOLUTION +inmunosupresión I-EVOLUTION +basado I-EVOLUTION +en I-EVOLUTION +tacrolimus I-EVOLUTION +de I-EVOLUTION +liberación I-EVOLUTION +prolongada. I-EVOLUTION +Nueve I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +trasplante, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +debutó I-EVOLUTION +con I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +diarrea I-EVOLUTION +sanguinolenta, I-EVOLUTION +con I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +CU I-EVOLUTION +de I-EVOLUTION +localización I-EVOLUTION +extensa I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +actividad I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +endoscópica I-EVOLUTION +moderada. I-EVOLUTION +Desde I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +CU, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +cumplió I-EVOLUTION +criterios I-EVOLUTION +de I-EVOLUTION +corticodependencia. I-EVOLUTION +Ante B-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +discreta I-TREATMENT +leucopenia, I-TREATMENT +no I-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +azatioprina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +biológico I-TREATMENT +anti-TNFα I-TREATMENT +con I-TREATMENT +golimumab I-TREATMENT +subcutáneo I-TREATMENT +(dosis I-TREATMENT +de I-TREATMENT +inducción I-TREATMENT +habitual I-TREATMENT +200 I-TREATMENT +mg I-TREATMENT +sc I-TREATMENT +inicialmente, I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +a I-TREATMENT +las I-TREATMENT +dos I-TREATMENT +semanas) I-TREATMENT +y I-TREATMENT +50 I-TREATMENT +mg I-TREATMENT +mensualmente I-TREATMENT +de I-TREATMENT +mantenimiento I-TREATMENT +(peso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +61 I-TREATMENT +kg). I-TREATMENT +La I-TREATMENT +respuesta I-TREATMENT +a I-TREATMENT +golimumab I-TREATMENT +fue I-TREATMENT +solo I-TREATMENT +parcial, I-TREATMENT +precisando I-TREATMENT +de I-TREATMENT +intensificación I-TREATMENT +a I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +mensuales I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +segundo I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +no I-TREATMENT +consiguiendo I-TREATMENT +suspender I-TREATMENT +los I-TREATMENT +esteroides I-TREATMENT +orales, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +a I-TREATMENT +los I-TREATMENT +cuatro I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +golimumab I-TREATMENT +se I-TREATMENT +cambia I-TREATMENT +a I-TREATMENT +un I-TREATMENT +agente I-TREATMENT +anti-TNF I-TREATMENT +intravenoso: I-TREATMENT +infliximab I-TREATMENT +(IFX). I-TREATMENT +Tras B-EVOLUTION +iniciar I-EVOLUTION +IFX I-EVOLUTION +a I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +inducción I-EVOLUTION +convencionales I-EVOLUTION +(5 I-EVOLUTION +mg/kg I-EVOLUTION +intravenoso I-EVOLUTION +[iv], I-EVOLUTION +semanas I-EVOLUTION +0, I-EVOLUTION +2 I-EVOLUTION +y I-EVOLUTION +6), I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +alcanzó I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +ni I-EVOLUTION +suspensión I-EVOLUTION +de I-EVOLUTION +esteroides I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +tratamiento, I-EVOLUTION +pese I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +intensificación I-EVOLUTION +precoz I-EVOLUTION +(5 I-EVOLUTION +mg/kg I-EVOLUTION +iv I-EVOLUTION +cada I-EVOLUTION +cuatro I-EVOLUTION +semanas) I-EVOLUTION +a I-EVOLUTION +partir I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +quinta I-EVOLUTION +infusión. I-EVOLUTION +La B-EXPLORATION +monitorización I-EXPLORATION +de I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +IFX I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +demostró I-EXPLORATION +que I-EXPLORATION +estaban I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +terapéutico. I-EXPLORATION +Ello, I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +anti-infliximab I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +infección I-EXPLORATION +entérica I-EXPLORATION +concomitante I-EXPLORATION +o I-EXPLORATION +sobreinfección I-EXPLORATION +por I-EXPLORATION +citomegalovirus I-EXPLORATION +(CMV), I-EXPLORATION +hizo I-EXPLORATION +cambiar I-EXPLORATION +de I-EXPLORATION +diana I-EXPLORATION +terapéutica. I-EXPLORATION +En B-TREATMENT +diciembre I-TREATMENT +de I-TREATMENT +2016 I-TREATMENT +(35 I-TREATMENT +meses I-TREATMENT +después I-TREATMENT +del I-TREATMENT +trasplante), I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +vedolizumab I-TREATMENT +(VDZ), I-TREATMENT +según I-TREATMENT +pauta I-TREATMENT +de I-TREATMENT +inducción I-TREATMENT +habitual I-TREATMENT +(300 I-TREATMENT +mg I-TREATMENT +iv I-TREATMENT +en I-TREATMENT +semanas I-TREATMENT +0, I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +6), I-TREATMENT +y I-TREATMENT +mantenimiento I-TREATMENT +con I-TREATMENT +300 I-TREATMENT +mg I-TREATMENT +VDZ I-TREATMENT +iv I-TREATMENT +cada I-TREATMENT +ocho I-TREATMENT +semanas. I-TREATMENT +Justo I-TREATMENT +antes I-TREATMENT +del I-TREATMENT +inicio I-TREATMENT +de I-TREATMENT +VDZ, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +presentaba I-TREATMENT +un I-TREATMENT +índice I-TREATMENT +de I-TREATMENT +Mayo I-TREATMENT +total I-TREATMENT +de I-TREATMENT +7. I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +infusión I-EVOLUTION +se I-EVOLUTION +asistió I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +del I-EVOLUTION +hábito I-EVOLUTION +deposicional I-EVOLUTION +pero I-EVOLUTION +manteniendo I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +actividad I-EVOLUTION +biológica I-EVOLUTION +elevados I-EVOLUTION +(calprotectina I-EVOLUTION +fecal I-EVOLUTION +805 I-EVOLUTION +mcg/g I-EVOLUTION +y I-EVOLUTION +proteína I-EVOLUTION +C I-EVOLUTION +reactiva I-EVOLUTION +[PCR] I-EVOLUTION +8 I-EVOLUTION +mg/l). I-EVOLUTION +A B-TREATMENT +los I-TREATMENT +tres I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +suspender I-TREATMENT +los I-TREATMENT +esteroides, I-TREATMENT +y I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +después I-TREATMENT +de I-TREATMENT +su I-TREATMENT +retirada I-TREATMENT +fue I-TREATMENT +precisa I-TREATMENT +una I-TREATMENT +intensificación I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +VDZ, I-TREATMENT +acortando I-TREATMENT +el I-TREATMENT +intervalo I-TREATMENT +de I-TREATMENT +infusiones I-TREATMENT +a I-TREATMENT +cuatro I-TREATMENT +semanas. I-TREATMENT +Al B-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +su I-EVOLUTION +puntuación I-EVOLUTION +de I-EVOLUTION +Mayo I-EVOLUTION +total I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +4 I-EVOLUTION +(subpuntuación I-EVOLUTION +endoscópica I-EVOLUTION +1), I-EVOLUTION +la I-EVOLUTION +calprotectina I-EVOLUTION +descendió I-EVOLUTION +a I-EVOLUTION +270 I-EVOLUTION +mcg/g I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +PCR I-EVOLUTION +se I-EVOLUTION +normalizaron. I-EVOLUTION +Los I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +tacrolimus I-EVOLUTION +permanecieron I-EVOLUTION +estables, I-EVOLUTION +dentro I-EVOLUTION +del I-EVOLUTION +rango I-EVOLUTION +pretendido I-EVOLUTION +(5-10 I-EVOLUTION +ng/ml) I-EVOLUTION +y B-TREATMENT +sin I-TREATMENT +requerir I-TREATMENT +ajustes I-TREATMENT +de I-TREATMENT +dosis. I-TREATMENT +La B-EVOLUTION +bioquímica I-EVOLUTION +hepática I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +estable I-EVOLUTION +durante I-EVOLUTION +todo I-EVOLUTION +este I-EVOLUTION +periodo. I-EVOLUTION +No I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +registrado I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +fecha I-EVOLUTION +efectos I-EVOLUTION +adversos I-EVOLUTION +infecciosos I-EVOLUTION +ni I-EVOLUTION +interacciones I-EVOLUTION +farmacológicas. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +VIH, I-PAST_MEDICAL_HISTORY +estudiado B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +proctitis I-PRESENT_ILLNESS +en B-EXPLORATION +cuya I-EXPLORATION +colonoscopia I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +patológica I-EXPLORATION +con I-EXPLORATION +exudado I-EXPLORATION +purulento I-EXPLORATION +en I-EXPLORATION +rectosigma. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +proceso I-EXPLORATION +maligno I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +heces I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simple I-EXPLORATION +tipo I-EXPLORATION +2 I-EXPLORATION +y I-EXPLORATION +Chalmydia I-EXPLORATION +trachomatis. I-EXPLORATION +Fue B-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +valganciclovir I-TREATMENT +y I-TREATMENT +azitromicina, I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +clínica I-TREATMENT +infecciosa I-TREATMENT +pero I-TREATMENT +con I-TREATMENT +estreñimiento I-TREATMENT +progresivo. I-TREATMENT +Una B-EXPLORATION +nueva I-EXPLORATION +rectoscopia I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +fibrótica I-EXPLORATION +y I-EXPLORATION +ulcerada I-EXPLORATION +en I-EXPLORATION +recto I-EXPLORATION +distal, I-EXPLORATION +con I-EXPLORATION +biopsias I-EXPLORATION +y I-EXPLORATION +análisis I-EXPLORATION +microbiológico I-EXPLORATION +negativos. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +clínica I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +conservador, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +resección I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +recto I-TREATMENT +ultrabaja I-TREATMENT +con I-TREATMENT +reservorio I-TREATMENT +coloanal I-TREATMENT +e I-TREATMENT +ileostomía. I-TREATMENT +Tras B-EVOLUTION +posoperatorio I-EVOLUTION +complicado, I-EVOLUTION +se I-EVOLUTION +reconstruye I-EVOLUTION +el I-EVOLUTION +tránsito I-EVOLUTION +sin I-EVOLUTION +incidencias, I-EVOLUTION +con I-EVOLUTION +seguimiento I-EVOLUTION +actual I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardiaca I-PAST_MEDICAL_HISTORY +grave, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY +Debutó B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +eritematosa, I-PRESENT_ILLNESS +dura I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +dolorosa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +subcutáneo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +esternal I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +extirpó. I-PRESENT_ILLNESS +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +subcutánea I-EXPLORATION +de I-EXPLORATION +cistoadenocarcinoma I-EXPLORATION +mucinoso I-EXPLORATION +de I-EXPLORATION +origen I-EXPLORATION +biliar. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +abdominal I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hepática I-EXPLORATION +central I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +colangiocarcinoma I-EXPLORATION +hiliar I-EXPLORATION +o I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +Klatskin. I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +situación I-TREATMENT +basal I-TREATMENT +se I-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +paliativo. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +estenosis I-PRESENT_ILLNESS +esofágica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +accidental I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cáustico. I-PRESENT_ILLNESS +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +institución I-DERIVED_FROM/TO +siendo I-DERIVED_FROM/TO +portador I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +gastrostomía I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +sutura I-DERIVED_FROM/TO +nasogástrica I-DERIVED_FROM/TO +(stringing) I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +permitía I-DERIVED_FROM/TO +dilataciones I-DERIVED_FROM/TO +retrógradas. I-DERIVED_FROM/TO +El B-EXPLORATION +esofagograma I-EXPLORATION +de I-EXPLORATION +bario I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +longitud I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +nivel I-EXPLORATION +cricotraqueal I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +esófago. I-EXPLORATION +Se B-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +un I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +dilataciones I-TREATMENT +esofágicas I-TREATMENT +retrógradas I-TREATMENT +cada I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +sin I-TREATMENT +ninguna I-TREATMENT +mejora, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que, I-TREATMENT +a I-TREATMENT +los I-TREATMENT +cinco I-TREATMENT +meses I-TREATMENT +postingesta I-TREATMENT +del I-TREATMENT +agente I-TREATMENT +corrosivo, I-TREATMENT +se I-TREATMENT +colocaron I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +modo I-TREATMENT +tres I-TREATMENT +stents I-TREATMENT +autoexpandibles I-TREATMENT +de I-TREATMENT +nitinol I-TREATMENT +cubiertos I-TREATMENT +de I-TREATMENT +silicona I-TREATMENT +internamente I-TREATMENT +(Stents I-TREATMENT +MI I-TREATMENT +Tech, I-TREATMENT +Izasa); I-TREATMENT +dos I-TREATMENT +de I-TREATMENT +16 I-TREATMENT +x I-TREATMENT +60 I-TREATMENT +mm I-TREATMENT +y I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +16 I-TREATMENT +x I-TREATMENT +40 I-TREATMENT +mm. I-TREATMENT +El I-TREATMENT +más I-TREATMENT +craneal I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +primero, I-TREATMENT +introduciendo I-TREATMENT +los I-TREATMENT +otros I-TREATMENT +en I-TREATMENT +dirección I-TREATMENT +caudal I-TREATMENT +y I-TREATMENT +manteniendo I-TREATMENT +una I-TREATMENT +distancia I-TREATMENT +de I-TREATMENT +superposición I-TREATMENT +de I-TREATMENT +1-2 I-TREATMENT +cm I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +el I-TREATMENT +desplazamiento I-TREATMENT +de I-TREATMENT +los I-TREATMENT +mismos. I-TREATMENT +Este B-EVOLUTION +procedimiento I-EVOLUTION +logró I-EVOLUTION +una I-EVOLUTION +dilatación I-EVOLUTION +completa I-EVOLUTION +durante I-EVOLUTION +un I-EVOLUTION +mes. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +niño I-EVOLUTION +refirió I-EVOLUTION +dolor I-EVOLUTION +como I-EVOLUTION +único I-EVOLUTION +síntoma I-EVOLUTION +postoperatorio I-EVOLUTION +que I-EVOLUTION +remitió I-EVOLUTION +espontáneamente I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +cuatro I-EVOLUTION +días. I-EVOLUTION +No B-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +ni I-EXPLORATION +migración I-EXPLORATION +ni I-EXPLORATION +otras I-EXPLORATION +complicaciones I-EXPLORATION +a I-EXPLORATION +corto I-EXPLORATION +plazo. I-EXPLORATION +Tolerando B-TREATMENT +su I-TREATMENT +alimentación I-TREATMENT +habitual I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +adecuada, I-TREATMENT +fue I-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +con I-TREATMENT +omeprazol I-TREATMENT +pautado I-TREATMENT +(15 I-TREATMENT +mg/24 I-TREATMENT +horas I-TREATMENT +vía I-TREATMENT +oral) I-TREATMENT +y I-TREATMENT +seguimiento I-TREATMENT +en I-TREATMENT +consultas I-TREATMENT +externas. I-TREATMENT + I-TREATMENT +Los I-TREATMENT +stents I-TREATMENT +se I-TREATMENT +retiraron I-TREATMENT +a I-TREATMENT +las I-TREATMENT +cuatro I-TREATMENT +semanas I-TREATMENT +y I-TREATMENT +en I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +procedimiento I-TREATMENT +se I-TREATMENT +pulverizó I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +mitomicina I-TREATMENT +(0, I-TREATMENT +4 I-TREATMENT +ml/kg) I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +área I-TREATMENT +dilatada I-TREATMENT +a I-TREATMENT +través I-TREATMENT +del I-TREATMENT +irrigador I-TREATMENT +del I-TREATMENT +endoscopio. I-TREATMENT +Se B-EXPLORATION +identificaron I-EXPLORATION +dos I-EXPLORATION +estenosis I-EXPLORATION +residuales I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +largo I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +esfínter I-EXPLORATION +cricofaríngeo I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +por I-EXPLORATION +encima I-EXPLORATION +del I-EXPLORATION +cardias I-EXPLORATION +respectivamente. I-EXPLORATION +La I-EXPLORATION +primera I-EXPLORATION +ya I-EXPLORATION +había I-EXPLORATION +sido I-EXPLORATION +visualizada I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +endoscópica I-EXPLORATION +previa, I-EXPLORATION +cuando I-EXPLORATION +fue I-EXPLORATION +imposible I-EXPLORATION +la I-EXPLORATION +colocación I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +stent I-EXPLORATION +en I-EXPLORATION +dicha I-EXPLORATION +región I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +compresión I-EXPLORATION +traqueal. I-EXPLORATION +La B-TREATMENT +estenosis I-TREATMENT +esofágica I-TREATMENT +distal I-TREATMENT +requirió I-TREATMENT +otro I-TREATMENT +stent I-TREATMENT +(16 I-TREATMENT +x I-TREATMENT +40 I-TREATMENT +mm), I-TREATMENT +obteniendo I-TREATMENT +la I-TREATMENT +dilatación I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +después I-TREATMENT +de I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +desde I-TREATMENT +su I-TREATMENT +colocación. I-TREATMENT +Las I-TREATMENT +dilataciones I-TREATMENT +con I-TREATMENT +balón I-TREATMENT +posteriores I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +a I-TREATMENT +intervalos I-TREATMENT +de I-TREATMENT +cuatro I-TREATMENT +semanas, I-TREATMENT +consiguiéndose I-TREATMENT +un I-TREATMENT +esófago I-TREATMENT +elástico I-TREATMENT +con I-TREATMENT +aspecto I-TREATMENT +normal I-TREATMENT +de I-TREATMENT +su I-TREATMENT +mucosa. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +la I-TREATMENT +estenosis I-TREATMENT +del I-TREATMENT +esófago I-TREATMENT +proximal I-TREATMENT +mencionada I-TREATMENT +con I-TREATMENT +anterioridad I-TREATMENT +tuvo I-TREATMENT +una I-TREATMENT +respuesta I-TREATMENT +pobre, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +resección I-TREATMENT +quirúrgica I-TREATMENT +y I-TREATMENT +anastomosis I-TREATMENT +mediante I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +laterocervical I-TREATMENT +inferior I-TREATMENT +izquierdo I-TREATMENT +seguida I-TREATMENT +de I-TREATMENT +dilataciones I-TREATMENT +neumáticas I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +mes I-TREATMENT +con I-TREATMENT +intervalos I-TREATMENT +progresivamente I-TREATMENT +más I-TREATMENT +largos I-TREATMENT +durante I-TREATMENT +cinco I-TREATMENT +meses. I-TREATMENT + I-TREATMENT +Después B-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +totalmente I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +excelente I-EVOLUTION +aspecto I-EVOLUTION +macroscópico I-EVOLUTION +del I-EVOLUTION +esófago I-EVOLUTION +valorado I-EVOLUTION +endoscópicamente I-EVOLUTION +y I-EVOLUTION +mediante I-EVOLUTION +un I-EVOLUTION +esofagograma I-EVOLUTION +baritado I-EVOLUTION +de I-EVOLUTION +control. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +19 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +sano, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +precisó I-PRESENT_ILLNESS +hospitalización I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otras I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +exploración. I-PRESENT_ILLNESS +Confesó B-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +usado I-PAST_MEDICAL_HISTORY +estanozolol I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg/48 I-PAST_MEDICAL_HISTORY +h I-PAST_MEDICAL_HISTORY +(Winstrol®), I-PAST_MEDICAL_HISTORY +enantato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +metenolona I-PAST_MEDICAL_HISTORY +(Primobolan®) I-PAST_MEDICAL_HISTORY +100 I-PAST_MEDICAL_HISTORY +mg/96 I-PAST_MEDICAL_HISTORY +h I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +propionato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +drostanolona I-PAST_MEDICAL_HISTORY +(Masteron®) I-PAST_MEDICAL_HISTORY +200 I-PAST_MEDICAL_HISTORY +mg/96 I-PAST_MEDICAL_HISTORY +h, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +intramuscular, I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +56 I-PAST_MEDICAL_HISTORY +días, I-PAST_MEDICAL_HISTORY +interrumpiendo I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +diez I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso. I-PAST_MEDICAL_HISTORY +Destacaba B-EXPLORATION +una I-EXPLORATION +bilirrubina I-EXPLORATION +de I-EXPLORATION +41, I-EXPLORATION +9 I-EXPLORATION +mg/dl I-EXPLORATION +con I-EXPLORATION +GPT I-EXPLORATION +114 I-EXPLORATION +UI/l I-EXPLORATION +y I-EXPLORATION +GGT I-EXPLORATION +normal; I-EXPLORATION +la I-EXPLORATION +creatinina I-EXPLORATION +máxima I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +mg/dl I-EXPLORATION +(día I-EXPLORATION ++39). I-EXPLORATION +Se I-EXPLORATION +excluyeron I-EXPLORATION +otras I-EXPLORATION +causas I-EXPLORATION +de I-EXPLORATION +hepatopatía, I-EXPLORATION +patología I-EXPLORATION +biliar I-EXPLORATION +y I-EXPLORATION +trastornos I-EXPLORATION +vasculares. I-EXPLORATION +Una I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +marcada I-EXPLORATION +colestasis I-EXPLORATION +parenquimatosa I-EXPLORATION +y I-EXPLORATION +canalicular I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +centrolobulillar. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +lentamente I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +resolución I-EVOLUTION +espontánea I-EVOLUTION +ad I-EVOLUTION +integrum I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION + +Recientemente, B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +colecistectomizada I-PRESENT_ILLNESS +se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +CPRE I-EXPLORATION +por I-EXPLORATION +coledocolitiasis. I-EXPLORATION +Horas B-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +misma, I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +derecho I-EVOLUTION +y I-EVOLUTION +anemización. I-EVOLUTION +Se B-EXPLORATION +solicitó I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +subcapsular I-EXPLORATION +hepático I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +16 I-EXPLORATION +cm, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +comprimía I-EXPLORATION +y I-EXPLORATION +desplazaba I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +hepático. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +a I-EXPLORATION +continuación I-EXPLORATION +angio-TC, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +extravasación I-EXPLORATION +del I-EXPLORATION +contraste. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +estabilidad I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +sangrado I-TREATMENT +activo, I-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +un I-TREATMENT +manejo I-TREATMENT +conservador I-TREATMENT +con I-TREATMENT +vigilancia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Cuidados I-TREATMENT +Intensivos I-TREATMENT +(UCI), I-TREATMENT +donde I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +hemodinámicamente I-TREATMENT +estable. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +diez I-EVOLUTION +días, I-EVOLUTION +un I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +mostró I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +colección, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +drenaje I-TREATMENT +percutáneo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +extrajeron I-TREATMENT +1.000 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +contenido I-TREATMENT +hemático. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +alta I-EVOLUTION +12 I-EVOLUTION +días I-EVOLUTION +después. I-EVOLUTION +No B-TREATMENT +obstante, I-TREATMENT +fue I-TREATMENT +necesario I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +unos I-TREATMENT +1.100 I-TREATMENT +ml I-TREATMENT +días I-TREATMENT +más I-TREATMENT +tarde, I-TREATMENT +tras B-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +país I-PAST_MEDICAL_HISTORY +africano I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +través I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +ONG. I-DERIVED_FROM/TO +Presentaba B-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +limitación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +apertura I-PRESENT_ILLNESS +oral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +mm I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consecuencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +casual I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +bicondílea. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +hipoplasia I-EXPLORATION +mandibular I-EXPLORATION +sin I-EXPLORATION +asimetría, I-EXPLORATION +oclusión I-EXPLORATION +en I-EXPLORATION +clase I-EXPLORATION +II I-EXPLORATION +con I-EXPLORATION +compensación I-EXPLORATION +de I-EXPLORATION +incisivos I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +deficiente I-EXPLORATION +higiene I-EXPLORATION +bucal I-EXPLORATION +con I-EXPLORATION +caries. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ortopantomografía I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +telerradiografía I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +anquilosis I-EXPLORATION +temporomandibular I-EXPLORATION +bilateral. I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +con I-EXPLORATION +reconstrucción I-EXPLORATION +3D, I-EXPLORATION +toma I-EXPLORATION +de I-EXPLORATION +fotografías I-EXPLORATION +y I-EXPLORATION +valoración I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Anestesiología. I-EXPLORATION +Las B-TREATMENT +características I-TREATMENT +sociales I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +impidieron I-TREATMENT +indicar I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +ortodóncico. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +planificó I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +contando I-TREATMENT +con I-TREATMENT +el I-TREATMENT +consentimiento I-TREATMENT +de I-TREATMENT +su I-TREATMENT +familia I-TREATMENT +de I-TREATMENT +acogida. I-TREATMENT +La I-TREATMENT +intubación I-TREATMENT +nasotraqueal I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +con I-TREATMENT +fibroscopio. I-TREATMENT +Realizamos I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +preauricular I-TREATMENT +con I-TREATMENT +exposición I-TREATMENT +del I-TREATMENT +bloque I-TREATMENT +anquilótico, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +resecó I-TREATMENT +ampliamente I-TREATMENT +creando I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +cavidad I-TREATMENT +glenoidea, I-TREATMENT +sin I-TREATMENT +interponer I-TREATMENT +ningún I-TREATMENT +material I-TREATMENT +en I-TREATMENT +el I-TREATMENT +espacio I-TREATMENT +creado. I-TREATMENT +Se I-TREATMENT +completó I-TREATMENT +con I-TREATMENT +una I-TREATMENT +coronoidectomía I-TREATMENT +con I-TREATMENT +desinserción I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +temporal I-TREATMENT +bilateral. I-TREATMENT +Seguidamente, I-TREATMENT +tras I-TREATMENT +comprobar I-TREATMENT +una I-TREATMENT +apertura I-TREATMENT +oral I-TREATMENT +de I-TREATMENT +30 I-TREATMENT +mm, I-TREATMENT +colocamos I-TREATMENT +un I-TREATMENT +distractor I-TREATMENT +extraoral I-TREATMENT +de I-TREATMENT +Molina I-TREATMENT +fijado I-TREATMENT +en I-TREATMENT +el I-TREATMENT +arco I-TREATMENT +cigomático I-TREATMENT +y I-TREATMENT +en I-TREATMENT +la I-TREATMENT +rama I-TREATMENT +mandibular I-TREATMENT +ascendente, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +finalidad I-TREATMENT +de I-TREATMENT +elongar I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +blando I-TREATMENT +y I-TREATMENT +prevenir I-TREATMENT +la I-TREATMENT +reanquilosis, I-TREATMENT +manteniendo I-TREATMENT +separadas I-TREATMENT +las I-TREATMENT +superficies I-TREATMENT +cruentas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +resección. I-TREATMENT +La I-TREATMENT +misma I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +en I-TREATMENT +la I-TREATMENT +articulación I-TREATMENT +contralateral. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +un I-TREATMENT +período I-TREATMENT +de I-TREATMENT +latencia I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +días, I-TREATMENT +iniciamos I-TREATMENT +la I-TREATMENT +distracción I-TREATMENT +a I-TREATMENT +1 I-TREATMENT +mm I-TREATMENT +diario I-TREATMENT +y I-TREATMENT +la I-TREATMENT +fisioterapia, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +implicaba I-TREATMENT +desactivar I-TREATMENT +el I-TREATMENT +distractor I-TREATMENT +mientras I-TREATMENT +se I-TREATMENT +realizaban I-TREATMENT +los I-TREATMENT +ejercicios. I-TREATMENT +La I-TREATMENT +distracción I-TREATMENT +se I-TREATMENT +completó I-TREATMENT +al I-TREATMENT +conseguir I-TREATMENT +una I-TREATMENT +clase I-TREATMENT +I. I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +período I-TREATMENT +de I-TREATMENT +«consolidación» I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +sufrió I-TREATMENT +un I-TREATMENT +accidente I-TREATMENT +de I-TREATMENT +tráfico I-TREATMENT +que I-TREATMENT +supuso I-TREATMENT +el I-TREATMENT +desanclaje I-TREATMENT +del I-TREATMENT +distractor I-TREATMENT +derecho I-TREATMENT +que I-TREATMENT +se I-TREATMENT +recolocó I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +y I-TREATMENT +mascarilla I-TREATMENT +laríngea. I-TREATMENT +La I-TREATMENT +retirada I-TREATMENT +definitiva I-TREATMENT +de I-TREATMENT +los I-TREATMENT +distratores I-TREATMENT +se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +local I-TREATMENT +11 I-TREATMENT +semanas I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía. I-TREATMENT +El B-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +mensual I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +retirada I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +distractores, I-EVOLUTION +hasta I-EVOLUTION +que I-EVOLUTION +tuvo I-EVOLUTION +que I-EVOLUTION +regresar I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +país I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +manteniendo I-EVOLUTION +la I-EVOLUTION +apertura I-EVOLUTION +oral I-EVOLUTION +de I-EVOLUTION +30 I-EVOLUTION +mm.. I-EVOLUTION +No I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +posible I-EVOLUTION +realizar I-EVOLUTION +un I-EVOLUTION +seguimiento I-EVOLUTION +a I-EVOLUTION +largo I-EVOLUTION +plazo. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que B-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Oral I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Maxilofacial I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Oftalmología I-DERIVED_FROM/TO +para B-PRESENT_ILLNESS +valoración I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +exoftalmos I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +mórbida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +yodo. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +1980 I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertiroidismo I-PAST_MEDICAL_HISTORY +originado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Graves-Basedow, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +operada I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +después, I-PAST_MEDICAL_HISTORY +realizándose I-PAST_MEDICAL_HISTORY +tiroidectomía I-PAST_MEDICAL_HISTORY +subtotal, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +pauta I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Levotiroxina I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg/día. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +1999 I-PAST_MEDICAL_HISTORY +acude I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Oftalmología I-PAST_MEDICAL_HISTORY +refiriendo I-PAST_MEDICAL_HISTORY +lento I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +progresivo I-PAST_MEDICAL_HISTORY +empeoramiento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +exoftalmos, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +signos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +queratitis. I-PAST_MEDICAL_HISTORY +Tras I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +megadosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esteroides I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desestimar I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +radioterapia, I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +dicho I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +realizándose I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +descompresión I-PAST_MEDICAL_HISTORY +quirúrgica I-PAST_MEDICAL_HISTORY +(pared I-PAST_MEDICAL_HISTORY +medial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +suelo) I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +abordaje I-PAST_MEDICAL_HISTORY +subciliar. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +Marzo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2002 I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realiza I-PAST_MEDICAL_HISTORY +tiroidectomía I-PAST_MEDICAL_HISTORY +total. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +Junio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2003 I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +Consulta, I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +retracción I-PRESENT_ILLNESS +palpebral I-PRESENT_ILLNESS +severa, I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +acentuada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tercio I-PRESENT_ILLNESS +externo I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +temporal I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +párpado I-PRESENT_ILLNESS +superior; I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +limbo I-PRESENT_ILLNESS +corneal I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +queda I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +descubierto, I-PRESENT_ILLNESS +dejando I-PRESENT_ILLNESS +porción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esclera I-PRESENT_ILLNESS +expuesta. I-PRESENT_ILLNESS +Se B-EXPLORATION +objetiva I-EXPLORATION +hipertrofia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +suborbicular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +subciliar I-EXPLORATION +del I-EXPLORATION +párpado I-EXPLORATION +inferior. I-EXPLORATION + I-EXPLORATION +Es I-EXPLORATION +evidente I-EXPLORATION +el I-EXPLORATION +exoftalmos, I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +bilateral. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +queja I-EXPLORATION +de I-EXPLORATION +incapacidad I-EXPLORATION +para I-EXPLORATION +mantener I-EXPLORATION +la I-EXPLORATION +lectura I-EXPLORATION +durante I-EXPLORATION +un I-EXPLORATION +tiempo I-EXPLORATION +prolongado, I-EXPLORATION +con I-EXPLORATION +fatiga I-EXPLORATION +y I-EXPLORATION +disconfort, I-EXPLORATION +síntomas I-EXPLORATION +de I-EXPLORATION +restricción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +ocular. I-EXPLORATION +La I-EXPLORATION +enfermedad I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +no I-EXPLORATION +inflamatoria, I-EXPLORATION +no I-EXPLORATION +presentando I-EXPLORATION +queratitis I-EXPLORATION +severa, I-EXPLORATION +hiperemia, I-EXPLORATION +quemosis I-EXPLORATION +conjuntival, I-EXPLORATION +ni I-EXPLORATION +diplopia. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +orbitario I-EXPLORATION +muestra I-EXPLORATION +exoftalmos, I-EXPLORATION +engrosamiento I-EXPLORATION +muscular, I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +volumen I-EXPLORATION +graso I-EXPLORATION +orbitario I-EXPLORATION +y I-EXPLORATION +rectificación I-EXPLORATION +del I-EXPLORATION +nervio I-EXPLORATION +óptico. I-EXPLORATION +Tiene I-EXPLORATION +la I-EXPLORATION +ventaja I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +el I-EXPLORATION +detalle I-EXPLORATION +óseo, I-EXPLORATION +que I-EXPLORATION +tiene I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +valor I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +planificación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +procedimientos I-EXPLORATION +quirúrgicos I-EXPLORATION +de I-EXPLORATION +descompresión. I-EXPLORATION +La I-EXPLORATION +RM I-EXPLORATION +muestra I-EXPLORATION +exoftalmos, I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +muscular I-EXPLORATION +severo I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +ventral I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +graso. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +los I-TREATMENT +antecedentes I-TREATMENT +descritos, I-TREATMENT +la I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +de I-TREATMENT +imagen I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +remoción I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +lateral I-TREATMENT +y I-TREATMENT +del I-TREATMENT +suelo I-TREATMENT +orbitario, I-TREATMENT +junto I-TREATMENT +a I-TREATMENT +lipectomía I-TREATMENT +y I-TREATMENT +osteotomía I-TREATMENT +con I-TREATMENT +avance I-TREATMENT +del I-TREATMENT +marco I-TREATMENT +orbitario I-TREATMENT +superior, I-TREATMENT +lateral I-TREATMENT +e I-TREATMENT +inferior. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +abordaje I-TREATMENT +bicoronal, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +subgaleal I-TREATMENT +hasta I-TREATMENT +aproximadamente I-TREATMENT +2 I-TREATMENT +cm. I-TREATMENT +del I-TREATMENT +reborde I-TREATMENT +supraorbitario, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +del I-TREATMENT +periostio I-TREATMENT +y I-TREATMENT +se I-TREATMENT +continúa I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +órbita I-TREATMENT +por I-TREATMENT +el I-TREATMENT +plano I-TREATMENT +subperióstico. I-TREATMENT +La I-TREATMENT +porción I-TREATMENT +anterior I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +temporal I-TREATMENT +fue I-TREATMENT +liberada I-TREATMENT +de I-TREATMENT +su I-TREATMENT +inserción I-TREATMENT +para I-TREATMENT +permitir I-TREATMENT +un I-TREATMENT +mejor I-TREATMENT +acceso I-TREATMENT +a I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +lateral I-TREATMENT +orbitaria. I-TREATMENT +El I-TREATMENT +abordaje I-TREATMENT +se I-TREATMENT +completó I-TREATMENT +con I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +subciliar I-TREATMENT +bilateral I-TREATMENT +que I-TREATMENT +permitió I-TREATMENT +el I-TREATMENT +acceso I-TREATMENT +al I-TREATMENT +reborde I-TREATMENT +infraorbitario I-TREATMENT +y I-TREATMENT +a I-TREATMENT +la I-TREATMENT +región I-TREATMENT +medial I-TREATMENT +del I-TREATMENT +suelo I-TREATMENT +orbitario. I-TREATMENT + I-TREATMENT +Realizamos I-TREATMENT +una I-TREATMENT +osteotomía I-TREATMENT +bilateral I-TREATMENT +-orbitotomía- I-TREATMENT +del I-TREATMENT +marco I-TREATMENT +orbitario I-TREATMENT +superior, I-TREATMENT +lateral I-TREATMENT +e I-TREATMENT +inferior; I-TREATMENT +que I-TREATMENT +se I-TREATMENT +avanza I-TREATMENT +8 I-TREATMENT +mm I-TREATMENT +respecto I-TREATMENT +a I-TREATMENT +su I-TREATMENT +posición I-TREATMENT +de I-TREATMENT +origen. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +osteosíntesis I-TREATMENT +con I-TREATMENT +miniplacas I-TREATMENT +2, I-TREATMENT +0. I-TREATMENT +Se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +eliminación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +lateral I-TREATMENT +orbitaria I-TREATMENT +y I-TREATMENT +del I-TREATMENT +suelo I-TREATMENT +en I-TREATMENT +su I-TREATMENT +porción I-TREATMENT +medial I-TREATMENT +y I-TREATMENT +lateral, I-TREATMENT +respetando I-TREATMENT +el I-TREATMENT +trayecto I-TREATMENT +del I-TREATMENT +nervio I-TREATMENT +infraorbitario. I-TREATMENT +Se I-TREATMENT +realizan I-TREATMENT +incisiones I-TREATMENT +en I-TREATMENT +la I-TREATMENT +periórbita I-TREATMENT +y I-TREATMENT +lipectomía I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +liberación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +grasa I-TREATMENT +periorbitaria. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +aspirativo I-TREATMENT +subgaleal I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +retirado I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +horas. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +mantuvo I-TREATMENT +una I-TREATMENT +tarsorrafia I-TREATMENT +temporal I-TREATMENT +(punto I-TREATMENT +de I-TREATMENT +Frost) I-TREATMENT +las I-TREATMENT +primeras I-TREATMENT +48 I-TREATMENT +horas. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +horas I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +dolor I-EVOLUTION +intenso I-EVOLUTION +en I-EVOLUTION +región I-EVOLUTION +posterior I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +pierna I-EVOLUTION +izquierda, I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +diagnosticado I-EVOLUTION +como I-EVOLUTION +trombosis I-EVOLUTION +del I-EVOLUTION +lago I-EVOLUTION +gemelar I-EVOLUTION +y I-EVOLUTION +tratada I-EVOLUTION +con I-EVOLUTION +heparina. I-EVOLUTION +La I-EVOLUTION +sutura I-EVOLUTION +subciliar I-EVOLUTION +se I-EVOLUTION +retiró I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +coronal I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +44 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +médico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cabecera I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Oral I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Maxilofacial I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +tumoración I-DERIVED_FROM/TO +parotídea, I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +palpación I-DERIVED_FROM/TO +parecía I-DERIVED_FROM/TO +constar I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +único I-DERIVED_FROM/TO +nódulo. I-DERIVED_FROM/TO +Con B-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +tumoración I-EXPLORATION +benigna I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +punción I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +de I-EXPLORATION +23-G I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Anatomía I-EXPLORATION +Patológica, I-EXPLORATION +fijando I-EXPLORATION +el I-EXPLORATION +material I-EXPLORATION +obtenido, I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +inmediata, I-EXPLORATION +en I-EXPLORATION +alcohol I-EXPLORATION +de I-EXPLORATION +95% I-EXPLORATION +y I-EXPLORATION +reservando I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +aspirados I-EXPLORATION +para I-EXPLORATION +secado I-EXPLORATION +al I-EXPLORATION +aire. I-EXPLORATION +Las I-EXPLORATION +muestras I-EXPLORATION +fijadas I-EXPLORATION +en I-EXPLORATION +alcohol I-EXPLORATION +se I-EXPLORATION +tiñeron I-EXPLORATION +siguiendo I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Papanicolaou, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +secados I-EXPLORATION +al I-EXPLORATION +aire I-EXPLORATION +se I-EXPLORATION +colorean I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Diff- I-EXPLORATION +Quick. I-EXPLORATION + I-EXPLORATION +Citológicamente I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +compuesta I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +y I-EXPLORATION +ductales I-EXPLORATION +sobre I-EXPLORATION +un I-EXPLORATION +fondo I-EXPLORATION +basofílico I-EXPLORATION +fibrilar I-EXPLORATION +y I-EXPLORATION +mixomatoso, I-EXPLORATION +además I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +material I-EXPLORATION +condroide I-EXPLORATION +y I-EXPLORATION +fragmentos I-EXPLORATION +de I-EXPLORATION +estroma I-EXPLORATION +eosinófilo I-EXPLORATION +fibrilar. I-EXPLORATION +El B-TREATMENT +diagnóstico I-TREATMENT +citológico I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +adenoma I-TREATMENT +pleomorfo I-TREATMENT +(AP) I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +parotidectomía I-TREATMENT +total I-TREATMENT +con I-TREATMENT +preservación I-TREATMENT +del I-TREATMENT +nervio I-TREATMENT +facial. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +se I-EXPLORATION +incluyó I-EXPLORATION +en I-EXPLORATION +formaldehído I-EXPLORATION +al I-EXPLORATION +10% I-EXPLORATION +observando I-EXPLORATION +macroscópicamente I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +2x2 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +blando-elástica I-EXPLORATION +y I-EXPLORATION +coloración I-EXPLORATION +blanquecina, I-EXPLORATION +parcialmente I-EXPLORATION +encapsulado, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +nodular I-EXPLORATION +polilobulada I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +linfoide, I-EXPLORATION +separada I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +principal I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +fino I-EXPLORATION +cordón I-EXPLORATION +estromal. I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +fijación I-EXPLORATION +se I-EXPLORATION +secciona I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +totalidad I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +procesa I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +rutinaria I-EXPLORATION +para I-EXPLORATION +obtener I-EXPLORATION +los I-EXPLORATION +bloques I-EXPLORATION +de I-EXPLORATION +parafina. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +empleada I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +observación I-EXPLORATION +microscópica I-EXPLORATION +es I-EXPLORATION +hematoxilina-eosina I-EXPLORATION +clásica. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +principal I-EXPLORATION +bien I-EXPLORATION +circunscrito, I-EXPLORATION +rodeado I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +pseudocápsula I-EXPLORATION +conectiva, I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +población I-EXPLORATION +celular I-EXPLORATION +bifásica I-EXPLORATION +de I-EXPLORATION +epitelio I-EXPLORATION +glandular I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +mioepiteliales I-EXPLORATION +rodeadas I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +material I-EXPLORATION +fibrilar I-EXPLORATION +mixoide, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +pleomorfo. I-EXPLORATION +Los I-EXPLORATION +otros I-EXPLORATION +nódulos I-EXPLORATION +eran I-EXPLORATION +ganglios I-EXPLORATION +linfáticos, I-EXPLORATION +pero I-EXPLORATION +apareció I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +lesión, I-EXPLORATION +de I-EXPLORATION +pequeña I-EXPLORATION +talla, I-EXPLORATION +muy I-EXPLORATION +cercana I-EXPLORATION +al I-EXPLORATION +tumor I-EXPLORATION +mixto, I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +quística I-EXPLORATION +y I-EXPLORATION +papilar, I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +doble I-EXPLORATION +hilera I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +oncocíticas I-EXPLORATION +rodeando I-EXPLORATION +los I-EXPLORATION +espacios I-EXPLORATION +quísticos I-EXPLORATION +con I-EXPLORATION +estroma I-EXPLORATION +linfoide I-EXPLORATION +adyacente. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +histopatológico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +pleomorfo I-EXPLORATION +y I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +Warthin I-EXPLORATION +sincrónicos I-EXPLORATION +de I-EXPLORATION +parótida I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +84 I-PRESENT_ILLNESS +enviada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +recidiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +epidermoide I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +preauricular I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +tratada I-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cirugía I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +RT. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +facial I-EXPLORATION +aparece I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +preauricular I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +hacia I-EXPLORATION +las I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +malar, I-EXPLORATION +contactando I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +músculo I-EXPLORATION +masetero I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +parótida. I-EXPLORATION +El I-EXPLORATION +tratamiento I-EXPLORATION +quirúrgico I-EXPLORATION +consistió I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extirpación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +incluyendo I-EXPLORATION +el I-EXPLORATION +pabellón I-EXPLORATION +auricular I-EXPLORATION +derecho, I-EXPLORATION +CAE I-EXPLORATION +y I-EXPLORATION +parotidectomía I-EXPLORATION +total I-EXPLORATION +radical. I-EXPLORATION +La I-EXPLORATION +reconstrucción I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +con I-EXPLORATION +colgajo I-EXPLORATION +de I-EXPLORATION +músculo I-EXPLORATION +temporal I-EXPLORATION +que I-EXPLORATION +desinsertado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cresta I-EXPLORATION +temporal I-EXPLORATION +y I-EXPLORATION +pediculado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +coronoides, I-EXPLORATION +fue I-EXPLORATION +rotado I-EXPLORATION +en I-EXPLORATION +dirección I-EXPLORATION +caudal I-EXPLORATION +para I-EXPLORATION +cubrir I-EXPLORATION +el I-EXPLORATION +defecto. I-EXPLORATION +La I-EXPLORATION +porción I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fascia I-EXPLORATION +temporal I-EXPLORATION +profunda I-EXPLORATION +fue I-EXPLORATION +disecada I-EXPLORATION +y I-EXPLORATION +dividida I-EXPLORATION +en I-EXPLORATION +dos I-EXPLORATION +láminas I-EXPLORATION +cuyos I-EXPLORATION +extremos I-EXPLORATION +libres I-EXPLORATION +fueron I-EXPLORATION +suturados I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +comisura I-EXPLORATION +y I-EXPLORATION +musculatura I-EXPLORATION +del I-EXPLORATION +labio I-EXPLORATION +superior. I-EXPLORATION +El I-EXPLORATION +músculo I-EXPLORATION +temporal I-EXPLORATION +traspuesto I-EXPLORATION +se I-EXPLORATION +cubrió I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +injerto I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +piel. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +postoperatorio I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +cómo I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +consigue I-EVOLUTION +elevar I-EVOLUTION +la I-EVOLUTION +comisura I-EVOLUTION +bucal I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +estética I-EVOLUTION +aceptable I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +reconstruida. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +acude I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +consultas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Oral I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Maxilofacial I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Infanta I-DERIVED_FROM/TO +Cristina I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Badajoz, I-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +Médico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Familia. I-DERIVED_FROM/TO +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tensión I-PRESENT_ILLNESS +hemifacial I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +palpación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dicha I-PRESENT_ILLNESS +región. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolorinflamación I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cedieron I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antibióticos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +antiinflamatorios. I-PRESENT_ILLNESS +Describe I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +discreta I-PRESENT_ILLNESS +asimetría I-PRESENT_ILLNESS +facial I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +ido I-PRESENT_ILLNESS +evolucionando I-PRESENT_ILLNESS +progresivamente I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +hacerse I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +patente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +abombamiento I-EXPLORATION +de I-EXPLORATION +vestíbulo I-EXPLORATION +superior I-EXPLORATION +derecho, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +ortopantomografía I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +facial I-EXPLORATION +apreciándose I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +un I-EXPLORATION +tercer I-EXPLORATION +molar I-EXPLORATION +(18) I-EXPLORATION +incluido I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +techo I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho I-EXPLORATION +- I-EXPLORATION +región I-EXPLORATION +infraorbitaria I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +sintomatología I-TREATMENT +clínica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +realizar I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +mediante I-TREATMENT +abordaje I-TREATMENT +de I-TREATMENT +Caldwell- I-TREATMENT +Luc.13-21 I-TREATMENT +Bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +e I-TREATMENT +intubación I-TREATMENT +oro-traqueal I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +incisión I-TREATMENT +de I-TREATMENT +Neumann I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +vestíbulo I-TREATMENT +superior I-TREATMENT +derecho. I-TREATMENT +Tras I-TREATMENT +elevación I-TREATMENT +de I-TREATMENT +colgajo I-TREATMENT +mucoperióstico I-TREATMENT +se I-TREATMENT +visualizó I-TREATMENT +la I-TREATMENT +cápsula I-TREATMENT +quística I-TREATMENT +y I-TREATMENT +la I-TREATMENT +cortical I-TREATMENT +maxilar I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +papiráceo I-TREATMENT +con I-TREATMENT +adherencias I-TREATMENT +y I-TREATMENT +fibrosis. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +quística I-TREATMENT +y I-TREATMENT +exodoncia I-TREATMENT +del I-TREATMENT +cordal I-TREATMENT +mediante I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +fórceps. I-TREATMENT +Finalmente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +legrado I-TREATMENT +intenso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +y I-TREATMENT +sutura I-TREATMENT +del I-TREATMENT +colgajo I-TREATMENT +mediante I-TREATMENT +material I-TREATMENT +reabsorbible. I-TREATMENT + B-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +quiste I-EXPLORATION +radicular. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +género I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +desdentada I-PRESENT_ILLNESS +parcial I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +clase I-PRESENT_ILLNESS +I I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Kennedy I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +remanencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +piezas I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +boca, I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +rehabilitar I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sector I-PRESENT_ILLNESS +posterior. I-PRESENT_ILLNESS +De B-EXPLORATION +acuerdo I-EXPLORATION +al I-EXPLORATION +estudio I-EXPLORATION +radiográfico I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +reabsorción I-EXPLORATION +bilateral I-EXPLORATION +por I-EXPLORATION +neumatización I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +planifica I-EXPLORATION +una I-EXPLORATION +reconstrucción I-EXPLORATION +con I-EXPLORATION +injerto I-EXPLORATION +de I-EXPLORATION +calota I-EXPLORATION +e I-EXPLORATION +implantes I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +segundo I-EXPLORATION +tiempo, I-EXPLORATION +tratamiento I-EXPLORATION +que I-EXPLORATION +rechaza I-EXPLORATION +por I-EXPLORATION +su I-EXPLORATION +alta I-EXPLORATION +morbilidad. I-EXPLORATION +Por B-TREATMENT +esta I-TREATMENT +razón I-TREATMENT +se I-TREATMENT +planifica I-TREATMENT +la I-TREATMENT +rehabilitación I-TREATMENT +en I-TREATMENT +base I-TREATMENT +a I-TREATMENT +implantes I-TREATMENT +cigomáticos, I-TREATMENT +para I-TREATMENT +reemplazar I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +molar. I-TREATMENT +Para I-TREATMENT +esto I-TREATMENT +se I-TREATMENT +instalan I-TREATMENT +dos I-TREATMENT +implantes I-TREATMENT +cigomáticos I-TREATMENT +a I-TREATMENT +cada I-TREATMENT +lado, I-TREATMENT +3 I-TREATMENT +de I-TREATMENT +45 I-TREATMENT +mm I-TREATMENT +y I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +mm. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +rehabilitar I-TREATMENT +en I-TREATMENT +base I-TREATMENT +a I-TREATMENT +prótesis I-TREATMENT +fija I-TREATMENT +se I-TREATMENT +requería I-TREATMENT +la I-TREATMENT +emergencia I-TREATMENT +de I-TREATMENT +los I-TREATMENT +implantes I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +reborde I-TREATMENT +alveolar, I-TREATMENT +para I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +modificó I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +original. I-TREATMENT +Los I-TREATMENT +implantes I-TREATMENT +del I-TREATMENT +lado I-TREATMENT +derecho I-TREATMENT +se I-TREATMENT +instalaron I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +las I-TREATMENT +piezas I-TREATMENT +dentarias I-TREATMENT +3 I-TREATMENT +y I-TREATMENT +4. I-TREATMENT +El I-TREATMENT +implante I-TREATMENT +posterior I-TREATMENT +se I-TREATMENT +ubicó I-TREATMENT +por I-TREATMENT +fuera I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +maxilar I-TREATMENT +y I-TREATMENT +el I-TREATMENT +anterior I-TREATMENT +por I-TREATMENT +dentro I-TREATMENT +pero I-TREATMENT +con I-TREATMENT +una I-TREATMENT +angulación I-TREATMENT +mayor I-TREATMENT +con I-TREATMENT +respecto I-TREATMENT +al I-TREATMENT +plano I-TREATMENT +oclusal. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +lado I-TREATMENT +izquierdo, I-TREATMENT +en I-TREATMENT +posición I-TREATMENT +de I-TREATMENT +las I-TREATMENT +piezas I-TREATMENT +dentarias I-TREATMENT +13 I-TREATMENT +y I-TREATMENT +14, I-TREATMENT +el I-TREATMENT +implante I-TREATMENT +anterior I-TREATMENT +se I-TREATMENT +posicionó I-TREATMENT +por I-TREATMENT +fuera I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +maxilar I-TREATMENT +y I-TREATMENT +el I-TREATMENT +implante I-TREATMENT +posterior I-TREATMENT +por I-TREATMENT +dentro I-TREATMENT +con I-TREATMENT +mayor I-TREATMENT +angulación. I-TREATMENT +Con I-TREATMENT +esto I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +que I-TREATMENT +los I-TREATMENT +cuatro I-TREATMENT +implantes I-TREATMENT +emergieran I-TREATMENT +en I-TREATMENT +el I-TREATMENT +reborde I-TREATMENT +alveolar I-TREATMENT +con I-TREATMENT +una I-TREATMENT +angulación I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +límites I-TREATMENT +aceptables. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +RGP, I-PRESENT_ILLNESS +HC: I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tiene I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +labio I-PRESENT_ILLNESS +inferior. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +remonta I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +mordisco I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +labio I-PAST_MEDICAL_HISTORY +inferior I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +intensa I-PAST_MEDICAL_HISTORY +hemorragia. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +partir I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +apareció I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +central I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +labio I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +progresivo, I-PAST_MEDICAL_HISTORY +indoloro, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +color I-PAST_MEDICAL_HISTORY +azul I-PAST_MEDICAL_HISTORY +violáceo, I-PAST_MEDICAL_HISTORY +pulsátil, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diámetro. I-PAST_MEDICAL_HISTORY +Clasificada I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +lesión I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +hemangioma I-PAST_MEDICAL_HISTORY +traumático, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +comenzó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +inyecciones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +betametasona. I-PAST_MEDICAL_HISTORY +Luego I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +betametasona, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +exéresis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +tumoración I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +bucal. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +histopatológico I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +compatible I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hemangioma I-PAST_MEDICAL_HISTORY +traumático. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +nos I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +nuevamente, I-PRESENT_ILLNESS +ya I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +labial I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +voluminoso, I-PRESENT_ILLNESS +pulsátil, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +soplo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +frenito. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +intrabucal I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +los I-EXPLORATION +relieves I-EXPLORATION +vasculares I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +del I-EXPLORATION +labio I-EXPLORATION +inferior I-EXPLORATION +Indicamos I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +y B-TREATMENT +ejecutamos I-TREATMENT +una I-TREATMENT +disección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +carótida I-TREATMENT +derecha I-TREATMENT +para I-TREATMENT +arteriografía I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +informa I-TREATMENT +de I-TREATMENT +un I-TREATMENT +saco I-TREATMENT +aneurismático I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +las I-TREATMENT +regiones I-TREATMENT +labial I-TREATMENT +inferior I-TREATMENT +y I-TREATMENT +mentoniana. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +ligó I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +carótida I-TREATMENT +externa I-TREATMENT +entre I-TREATMENT +la I-TREATMENT +tiroidea I-TREATMENT +superior I-TREATMENT +y I-TREATMENT +la I-TREATMENT +lingual, I-TREATMENT +por I-TREATMENT +incisión I-TREATMENT +submentoniana I-TREATMENT +se I-TREATMENT +ligaron I-TREATMENT +los I-TREATMENT +vasos I-TREATMENT +venosos I-TREATMENT +del I-TREATMENT +aneurisma, I-TREATMENT +para I-TREATMENT +aislar I-TREATMENT +esta I-TREATMENT +cavidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +circulación. I-TREATMENT + I-TREATMENT +Al I-TREATMENT +final I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +se I-TREATMENT +inyectaron I-TREATMENT +4cc I-TREATMENT +de I-TREATMENT +betametasona I-TREATMENT +en I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +y I-TREATMENT +se I-TREATMENT +aplicó I-TREATMENT +un I-TREATMENT +esparadrapo I-TREATMENT +elástico. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +aplicaron I-TREATMENT +4 I-TREATMENT +inyecciones I-TREATMENT +adicionales I-TREATMENT +con I-TREATMENT +triancinolona I-TREATMENT +a I-TREATMENT +intervalos I-TREATMENT +de I-TREATMENT +3 I-TREATMENT +semanas, I-TREATMENT +notándose I-TREATMENT +una I-TREATMENT +progresiva I-TREATMENT +reducción I-TREATMENT +y I-TREATMENT +fibrosis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +no I-TREATMENT +constatándose I-TREATMENT +soplo. I-TREATMENT + I-TREATMENT +A I-TREATMENT +los I-TREATMENT +tres I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ligadura I-TREATMENT +de I-TREATMENT +los I-TREATMENT +vasos I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fibrosis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +labial. I-TREATMENT +El B-EVOLUTION +resultado I-EVOLUTION +estético I-EVOLUTION +final I-EVOLUTION +fue I-EVOLUTION +aceptable. I-EVOLUTION +En I-EVOLUTION +estos I-EVOLUTION +momentos I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +lleva I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +ultima I-EVOLUTION +intervención, I-EVOLUTION +no I-EVOLUTION +apareciendo I-EVOLUTION +recidiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +odontólogo, I-DERIVED_FROM/TO +quejándose I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +masa I-DERIVED_FROM/TO +dolorosa I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +región I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +canino I-DERIVED_FROM/TO +inferior I-DERIVED_FROM/TO +derecho, I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +había I-DERIVED_FROM/TO +descubierto I-DERIVED_FROM/TO +cuatro I-DERIVED_FROM/TO +semanas I-DERIVED_FROM/TO +antes. I-DERIVED_FROM/TO +Negaba B-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alteración I-PRESENT_ILLNESS +neurosensorial, I-PRESENT_ILLNESS +disfagia, I-PRESENT_ILLNESS +odinofagia, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +demostraba I-EXPLORATION +una I-EXPLORATION +mínima I-EXPLORATION +tumefacción I-EXPLORATION +facial I-EXPLORATION +y I-EXPLORATION +asimetría. I-EXPLORATION +Intraoralmente, I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +un I-EXPLORATION +abombamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +lingual I-EXPLORATION +derecha I-EXPLORATION +mandibular I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +canino, I-EXPLORATION +con I-EXPLORATION +vestibulización I-EXPLORATION +del I-EXPLORATION +mismo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +adenopatías I-EXPLORATION +cervicales. I-EXPLORATION +La I-EXPLORATION +ortopantomografía I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +area I-EXPLORATION +radiolúcida, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +regulares, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +canino, I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo. I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +como I-EXPLORATION +patología I-EXPLORATION +quística I-EXPLORATION +benigna. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +bajo I-EXPLORATION +anestesia I-EXPLORATION +local. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +microscópicos I-EXPLORATION +concluyeron I-EXPLORATION +que I-EXPLORATION +era I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +maligna I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +fusiformes. I-EXPLORATION + I-EXPLORATION +Como I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +pelvis, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +absolutamente I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +intervenida I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +tres I-TREATMENT +semanas I-TREATMENT +después I-TREATMENT +de I-TREATMENT +su I-TREATMENT +primera I-TREATMENT +visita. I-TREATMENT +En B-EXPLORATION +ese I-EXPLORATION +momento, I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +que I-EXPLORATION +había I-EXPLORATION +emergido I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +vestibular, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +disección I-TREATMENT +cervical I-TREATMENT +supraomohioidea I-TREATMENT +derecha, I-TREATMENT +con I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +glándula I-TREATMENT +submaxilar I-TREATMENT +y I-TREATMENT +los I-TREATMENT +ganglios I-TREATMENT +linfáticos I-TREATMENT +regionales. I-TREATMENT +La I-TREATMENT +mandíbula I-TREATMENT +fue I-TREATMENT +resecada I-TREATMENT +desde I-TREATMENT +la I-TREATMENT +sínfisis I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +molar I-TREATMENT +inferior I-TREATMENT +derecho. I-TREATMENT +La B-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +vaciamiento I-EXPLORATION +cervical I-EXPLORATION +estaban, I-EXPLORATION +macroscópicamente, I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +tumor. I-EXPLORATION +Para B-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +primaria I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +una I-TREATMENT +placa I-TREATMENT +de I-TREATMENT +reconstrucción. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +desarrolló I-EVOLUTION +una I-EVOLUTION +infección I-EVOLUTION +cervical, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +comunicación I-EVOLUTION +orocervical, I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sonda I-EVOLUTION +nasogástrica I-EVOLUTION +colocada I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION +A B-TREATMENT +pesar I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +intravenoso, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +mejoró, I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +la I-TREATMENT +placa I-TREATMENT +de I-TREATMENT +reconstrucción I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general. I-TREATMENT +Posteriormente, B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +20 I-EVOLUTION +día I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +mostraban I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +eran I-EXPLORATION +reactivas I-EXPLORATION +para I-EXPLORATION +vimentina I-EXPLORATION +y I-EXPLORATION +actina I-EXPLORATION +músculo-específica. I-EXPLORATION +Asimismo, I-EXPLORATION +también I-EXPLORATION +eran I-EXPLORATION +reactivas I-EXPLORATION +para I-EXPLORATION +desmina. I-EXPLORATION +Finalmente, I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +de I-EXPLORATION +leiomiosarcoma I-EXPLORATION +grado I-EXPLORATION +II. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +seguimientos I-EVOLUTION +periódicos I-EVOLUTION +en I-EVOLUTION +nuestra I-EVOLUTION +consulta, I-EVOLUTION +hace I-EVOLUTION +ya I-EVOLUTION +15 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico, I-EVOLUTION +y I-EVOLUTION +está I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +recidivas I-EVOLUTION +o I-EVOLUTION +metástasis. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +cutánea I-PRESENT_ILLNESS +nodular, I-PRESENT_ILLNESS +eritematosa, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +superficie I-PRESENT_ILLNESS +brillante, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +rápido, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mejilla I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +mejorado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +tópico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +corticoides I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +potencia I-PRESENT_ILLNESS +pautado I-PRESENT_ILLNESS +progresivamente I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cabecera. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +que I-EXPLORATION +arrojó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +Tumor I-EXPLORATION +de I-EXPLORATION +Merkel. I-EXPLORATION + I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +adenopatías I-EXPLORATION +cervicales. I-EXPLORATION +Analítica I-EXPLORATION +preoperatoria, I-EXPLORATION +incluyendo I-EXPLORATION +marcadores I-EXPLORATION +tumorales, I-EXPLORATION +normal I-EXPLORATION +salvo I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glucemia I-EXPLORATION +de I-EXPLORATION +177. I-EXPLORATION +TC I-EXPLORATION +cervical I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +ganglionar I-EXPLORATION +cervical I-EXPLORATION +donde I-EXPLORATION +únicamente I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cuánea I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +malar I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +coincide I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +localización I-EXPLORATION +externa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +afectación I-EXPLORATION +ósea. I-EXPLORATION +Rastreo I-EXPLORATION +corporal I-EXPLORATION +con I-EXPLORATION +TC I-EXPLORATION +toraco-abdominal I-EXPLORATION +igualmente I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +susceptibles I-EXPLORATION +de I-EXPLORATION +invasión I-EXPLORATION +sistémica. I-EXPLORATION + I-EXPLORATION +Bajo B-TREATMENT +Anestesia I-TREATMENT +General I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +con I-TREATMENT +márgenes I-TREATMENT +oncológicos I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +cutáneo I-TREATMENT +de I-TREATMENT +rotación-deslizamiento I-TREATMENT +cérvicofacial. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +Radioterapia I-TREATMENT +externa I-TREATMENT +con I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +acumulada I-TREATMENT +de I-TREATMENT +60 I-TREATMENT +Gy. I-TREATMENT +12 B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +revisión I-EVOLUTION +programada, I-EVOLUTION +una I-EVOLUTION +tumoración I-EVOLUTION +submandibular I-EVOLUTION +cuya I-EVOLUTION +PAAF I-EVOLUTION +fue I-EVOLUTION +informada I-EVOLUTION +como I-EVOLUTION +metástasis I-EVOLUTION +cervical I-EVOLUTION +de I-EVOLUTION +Carcinoma I-EVOLUTION +cutáneo I-EVOLUTION +de I-EVOLUTION +células I-EVOLUTION +de I-EVOLUTION +Merkel. I-EVOLUTION +Se B-TREATMENT +realizó I-TREATMENT +Disección I-TREATMENT +cervical I-TREATMENT +Radical, I-TREATMENT +cuyo I-TREATMENT +resultado I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +ganglios I-TREATMENT +afectos, I-TREATMENT +ninguno I-TREATMENT +de I-TREATMENT +ellos I-TREATMENT +presentando I-TREATMENT +afectación I-TREATMENT +extracapsular. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Hepatitis I-PAST_MEDICAL_HISTORY +C. I-PAST_MEDICAL_HISTORY +Diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +plasmocitoma I-PAST_MEDICAL_HISTORY +óseo I-PAST_MEDICAL_HISTORY +solitario I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +undécima I-PAST_MEDICAL_HISTORY +costilla, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +evolucionó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Mieloma I-PAST_MEDICAL_HISTORY +Múltiple I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +Bence I-PAST_MEDICAL_HISTORY +Jones I-PAST_MEDICAL_HISTORY +Lambda. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diálisis I-PAST_MEDICAL_HISTORY +peritoneal I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nefropatía I-PAST_MEDICAL_HISTORY +asociada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Mieloma I-PAST_MEDICAL_HISTORY +Múltiple. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +lengua I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +labio I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +producían I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +escozor. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +cinco I-EXPLORATION +lesiones I-EXPLORATION +nodulares I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +punta I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua, I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +y I-EXPLORATION +labio I-EXPLORATION +izquierdo. I-EXPLORATION +Tres I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +nódulos, I-EXPLORATION +presentaban I-EXPLORATION +un I-EXPLORATION +color I-EXPLORATION +violáceo I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +centro I-EXPLORATION +ligeramente I-EXPLORATION +blanquecino I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +otros I-EXPLORATION +dos, I-EXPLORATION +más I-EXPLORATION +claros, I-EXPLORATION +sin I-EXPLORATION +tonalidad I-EXPLORATION +violácea. I-EXPLORATION +La I-EXPLORATION +consistencia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +era I-EXPLORATION +algo I-EXPLORATION +indurada. I-EXPLORATION +El I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +diámetro I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +labio, I-EXPLORATION +el I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +ellos, I-EXPLORATION +tenía I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tamaño I-EXPLORATION +del I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +nódulos I-EXPLORATION +era I-EXPLORATION +inferior I-EXPLORATION +a I-EXPLORATION +estas I-EXPLORATION +medidas. I-EXPLORATION +Al B-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +exploración I-EVOLUTION +oral, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +acude I-EVOLUTION +de I-EVOLUTION +nuevo, I-EVOLUTION +presentando I-EVOLUTION +lesiones I-EVOLUTION +de I-EVOLUTION +color I-EVOLUTION +púrpura I-EVOLUTION +perioculares I-EVOLUTION +bilaterales. I-EVOLUTION + I-EVOLUTION +Se B-EXPLORATION +procede I-EXPLORATION +a I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +biopsias, I-EXPLORATION +una I-EXPLORATION +del I-EXPLORATION +labio I-EXPLORATION +y I-EXPLORATION +dos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +linguales. I-EXPLORATION +Dichas I-EXPLORATION +biopsias I-EXPLORATION +se I-EXPLORATION +describien I-EXPLORATION +como I-EXPLORATION +depósitos I-EXPLORATION +densos I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +hialino, I-EXPLORATION +acelular, I-EXPLORATION +homogéneo I-EXPLORATION +que I-EXPLORATION +ocupa I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +submucosa I-EXPLORATION +separando I-EXPLORATION +haces I-EXPLORATION +musculares I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +paredes I-EXPLORATION +vasculares. I-EXPLORATION +Estos I-EXPLORATION +depósitos I-EXPLORATION +se I-EXPLORATION +tiñen I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Rojo I-EXPLORATION +Congo I-EXPLORATION +presentado I-EXPLORATION +una I-EXPLORATION +birrefringencia I-EXPLORATION +verde I-EXPLORATION +manzana. I-EXPLORATION +Además I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +tioflavina I-EXPLORATION +T I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +fluorescencia I-EXPLORATION +verde-amarillenta. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +ligera I-EXPLORATION +acantosis I-EXPLORATION +con I-EXPLORATION +paraqueratosis I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +infiltrado I-EXPLORATION +linfoplasmocitario. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +observados, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +Puncion I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF) I-EXPLORATION +de I-EXPLORATION +grasa I-EXPLORATION +abdominal, I-EXPLORATION +que I-EXPLORATION +resulto I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +material I-EXPLORATION +amiloide I-EXPLORATION +con I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Rojo I-EXPLORATION +Congo. I-EXPLORATION +Se I-EXPLORATION +confirma I-EXPLORATION +con I-EXPLORATION +esto I-EXPLORATION +el I-EXPLORATION +diagnostico I-EXPLORATION +de I-EXPLORATION +Amiloidosis I-EXPLORATION +Sistémica, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizan I-EXPLORATION +diferentes I-EXPLORATION +pruebas I-EXPLORATION +que I-EXPLORATION +objetivan I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +multiorgánica, I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +piel, I-EXPLORATION +tejido I-EXPLORATION +nervioso, I-EXPLORATION +aparato I-EXPLORATION +gastrointestinal, I-EXPLORATION +corazón I-EXPLORATION +y I-EXPLORATION +riñón. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnostico I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +Amiloidosis, I-EVOLUTION +fallece I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +como I-EVOLUTION +consecuencia I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +megacolon I-EVOLUTION +y I-EVOLUTION +por I-EVOLUTION +fallo I-EVOLUTION +multiorgánico. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disfagia, I-PRESENT_ILLNESS +dislalia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +extraño I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cavidad I-PRESENT_ILLNESS +oral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +habitual. I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +intraoral I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +exofítica I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo, I-EXPLORATION +carnosa, I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +pediculada I-EXPLORATION +a I-EXPLORATION +paladar I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +orofaringe. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +adenopatías I-EXPLORATION +cervicales. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +cervicofacial I-EXPLORATION +objetivaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +definidos I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +originarse I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +paladar I-EXPLORATION +blando, I-EXPLORATION +creciendo I-EXPLORATION +exofíticamente I-EXPLORATION +y I-EXPLORATION +ocupando I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +orofaringe. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +adenopatías I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +patológicas. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +toracoabdominal I-EXPLORATION +no I-EXPLORATION +objetivaron I-EXPLORATION +otras I-EXPLORATION +lesiones I-EXPLORATION +a I-EXPLORATION +distancia. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +fusocelular I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +población I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +hábito I-EXPLORATION +fibrohistiocitario I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +tipo I-EXPLORATION +estoriforme, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +fibrohistiocitoma I-EXPLORATION +maligno. I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +obstrucción I-TREATMENT +rápidamente I-TREATMENT +progresiva I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +aérea I-TREATMENT +superior, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +requirió I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +una I-TREATMENT +traqueostomía I-TREATMENT +previamente I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +definitiva. I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +realizándose I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +mediante I-TREATMENT +labiomandibulotomía I-TREATMENT +media, I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +con I-TREATMENT +márgenes I-TREATMENT +de I-TREATMENT +seguridad I-TREATMENT +-lo I-TREATMENT +que I-TREATMENT +supuso I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +totalidad I-TREATMENT +del I-TREATMENT +paladar I-TREATMENT +blando, I-TREATMENT +pilares I-TREATMENT +amigdalinos I-TREATMENT +y I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +de I-TREATMENT +orofaringe I-TREATMENT +izquierda- I-TREATMENT +y I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +inmediata I-TREATMENT +con I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +fasciocutáneo I-TREATMENT +radial I-TREATMENT +del I-TREATMENT +lado I-TREATMENT +izquierdo. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +fusocelular I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +población I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +hábito I-EXPLORATION +fibrohistiocitario, I-EXPLORATION +de I-EXPLORATION +núcleos I-EXPLORATION +ovalados, I-EXPLORATION +pleomórficos I-EXPLORATION +y I-EXPLORATION +citoplasmas I-EXPLORATION +fusiformes, I-EXPLORATION +que I-EXPLORATION +alternaba I-EXPLORATION +con I-EXPLORATION +otras I-EXPLORATION +de I-EXPLORATION +hábito I-EXPLORATION +epitelioide, I-EXPLORATION +dispuestas I-EXPLORATION +formando I-EXPLORATION +haces I-EXPLORATION +entrecruzados I-EXPLORATION +y I-EXPLORATION +adoptando I-EXPLORATION +en I-EXPLORATION +zonas I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +tipo I-EXPLORATION +estoriforme, I-EXPLORATION +confirmando I-EXPLORATION +así I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +inicial. I-EXPLORATION +Se I-EXPLORATION +identificaron I-EXPLORATION +frecuentes I-EXPLORATION +figuras I-EXPLORATION +de I-EXPLORATION +mitosis, I-EXPLORATION +algunas I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +atípicas. I-EXPLORATION +Las I-EXPLORATION +tinciones I-EXPLORATION +para I-EXPLORATION +vimentina I-EXPLORATION +y I-EXPLORATION +proteina I-EXPLORATION +CD68 I-EXPLORATION +fueron I-EXPLORATION +positivas. I-EXPLORATION +La I-EXPLORATION +neoplasia I-EXPLORATION +respetaba I-EXPLORATION +ampliamente I-EXPLORATION +los I-EXPLORATION +márgenes I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +quirúrgicos. I-EXPLORATION +Dado B-TREATMENT +el I-TREATMENT +gran I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +fue I-TREATMENT +administrado I-TREATMENT +tratamiento I-TREATMENT +radioterápico I-TREATMENT +complementario. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +permanecido I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +local I-EVOLUTION +o I-EVOLUTION +a I-EVOLUTION +distancia I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +actual I-EVOLUTION +y I-EVOLUTION +presenta I-EVOLUTION +un I-EVOLUTION +excelente I-EVOLUTION +resultado I-EVOLUTION +estético I-EVOLUTION +y I-EVOLUTION +funcional, I-EVOLUTION +con I-EVOLUTION +deglución I-EVOLUTION +y I-EVOLUTION +fonación I-EVOLUTION +normales. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +centrofacial I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tráfico. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +fractura I-EXPLORATION +tipo I-EXPLORATION +Le I-EXPLORATION +Fort I-EXPLORATION +II I-EXPLORATION +y I-EXPLORATION +nasoetmoidal I-EXPLORATION +derecha I-EXPLORATION +tipo I-EXPLORATION +II I-EXPLORATION +e I-EXPLORATION +izquierda I-EXPLORATION +tipo I-EXPLORATION +I I-EXPLORATION +que I-EXPLORATION +le I-EXPLORATION +produce I-EXPLORATION +una I-EXPLORATION +mordida I-EXPLORATION +abierta I-EXPLORATION +anterior, I-EXPLORATION +hipertelorismo I-EXPLORATION +y I-EXPLORATION +equimosis I-EXPLORATION +orbitaria I-EXPLORATION +bilateral. I-EXPLORATION +Tras B-TREATMENT +proceder I-TREATMENT +a I-TREATMENT +la I-TREATMENT +ferulización I-TREATMENT +de I-TREATMENT +ambas I-TREATMENT +arcadas I-TREATMENT +se I-TREATMENT +reduce I-TREATMENT +el I-TREATMENT +maxilar I-TREATMENT +y I-TREATMENT +se I-TREATMENT +lleva I-TREATMENT +a I-TREATMENT +bloqueo I-TREATMENT +rígido. I-TREATMENT +Se I-TREATMENT +exponen I-TREATMENT +las I-TREATMENT +fracturas I-TREATMENT +desde I-TREATMENT +abordajes I-TREATMENT +inferiores I-TREATMENT +bilateralmente. I-TREATMENT +Se I-TREATMENT +consigue I-TREATMENT +una I-TREATMENT +buena I-TREATMENT +estabilización I-TREATMENT +del I-TREATMENT +maxilar I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fractura I-TREATMENT +nasoetmoidal I-TREATMENT +en I-TREATMENT +el I-TREATMENT +lado I-TREATMENT +izquierdo. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +transconjuntival I-TREATMENT +en I-TREATMENT +el I-TREATMENT +derecho I-TREATMENT +que I-TREATMENT +se I-TREATMENT +amplia I-TREATMENT +con I-TREATMENT +una I-TREATMENT +transcaruncular. I-TREATMENT +Ambos I-TREATMENT +abordajes I-TREATMENT +se I-TREATMENT +unen I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +desinserción I-TREATMENT +del I-TREATMENT +oblícuo I-TREATMENT +inferior. I-TREATMENT +Se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +reducción I-TREATMENT +de I-TREATMENT +los I-TREATMENT +fragmentos I-TREATMENT +comprobando I-TREATMENT +el I-TREATMENT +plano I-TREATMENT +de I-TREATMENT +reducción I-TREATMENT +en I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +medial. I-TREATMENT +Osteosíntesis I-TREATMENT +con I-TREATMENT +microplacas I-TREATMENT +en I-TREATMENT +reborde I-TREATMENT +infraorbitario. I-TREATMENT +Colocamos I-TREATMENT +injertos I-TREATMENT +de I-TREATMENT +PDS I-TREATMENT +de I-TREATMENT +20 I-TREATMENT +mm I-TREATMENT +por I-TREATMENT +25 I-TREATMENT +mm I-TREATMENT +en I-TREATMENT +pared I-TREATMENT +medial I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +adecuada I-TREATMENT +restitución I-TREATMENT +volumétrica. I-TREATMENT +Con I-TREATMENT +Vicryl I-TREATMENT +5/0 I-TREATMENT +de I-TREATMENT +aguja I-TREATMENT +de I-TREATMENT +13 I-TREATMENT +mm I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +sutura I-TREATMENT +del I-TREATMENT +periostio I-TREATMENT +y I-TREATMENT +se I-TREATMENT +reinserta I-TREATMENT +el I-TREATMENT +oblícuo I-TREATMENT +inferior. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +cierra I-TREATMENT +abordaje I-TREATMENT +transconjuntival. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +refiere I-EVOLUTION +diplopia I-EVOLUTION +ni I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +déficit I-EVOLUTION +o I-EVOLUTION +sobreacción I-EVOLUTION +del I-EVOLUTION +oblícuo I-EVOLUTION +inferior I-EVOLUTION +ni I-EVOLUTION +del I-EVOLUTION +resto I-EVOLUTION +de I-EVOLUTION +musculatura I-EVOLUTION +extrínseca, I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +oftalmológicos I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +placa I-PRESENT_ILLNESS +violácea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ocupaba I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +parte I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +punta I-PRESENT_ILLNESS +nasal; I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +valorada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +pediatra I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +mantiene I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +expectante I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +observar I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +continuaba I-PRESENT_ILLNESS +progresando, I-PRESENT_ILLNESS +ocasionándole I-PRESENT_ILLNESS +deformidad I-PRESENT_ILLNESS +facial, I-PRESENT_ILLNESS +decide I-PRESENT_ILLNESS +remitirla I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +ser I-EXPLORATION +valorada, I-EXPLORATION +detectamos I-EXPLORATION +deformidad I-EXPLORATION +del I-EXPLORATION +cartílago I-EXPLORATION +y I-EXPLORATION +discreta I-EXPLORATION +dificultad I-EXPLORATION +respiratoria. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +esclerosante I-TREATMENT +con I-TREATMENT +Betametazona I-TREATMENT +4 I-TREATMENT +mg I-TREATMENT +intralesional, I-TREATMENT +cuando I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +la I-TREATMENT +fibrosis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +su I-TREATMENT +exéresis I-TREATMENT +quirúrgica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +por I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +en I-TREATMENT +ala I-TREATMENT +de I-TREATMENT +gaviota I-TREATMENT +invertida. I-TREATMENT + I-TREATMENT +Paciente B-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +atendido I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +trauma I-PRESENT_ILLNESS +facial I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +violencia, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +mentoniana. I-PRESENT_ILLNESS +La B-EXPLORATION +imagen I-EXPLORATION +radiográfica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +fractura I-EXPLORATION +sinfisiaria I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +radio I-EXPLORATION +lúcida I-EXPLORATION +periapical. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +enucleación I-TREATMENT +del I-TREATMENT +quiste I-TREATMENT +e I-TREATMENT +inmovilización I-TREATMENT +de I-TREATMENT +fragmentos I-TREATMENT +por I-TREATMENT +bloqueo I-TREATMENT +intermaxilar I-TREATMENT +y I-TREATMENT +terapia I-TREATMENT +endodóntica I-TREATMENT +posterior I-TREATMENT +a I-TREATMENT +la I-TREATMENT +intervención. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +comprobó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +radicular. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +panorámica I-EXPLORATION +realizada I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +mes I-EXPLORATION +de I-EXPLORATION +post I-EXPLORATION +operatorio, I-EXPLORATION +evidenció I-EXPLORATION +la I-EXPLORATION +evolución I-EXPLORATION +favorable I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +lesiones. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +ingresado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ángulo I-PRESENT_ILLNESS +mandibular I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +mandibular I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +larga I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +radiolúcida. I-PRESENT_ILLNESS +Esta B-TREATMENT +fue I-TREATMENT +enucleada I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +intraoral I-TREATMENT +al I-TREATMENT +igual I-TREATMENT +que I-TREATMENT +las I-TREATMENT +raíces I-TREATMENT +dentarias I-TREATMENT +asociadas, I-TREATMENT +seguido I-TREATMENT +de I-TREATMENT +estabilización I-TREATMENT +de I-TREATMENT +fragmentos I-TREATMENT +mediante I-TREATMENT +bloqueo I-TREATMENT +intermaxilar I-TREATMENT +utilizando I-TREATMENT +ligaduras I-TREATMENT +Ivy. I-TREATMENT +La B-EXPLORATION +histología I-EXPLORATION +confirmó I-EXPLORATION +su I-EXPLORATION +naturaleza I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +radicular. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +tercer I-PRESENT_ILLNESS +molar I-PRESENT_ILLNESS +fusionado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuarto I-PRESENT_ILLNESS +molar I-PRESENT_ILLNESS +supernumerario I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Departamento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Medicina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Cirugía I-PRESENT_ILLNESS +Bucofacial I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor, I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +trismo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +repetición I-PRESENT_ILLNESS +causados I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tercer I-PRESENT_ILLNESS +molar I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +semierupcionado. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +tercer I-EXPLORATION +molar I-EXPLORATION +de I-EXPLORATION +grandes I-EXPLORATION +dimensiones I-EXPLORATION +en I-EXPLORATION +posición I-EXPLORATION +mesioangular I-EXPLORATION +semierupcionado, I-EXPLORATION +responsable I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +pericoronaritis. I-EXPLORATION +Realizamos I-EXPLORATION +una I-EXPLORATION +ortopantomografía I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +el I-EXPLORATION +tercer I-EXPLORATION +molar I-EXPLORATION +unido I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +supernumerario I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +corona I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +raíz. I-EXPLORATION +Se I-EXPLORATION +da I-EXPLORATION +la I-EXPLORATION +circunstancia I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +otro I-EXPLORATION +molar I-EXPLORATION +supernumerario I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +lado I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Tras B-PAST_MEDICAL_HISTORY +realizar I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +(sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés), I-PAST_MEDICAL_HISTORY +se B-TREATMENT +explica I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +el I-TREATMENT +propósito I-TREATMENT +y I-TREATMENT +los I-TREATMENT +riesgos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +y I-TREATMENT +firma I-TREATMENT +el I-TREATMENT +consentimiento I-TREATMENT +informado. I-TREATMENT +El B-EXPLORATION +paciente I-EXPLORATION +rechaza I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +escáner I-EXPLORATION +para I-EXPLORATION +conocer I-EXPLORATION +la I-EXPLORATION +relación I-EXPLORATION +del I-EXPLORATION +molar I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +conducto I-EXPLORATION +del I-EXPLORATION +nervio I-EXPLORATION +dentario I-EXPLORATION +inferior. I-EXPLORATION +Se B-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +extracción I-TREATMENT +quirúrgica I-TREATMENT +del I-TREATMENT +tercer I-TREATMENT +y I-TREATMENT +cuarto I-TREATMENT +molar, I-TREATMENT +con I-TREATMENT +anestesia I-TREATMENT +local, I-TREATMENT +siendo I-TREATMENT +necesario I-TREATMENT +hacer I-TREATMENT +odontosección I-TREATMENT +por I-TREATMENT +el I-TREATMENT +gran I-TREATMENT +tamaño I-TREATMENT +del I-TREATMENT +molar I-TREATMENT +fusionado. I-TREATMENT + I-TREATMENT +No B-EVOLUTION +hubo I-EVOLUTION +complicaciones I-EVOLUTION +ni I-EVOLUTION +intra I-EVOLUTION +ni I-EVOLUTION +postoperatorias. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +revisión I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses, I-EVOLUTION +descartándose I-EVOLUTION +problemas I-EVOLUTION +periodontales I-EVOLUTION +y I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +caries I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +segundo I-EVOLUTION +molar. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +enoftalmos, I-PRESENT_ILLNESS +diplopia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +distopia I-PRESENT_ILLNESS +derechas I-PRESENT_ILLNESS +posteriores I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tránsito I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +blow-out I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Se B-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +corrección I-TREATMENT +de I-TREATMENT +dichas I-TREATMENT +secuelas I-TREATMENT +realizando I-TREATMENT +injerto I-TREATMENT +escalonado I-TREATMENT +de I-TREATMENT +calota I-TREATMENT +en I-TREATMENT +piso I-TREATMENT +de I-TREATMENT +orbita I-TREATMENT +derecho I-TREATMENT +y I-TREATMENT +adición I-TREATMENT +de I-TREATMENT +gel I-TREATMENT +de I-TREATMENT +plasma I-TREATMENT +rico I-TREATMENT +en I-TREATMENT +plaquetas, I-TREATMENT +11 I-TREATMENT +meses I-TREATMENT +posterior I-TREATMENT +al I-TREATMENT +accidente, I-TREATMENT +mediante I-TREATMENT +abordaje I-TREATMENT +infraorbitario I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +cicatriz I-TREATMENT +previa. I-TREATMENT +Tanto B-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +postoperatorio, I-EVOLUTION +como I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +16 I-EVOLUTION +semanas, I-EVOLUTION +se I-EVOLUTION +observan I-EVOLUTION +ejes I-EVOLUTION +pupilares I-EVOLUTION +más I-EVOLUTION +simétricos I-EVOLUTION +y I-EVOLUTION +mejoría I-EVOLUTION +importante I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +proyección I-EVOLUTION +del I-EVOLUTION +globo I-EVOLUTION +ocular I-EVOLUTION +derecho I-EVOLUTION +y I-EVOLUTION +especialmente I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +diplopia I-EVOLUTION +postraumática. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +secuelas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +trauma I-PRESENT_ILLNESS +contundente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hemicara I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +blow-out I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +tratada. I-PRESENT_ILLNESS +Como B-EXPLORATION +consecuencia I-EXPLORATION +presentó I-EXPLORATION +enoftalmos, I-EXPLORATION +distopia I-EXPLORATION +y I-EXPLORATION +diplopia I-EXPLORATION +izquierdas I-EXPLORATION +; I-EXPLORATION +18 B-TREATMENT +meses I-TREATMENT +posterior I-TREATMENT +al I-TREATMENT +trauma I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +corrección I-TREATMENT +de I-TREATMENT +dichas I-TREATMENT +secuelas I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +injerto I-TREATMENT +escalonado I-TREATMENT +de I-TREATMENT +calota I-TREATMENT +en I-TREATMENT +suelo I-TREATMENT +de I-TREATMENT +órbita, I-TREATMENT +previo I-TREATMENT +abordaje I-TREATMENT +transconjuntival I-TREATMENT +izquierdo. I-TREATMENT +Observándose B-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +evaluación I-EVOLUTION +postoperatoria I-EVOLUTION +mejoría I-EVOLUTION +estética I-EVOLUTION +y I-EVOLUTION +funcional I-EVOLUTION +importante I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +condiciones I-EVOLUTION +ya I-EVOLUTION +descritas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitido I-PRESENT_ILLNESS +a B-DERIVED_FROM/TO +nuestras I-DERIVED_FROM/TO +consultas I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +oftalmología I-DERIVED_FROM/TO +por B-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +exoftalmos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +globo I-PRESENT_ILLNESS +ocular I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +seno I-PRESENT_ILLNESS +maxilar I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +máxilo-malar I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +28 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +reducción I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fijación I-PAST_MEDICAL_HISTORY +alámbrica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +reborde I-PAST_MEDICAL_HISTORY +infraorbitario I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +arbotante I-PAST_MEDICAL_HISTORY +frontomalar. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +encontramos I-EXPLORATION +exoftalmos, I-EXPLORATION +distopia I-EXPLORATION +vertical I-EXPLORATION +del I-EXPLORATION +globo I-EXPLORATION +ocular I-EXPLORATION +y I-EXPLORATION +oftalmoplejia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mirada I-EXPLORATION +vertical. I-EXPLORATION +Se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +proyección I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +infraorbitario I-EXPLORATION +que I-EXPLORATION +permitía I-EXPLORATION +palpar I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +blanda I-EXPLORATION +a I-EXPLORATION +dicho I-EXPLORATION +nivel. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ortopantomografía I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +vió I-EXPLORATION +relación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +con I-EXPLORATION +dientes. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho, I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +con I-EXPLORATION +remodelación I-EXPLORATION +ósea I-EXPLORATION +y I-EXPLORATION +destrucción I-EXPLORATION +del I-EXPLORATION +suelo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita I-EXPLORATION +y I-EXPLORATION +desplazamiento I-EXPLORATION +del I-EXPLORATION +músculo I-EXPLORATION +recto I-EXPLORATION +inferior, I-EXPLORATION +provocando I-EXPLORATION +un I-EXPLORATION +exoftalmos I-EXPLORATION +secundario. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +la I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +las I-TREATMENT +fijaciones I-TREATMENT +alámbricas I-TREATMENT +vía I-TREATMENT +subciliar I-TREATMENT +figura I-TREATMENT +3), I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +con I-TREATMENT +prótesis I-TREATMENT +de I-TREATMENT +Medpor I-TREATMENT +del I-TREATMENT +complejo I-TREATMENT +máxilomalar I-TREATMENT +destruido I-TREATMENT +(reborde I-TREATMENT +infraorbitario, I-TREATMENT +suelo I-TREATMENT +de I-TREATMENT +órbita, I-TREATMENT +arbotante I-TREATMENT +frontomalar). I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +mucocele I-EXPLORATION +maxilar. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +enfermo I-EVOLUTION +fue I-EVOLUTION +satisfactoria, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +motilidad I-EVOLUTION +ocular, I-EVOLUTION +sin I-EVOLUTION +diplopia I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +correcto I-EVOLUTION +resultado I-EVOLUTION +estético. I-EVOLUTION +El I-EVOLUTION +seguimiento I-EVOLUTION +actual I-EVOLUTION +tras I-EVOLUTION +tres I-EVOLUTION +años I-EVOLUTION +continúa I-EVOLUTION +siendo I-EVOLUTION +satisfactorio I-EVOLUTION +sin I-EVOLUTION +recidiva I-EVOLUTION +ni I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +ingresada I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +quirúrgico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +deformidad I-PRESENT_ILLNESS +dentofacial. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +ferropénica, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +ninguna I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +medicamentosa I-PAST_MEDICAL_HISTORY +conocida. I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +prognatismo I-EXPLORATION +marcado I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +clase I-EXPLORATION +III I-EXPLORATION +molar I-EXPLORATION +y I-EXPLORATION +pseudohipoplasia I-EXPLORATION +de I-EXPLORATION +maxilar I-EXPLORATION +superior. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ortopantomografía I-EXPLORATION +y I-EXPLORATION +telerradiografía I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +cráneo, I-EXPLORATION +iniciando I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +cefalométrico I-EXPLORATION +correspondiente. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +tratamiento I-TREATMENT +ortodóncico I-TREATMENT +y I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +los I-TREATMENT +4 I-TREATMENT +cordales I-TREATMENT +se I-TREATMENT +somete I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +a I-TREATMENT +intervención I-TREATMENT +de I-TREATMENT +cirugía I-TREATMENT +ortognática I-TREATMENT +convencional I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +e I-TREATMENT +intubación I-TREATMENT +nasotraqueal I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +osteotomía I-TREATMENT +tipo I-TREATMENT +LeFort I-TREATMENT +I I-TREATMENT +fijada I-TREATMENT +con I-TREATMENT +dos I-TREATMENT +placas I-TREATMENT +preformadas I-TREATMENT +de I-TREATMENT +titanio I-TREATMENT +en I-TREATMENT +ambos I-TREATMENT +arbotantes I-TREATMENT +naso I-TREATMENT +maxilares I-TREATMENT +con I-TREATMENT +avance I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +mm, I-TREATMENT +impactación I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +3 I-TREATMENT +mm I-TREATMENT +y I-TREATMENT +posterior I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mm, I-TREATMENT +rotación I-TREATMENT +izquierda I-TREATMENT +de I-TREATMENT +1mm, I-TREATMENT +resección I-TREATMENT +parcial I-TREATMENT +inferior I-TREATMENT +de I-TREATMENT +septum I-TREATMENT +nasal, I-TREATMENT +cincha I-TREATMENT +de I-TREATMENT +alares I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +labial I-TREATMENT +en I-TREATMENT +V-Y. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +y I-EVOLUTION +seguida I-EVOLUTION +en I-EVOLUTION +revisiones I-EVOLUTION +en I-EVOLUTION +consultas I-EVOLUTION +externas I-EVOLUTION +evidenciándose I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +celulitis I-EVOLUTION +genianas I-EVOLUTION +bilaterales I-EVOLUTION +de I-EVOLUTION +repetición. I-EVOLUTION +Su I-EVOLUTION +inicio I-EVOLUTION +se I-EVOLUTION +produjo I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6-9 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +inicial. I-EVOLUTION +Se B-TREATMENT +decide I-TREATMENT +reintervenir I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +1 I-TREATMENT +año I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +intervención I-TREATMENT +y I-TREATMENT +retirar I-TREATMENT +el I-TREATMENT +material I-TREATMENT +de I-TREATMENT +osteosíntesis I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +osteotomía I-TREATMENT +LeFort I-TREATMENT +I I-TREATMENT +tras I-TREATMENT +reapertura I-TREATMENT +del I-TREATMENT +abordaje I-TREATMENT +sublabial I-TREATMENT +superior I-TREATMENT +bilateral I-TREATMENT +previo. I-TREATMENT +Intraoperatoriamente I-TREATMENT +no I-TREATMENT +se I-TREATMENT +objetiva I-TREATMENT +movilidad I-TREATMENT +del I-TREATMENT +tercio I-TREATMENT +medio I-TREATMENT +facial I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +osteotomía I-TREATMENT +tipo I-TREATMENT +LeFort I-TREATMENT +I I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cataloga I-TREATMENT +dicho I-TREATMENT +episodio I-TREATMENT +quirúrgico I-TREATMENT +como I-TREATMENT +una I-TREATMENT +intolerancia I-TREATMENT +al I-TREATMENT +material I-TREATMENT +de I-TREATMENT +osteosíntesis. I-TREATMENT + I-TREATMENT +Tras B-EVOLUTION +seguir I-EVOLUTION +revisiones I-EVOLUTION +periódicas I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad I-EVOLUTION +tanto I-EVOLUTION +en I-EVOLUTION +nuestras I-EVOLUTION +consultas I-EVOLUTION +externas I-EVOLUTION +como I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +ortodoncista, I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +última I-EVOLUTION +intervención I-EVOLUTION +quirúrgica I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +fuerza I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +masticación, I-EVOLUTION +impidiendo I-EVOLUTION +la I-EVOLUTION +práctica I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +dieta I-EVOLUTION +con I-EVOLUTION +alimentos I-EVOLUTION +sólidos. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +leve I-EXPLORATION +movilidad I-EXPLORATION +del I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +LeFort I-EXPLORATION +I, I-EXPLORATION +manteniendo I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +una I-EXPLORATION +oclusión I-EXPLORATION +correcta I-EXPLORATION +en I-EXPLORATION +clase I-EXPLORATION +I. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +facial I-EXPLORATION +solicitado I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +consolidación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +con I-EXPLORATION +solución I-EXPLORATION +de I-EXPLORATION +continuidad I-EXPLORATION +ósea I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +osteotomía I-EXPLORATION +LeFort I-EXPLORATION +I. I-EXPLORATION +Dado B-EVOLUTION +el I-EVOLUTION +tiempo I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +intervención I-EVOLUTION +se I-EVOLUTION +establece I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +presunción I-EVOLUTION +de I-EVOLUTION +pseudoartrosis I-EVOLUTION +de I-EVOLUTION +maxilar I-EVOLUTION +superior I-EVOLUTION +en I-EVOLUTION +dicha I-EVOLUTION +osteotomía. I-EVOLUTION + I-EVOLUTION +Se B-TREATMENT +decide I-TREATMENT +reintervenir I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +definitivo I-TREATMENT +de I-TREATMENT +dicha I-TREATMENT +complicación. I-TREATMENT +Tras I-TREATMENT +realizar I-TREATMENT +un I-TREATMENT +bloqueo I-TREATMENT +intermaxilar I-TREATMENT +elástico I-TREATMENT +en I-TREATMENT +clase I-TREATMENT +I I-TREATMENT +y I-TREATMENT +reabrir I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +el I-TREATMENT +abordaje I-TREATMENT +sublabial I-TREATMENT +superior I-TREATMENT +previo, I-TREATMENT +se I-TREATMENT +retira I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +fibroso I-TREATMENT +interpuesto I-TREATMENT +en I-TREATMENT +los I-TREATMENT +márgenes I-TREATMENT +óseos I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +osteotomía I-TREATMENT +maxilar I-TREATMENT +superior. I-TREATMENT +Se I-TREATMENT +fija I-TREATMENT +la I-TREATMENT +osteotomía I-TREATMENT +maxilar I-TREATMENT +superior I-TREATMENT +mediante I-TREATMENT +dos I-TREATMENT +placas I-TREATMENT +preformadas I-TREATMENT +de I-TREATMENT +titanio I-TREATMENT +con I-TREATMENT +el I-TREATMENT +avance I-TREATMENT +inicialmente I-TREATMENT +establecido. I-TREATMENT +Se I-TREATMENT +obtienen I-TREATMENT +injertos I-TREATMENT +óseos I-TREATMENT +esponjosos I-TREATMENT +de I-TREATMENT +tibia I-TREATMENT +derecha I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +medial I-TREATMENT +y I-TREATMENT +se I-TREATMENT +colocan I-TREATMENT +los I-TREATMENT +mismos I-TREATMENT +en I-TREATMENT +el I-TREATMENT +gap I-TREATMENT +óseo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +osteotomía I-TREATMENT +Le-Fort I-TREATMENT +I I-TREATMENT +sellando I-TREATMENT +dicho I-TREATMENT +defecto. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +foco I-EXPLORATION +interfracturario I-EXPLORATION +revela I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +cartilaginosas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +con I-EXPLORATION +predominante I-EXPLORATION +proliferación I-EXPLORATION +fibroblástica. I-EXPLORATION + I-EXPLORATION +Tras B-EVOLUTION +dicha I-EVOLUTION +intervención I-EVOLUTION +es I-EVOLUTION +seguida I-EVOLUTION +en I-EVOLUTION +nuestras I-EVOLUTION +consultas I-EVOLUTION +apreciándose I-EVOLUTION +la I-EVOLUTION +consolidación I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +osteotomía, I-EVOLUTION +sin I-EVOLUTION +movilidad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +misma, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +oclusión I-EVOLUTION +estable I-EVOLUTION +y I-EVOLUTION +aspecto I-EVOLUTION +estético I-EVOLUTION +favorable. I-EVOLUTION +Asimismo I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +apreciaron I-EVOLUTION +complicaciones I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +toma I-EVOLUTION +del I-EVOLUTION +injerto I-EVOLUTION +tibial, I-EVOLUTION +siendo I-EVOLUTION +favorable I-EVOLUTION +su I-EVOLUTION +Rx I-EVOLUTION +de I-EVOLUTION +control. I-EVOLUTION + I-EVOLUTION + +El B-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +cerrar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +boca. I-PRESENT_ILLNESS +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +valorado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +pediatría I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +diagnosticado I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +luxación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ATM, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +referido I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +cirujano I-DERIVED_FROM/TO +maxilofacial I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +guardia. I-DERIVED_FROM/TO +En B-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +el I-EXPLORATION +niño I-EXPLORATION +estaba I-EXPLORATION +inquieto I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +boca I-EXPLORATION +semiabierta, I-EXPLORATION +sin I-EXPLORATION +embargo I-EXPLORATION +al I-EXPLORATION +forzar I-EXPLORATION +el I-EXPLORATION +cierre I-EXPLORATION +la I-EXPLORATION +oclusión I-EXPLORATION +dentaria I-EXPLORATION +era I-EXPLORATION +buena I-EXPLORATION +aunque I-EXPLORATION +muy I-EXPLORATION +dolorosa. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +fiebre I-EXPLORATION +ni I-EXPLORATION +supuración I-EXPLORATION +de I-EXPLORATION +oídos. I-EXPLORATION +En B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +duración I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +unas I-PAST_MEDICAL_HISTORY +horas, I-PAST_MEDICAL_HISTORY +pues I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +acompañaba I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +maestra I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +guardería. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +interrogó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +maestra I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +busca I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +infecciosos I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +traumáticos, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +nos I-PAST_MEDICAL_HISTORY +informó I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +habían I-PAST_MEDICAL_HISTORY +faltado I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +niños I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +porque I-PAST_MEDICAL_HISTORY +estaban I-PAST_MEDICAL_HISTORY +enfermos. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ortopantomografía, I-EXPLORATION +sin I-EXPLORATION +evidenciarse I-EXPLORATION +patología I-EXPLORATION +articular. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +otoscopia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +otitis I-EXPLORATION +externa I-EXPLORATION +aguda. I-EXPLORATION +Tras B-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +adecuado I-TREATMENT +se B-EVOLUTION +produjo I-EVOLUTION +la I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +situación I-EVOLUTION +clínica. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +japonesa, B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médico-quirúrgicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +fumadora I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +bebedora, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +maxilar I-PRESENT_ILLNESS +indolora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +que I-EXPLORATION +hace I-EXPLORATION +prominencia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +vestibular I-EXPLORATION +premolar I-EXPLORATION +izquierda I-EXPLORATION +del I-EXPLORATION +maxilar I-EXPLORATION +superior, I-EXPLORATION +manteniéndose I-EXPLORATION +la I-EXPLORATION +integridad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa. I-EXPLORATION +No I-EXPLORATION +presenta I-EXPLORATION +alteraciones I-EXPLORATION +sensitivas I-EXPLORATION +asociadas I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +cervical I-EXPLORATION +es I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +panorámica I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +mixta I-EXPLORATION +radioopaca-radiolúcida I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +"panal I-EXPLORATION +de I-EXPLORATION +abejas" I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +expande I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +canino I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +bicúspide I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +origina I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +separación I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +raíces I-EXPLORATION +de I-EXPLORATION +esas I-EXPLORATION +piezas I-EXPLORATION +dentarias, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +ligero I-EXPLORATION +desplazamiento I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +y I-EXPLORATION +escotadura I-EXPLORATION +piriforme. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +delimita I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +precisión I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +tumoración, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +palatina I-EXPLORATION +sin I-EXPLORATION +llegar I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media; I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +zona I-EXPLORATION +central I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +clara I-EXPLORATION +imagen I-EXPLORATION +radiolúcida I-EXPLORATION +rodeada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +punteado I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +alternantes I-EXPLORATION +radiolúcidas I-EXPLORATION +y I-EXPLORATION +radioopacas I-EXPLORATION +que I-EXPLORATION +configuran I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +tumoral. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +diagnósticos I-EXPLORATION +diferenciales I-EXPLORATION +barajados, I-EXPLORATION +en I-EXPLORATION +espera I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +confirmación I-EXPLORATION +histológica, I-EXPLORATION +fueron: I-EXPLORATION +lesión I-EXPLORATION +fibroósea I-EXPLORATION +benigna, I-EXPLORATION +sarcoma I-EXPLORATION +osteogénico, I-EXPLORATION +tumor I-EXPLORATION +epitelial I-EXPLORATION +calcificante, I-EXPLORATION +etc. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +primera I-EXPLORATION +biopsia I-EXPLORATION +realizada I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +ameloblastoma, I-EXPLORATION +pero I-EXPLORATION +la I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +concordancia I-EXPLORATION +clínico-radiológica I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +ameloblastoma I-EXPLORATION +común I-EXPLORATION +apoyó I-EXPLORATION +la I-EXPLORATION +indicación I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +biopsia. I-EXPLORATION +En I-EXPLORATION +esta I-EXPLORATION +se I-EXPLORATION +podían I-EXPLORATION +observar I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +claridad I-EXPLORATION +escasos I-EXPLORATION +nidos I-EXPLORATION +y I-EXPLORATION +cordones I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +basaloides, I-EXPLORATION +sin I-EXPLORATION +atipia, I-EXPLORATION +dispuestas I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +estroma I-EXPLORATION +fibroso I-EXPLORATION +densamente I-EXPLORATION +colagenizado, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +consideró I-EXPLORATION +característico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +variante I-EXPLORATION +desmoplásica I-EXPLORATION +del I-EXPLORATION +ameloblastoma. I-EXPLORATION + I-EXPLORATION +Bajo B-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +de I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +mucoso I-TREATMENT +palatino I-TREATMENT +y I-TREATMENT +vestibular I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +peritumoral, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +la I-TREATMENT +separación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mucosa I-TREATMENT +nasal I-TREATMENT +y I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +maxilar, I-TREATMENT +que I-TREATMENT +en I-TREATMENT +ningún I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +encontraban I-TREATMENT +adheridas I-TREATMENT +al I-TREATMENT +tumor. I-TREATMENT +Expuesta I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +a I-TREATMENT +resecar, I-TREATMENT +y I-TREATMENT +siguiendo I-TREATMENT +los I-TREATMENT +límites I-TREATMENT +macroscópicos I-TREATMENT +del I-TREATMENT +tumor, I-TREATMENT +se I-TREATMENT +practica I-TREATMENT +una I-TREATMENT +maxilectomía I-TREATMENT +en I-TREATMENT +bloque I-TREATMENT +que I-TREATMENT +abarca I-TREATMENT +desde I-TREATMENT +distal I-TREATMENT +del I-TREATMENT +incisivo I-TREATMENT +lateral, I-TREATMENT +hasta I-TREATMENT +mesial I-TREATMENT +del I-TREATMENT +segundo I-TREATMENT +molar, I-TREATMENT +incluyendo I-TREATMENT +en I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +lateral I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fosa I-TREATMENT +nasal I-TREATMENT +izquierda, I-TREATMENT +el I-TREATMENT +suelo I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +maxilar I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +palatina I-TREATMENT +afectada. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +retirado I-TREATMENT +el I-TREATMENT +bloque I-TREATMENT +tumoral I-TREATMENT +se I-TREATMENT +amplían I-TREATMENT +los I-TREATMENT +límites I-TREATMENT +de I-TREATMENT +seguridad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +sobre I-TREATMENT +hueso I-TREATMENT +clínicamente I-TREATMENT +sano. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +acto I-TREATMENT +operatorio I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +resultante I-TREATMENT +mediante I-TREATMENT +interposición I-TREATMENT +de I-TREATMENT +un I-TREATMENT +bloque I-TREATMENT +de I-TREATMENT +autoinjerto I-TREATMENT +córtico-esponjoso I-TREATMENT +libre I-TREATMENT +de I-TREATMENT +cadera, I-TREATMENT +fijándolo I-TREATMENT +con I-TREATMENT +miniplacas I-TREATMENT +de I-TREATMENT +osteosíntesis I-TREATMENT +al I-TREATMENT +hueso I-TREATMENT +maxilar. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +macroscópico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +que I-EXPLORATION +medía I-EXPLORATION +3 I-EXPLORATION +x I-EXPLORATION +3 I-EXPLORATION +y I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +relativamente I-EXPLORATION +bien I-EXPLORATION +delimitada I-EXPLORATION +aunque I-EXPLORATION +infiltrante I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hueso I-EXPLORATION +maxilar, I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +al I-EXPLORATION +hueso I-EXPLORATION +limítrofe. I-EXPLORATION +Histológicamente I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +estaba I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +nidos I-EXPLORATION +irregulares I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +basaloide, I-EXPLORATION +con I-EXPLORATION +escaso I-EXPLORATION +citoplasma I-EXPLORATION +y I-EXPLORATION +núcleos I-EXPLORATION +monomorfos I-EXPLORATION +carentes I-EXPLORATION +de I-EXPLORATION +atipia. I-EXPLORATION +Los I-EXPLORATION +nidos I-EXPLORATION +celulares I-EXPLORATION +estaban I-EXPLORATION +dispuestos I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +salpicada I-EXPLORATION +sobre I-EXPLORATION +un I-EXPLORATION +abundante I-EXPLORATION +estroma I-EXPLORATION +muy I-EXPLORATION +colagenizado. I-EXPLORATION +Se I-EXPLORATION +emitió I-EXPLORATION +un I-EXPLORATION +informe I-EXPLORATION +de I-EXPLORATION +ameloblastoma I-EXPLORATION +variante I-EXPLORATION +desmoplásica I-EXPLORATION +que I-EXPLORATION +respetaba I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +óseos. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +cursa I-EVOLUTION +sin I-EVOLUTION +complicaciones; I-EVOLUTION +se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +dentaria I-TREATMENT +provisional I-TREATMENT +removible I-TREATMENT +al I-TREATMENT +cabo I-TREATMENT +de I-TREATMENT +unas I-TREATMENT +semanas. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +último I-EVOLUTION +control I-EVOLUTION +clínico-radiológico I-EVOLUTION +realizado I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +años I-EVOLUTION +no I-EVOLUTION +existen I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +recidiva; I-EVOLUTION +un B-EXPLORATION +año I-EXPLORATION +y I-EXPLORATION +medio I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +se I-EXPLORATION +realizó, I-EXPLORATION +para I-EXPLORATION +mayor I-EXPLORATION +seguridad, I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +histológico I-EXPLORATION +del I-EXPLORATION +hueso I-EXPLORATION +remanente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +distal I-EXPLORATION +del I-EXPLORATION +incisivo I-EXPLORATION +lateral I-EXPLORATION +por I-EXPLORATION +hallarse I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +muy I-EXPLORATION +próxima I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +residual. I-EXPLORATION +Se B-EVOLUTION +mantienen I-EVOLUTION +revisiones I-EVOLUTION +periódicas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +ni B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés, I-FAMILY_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +valorar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +latero-cervical I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +produce I-PRESENT_ILLNESS +disfonía, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +seca I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea. I-PRESENT_ILLNESS +Niega I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuenta I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +profusa I-PRESENT_ILLNESS +nocturna, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +holocraneal I-PRESENT_ILLNESS +frecuente. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +dura, I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +profundos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +cervical I-EXPLORATION +izquierdo, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media, I-EXPLORATION +sin I-EXPLORATION +palparse I-EXPLORATION +adenopatías I-EXPLORATION +locorregionales. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +revela I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +cm, I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +tiroideo I-EXPLORATION +izquierdo I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +cayado I-EXPLORATION +aórtico, I-EXPLORATION +que I-EXPLORATION +produce I-EXPLORATION +cierta I-EXPLORATION +estenosis I-EXPLORATION +traqueal I-EXPLORATION +y I-EXPLORATION +desplazamiento I-EXPLORATION +del I-EXPLORATION +esófago. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +cortes I-EXPLORATION +histológicos I-EXPLORATION +muestran I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +conjuntivo I-EXPLORATION +infiltrado I-EXPLORATION +en I-EXPLORATION +ciertas I-EXPLORATION +zonas I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +dispone I-EXPLORATION +formando I-EXPLORATION +grandes I-EXPLORATION +nidos I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +pequeño I-EXPLORATION +o I-EXPLORATION +intermedio. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +son I-EXPLORATION +reactivas I-EXPLORATION +exclusivamente I-EXPLORATION +para I-EXPLORATION +CD99, I-EXPLORATION +enolasa I-EXPLORATION +neuroespecífica I-EXPLORATION +y, I-EXPLORATION +débilmente, I-EXPLORATION +para I-EXPLORATION +sinaptofisina. I-EXPLORATION +La I-EXPLORATION +positividad I-EXPLORATION +nuclear I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +anticuerpo I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +Ki-67 I-EXPLORATION +oscila I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +25 I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +50% I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +núcleos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +tumorales. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +obtenido I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +biopsia, I-TREATMENT +se I-TREATMENT +programa I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +recibir I-TREATMENT +tratamiento I-TREATMENT +quimiorradioterápico. I-TREATMENT +Recibió I-TREATMENT +4 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia, I-TREATMENT +seguidos I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +radioterápico I-TREATMENT +con I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +administrada I-TREATMENT +de I-TREATMENT +55, I-TREATMENT +8 I-TREATMENT +Gy, I-TREATMENT +tras I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +presentó I-TREATMENT +esofagitis I-TREATMENT +y I-TREATMENT +epitelitis I-TREATMENT +de I-TREATMENT +grado I-TREATMENT +2. I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +radioterapia, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +poliquimioterapia. I-TREATMENT + I-TREATMENT +Los B-EVOLUTION +días I-EVOLUTION +siguientes I-EVOLUTION +al I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +estridor I-EVOLUTION +respiratorio, I-EVOLUTION +que I-EVOLUTION +desapareció I-EVOLUTION +por I-EVOLUTION +completo, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +tumoración I-EVOLUTION +latero-cervical I-EVOLUTION +mayor I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +50%. I-EVOLUTION +Tras I-EVOLUTION +finalizar I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +ciclos I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +se I-EVOLUTION +objetivó I-EVOLUTION +remisión I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +asintomático I-EVOLUTION +durante I-EVOLUTION +7 I-EVOLUTION +años I-EVOLUTION +hasta I-EVOLUTION +que I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +consulta I-EVOLUTION +refiriendo I-EVOLUTION +disnea I-EVOLUTION +y I-EVOLUTION +tos I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +y B-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +recidiva I-EXPLORATION +mediastínica I-EXPLORATION +con I-EXPLORATION +extensión I-EXPLORATION +pulmonar. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +traqueostomía I-TREATMENT +por I-TREATMENT +compresión I-TREATMENT +traqueal I-TREATMENT +del I-TREATMENT +tumor I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +citotóxico I-TREATMENT +con I-TREATMENT +4 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +poliquimioterapia. I-TREATMENT +Presentó B-EVOLUTION +una I-EVOLUTION +supervivencia I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +hasta I-EVOLUTION +su I-EVOLUTION +fallecimiento I-EVOLUTION +por I-EVOLUTION +causa I-EVOLUTION +tumoral. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +nota I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +chasquido I-PRESENT_ILLNESS +mandibular I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +apertura I-PRESENT_ILLNESS +mandibular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +palpable I-PRESENT_ILLNESS +preauricular I-PRESENT_ILLNESS +dolorosa I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +mejoró I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antiinflamatorios I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +esteroideos, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cirugía I-PRESENT_ILLNESS +Maxilofacial. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presenta I-EXPLORATION +asimetría I-EXPLORATION +facial, I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +preauricular I-EXPLORATION +izquierda, I-EXPLORATION +arco I-EXPLORATION +cigomático I-EXPLORATION +y I-EXPLORATION +ángulo I-EXPLORATION +mandibular I-EXPLORATION +izquierdo. I-EXPLORATION +Este I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +se I-EXPLORATION +halla I-EXPLORATION +mal I-EXPLORATION +delimitado, I-EXPLORATION +sin I-EXPLORATION +poderse I-EXPLORATION +definir I-EXPLORATION +clara I-EXPLORATION +tumoración. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +oral I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +induración I-EXPLORATION +irregular I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +masticador I-EXPLORATION +izquierdo, I-EXPLORATION +sospechosa I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +tumoral. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +apertura I-EXPLORATION +oral I-EXPLORATION +de I-EXPLORATION +40 I-EXPLORATION +mm. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +adenopatías I-EXPLORATION +cervicales I-EXPLORATION +ni I-EXPLORATION +supraclaviculares I-EXPLORATION +palpables. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +aparece I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +sólido I-EXPLORATION +en I-EXPLORATION +hemimandíbula I-EXPLORATION +izquierda, I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +x I-EXPLORATION +1, I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +del I-EXPLORATION +cóndilo I-EXPLORATION +mandibular, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +delimitados, I-EXPLORATION +que I-EXPLORATION +sugiere I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +agresiva, I-EXPLORATION +de I-EXPLORATION +probable I-EXPLORATION +origen I-EXPLORATION +óseo, I-EXPLORATION +objetivándose I-EXPLORATION +destrucción I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +mandibular I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +lítico. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +punción-aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +con I-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +redondas, I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +citoqueratinas, I-EXPLORATION +antígeno I-EXPLORATION +leucocitario I-EXPLORATION +común, I-EXPLORATION +sinaptofisina I-EXPLORATION +y I-EXPLORATION +CD99. I-EXPLORATION + I-EXPLORATION +Finalmente I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +PNET I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +tumoral I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +mandaron I-EXPLORATION +5 I-EXPLORATION +fragmentos I-EXPLORATION +irregulares I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +rojizo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +diagnosticaron I-EXPLORATION +como I-EXPLORATION +"tumoración I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +redondas I-EXPLORATION +y I-EXPLORATION +pequeñas I-EXPLORATION +infiltrando I-EXPLORATION +hueso". I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +material I-EXPLORATION +fijado I-EXPLORATION +en I-EXPLORATION +formol I-EXPLORATION +incluido I-EXPLORATION +en I-EXPLORATION +parafina I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +tan I-EXPLORATION +solo I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +positividad I-EXPLORATION +con I-EXPLORATION +vimentina I-EXPLORATION +y I-EXPLORATION +CD99. I-EXPLORATION +El I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +medido I-EXPLORATION +como I-EXPLORATION +positividad I-EXPLORATION +nuclear I-EXPLORATION +con I-EXPLORATION +MIB-1 I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +el I-EXPLORATION +15% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +celularidad I-EXPLORATION +tumoral. I-EXPLORATION +Dado I-EXPLORATION +el I-EXPLORATION +escaso I-EXPLORATION +material I-EXPLORATION +examinado, I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +posible I-EXPLORATION +determinar I-EXPLORATION +si I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +correspondía I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +Ewing I-EXPLORATION +o I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +neuroepitelioma I-EXPLORATION +periférico. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +citogenético I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +realizado. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +metastásica. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +comenzar I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +y I-TREATMENT +valorar I-TREATMENT +tratamiento I-TREATMENT +quirúrgico/radioterápico I-TREATMENT +según I-TREATMENT +la I-TREATMENT +respuesta. I-TREATMENT +Se I-TREATMENT +dieron I-TREATMENT +5 I-TREATMENT +ciclos I-TREATMENT +durante I-TREATMENT +4 I-TREATMENT +meses. I-TREATMENT +Tras B-EVOLUTION +el I-EVOLUTION +tercer I-EVOLUTION +ciclo I-EVOLUTION +precisó I-EVOLUTION +ingreso I-EVOLUTION +por I-EVOLUTION +neutropenia I-EVOLUTION +febril. I-EVOLUTION + I-EVOLUTION +La B-TREATMENT +resonancia I-TREATMENT +magnética I-TREATMENT +nuclear I-TREATMENT +(RMN) I-TREATMENT +tras I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +sugería I-TREATMENT +la I-TREATMENT +posible I-TREATMENT +progresión I-TREATMENT +del I-TREATMENT +tumor, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +dar I-TREATMENT +tratamiento I-TREATMENT +radioterápico I-TREATMENT +planificado I-TREATMENT +con I-TREATMENT +intención I-TREATMENT +radical, I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +y I-TREATMENT +medio. I-TREATMENT +La I-TREATMENT +irradiación I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +fases, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +sobre I-TREATMENT +tumor I-TREATMENT +y I-TREATMENT +margen I-TREATMENT +reducido I-TREATMENT +de I-TREATMENT +60 I-TREATMENT +Gy. I-TREATMENT +Después B-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +radioterápico I-EVOLUTION +presentó I-EVOLUTION +mucositis I-EVOLUTION +grado I-EVOLUTION +2, I-EVOLUTION +otitis I-EVOLUTION +externa I-EVOLUTION +y I-EVOLUTION +epitelitis I-EVOLUTION +grado I-EVOLUTION +2 I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +campo I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION +En B-TREATMENT +la I-TREATMENT +TAC I-TREATMENT +de I-TREATMENT +control I-TREATMENT +se I-TREATMENT +objetivaron I-TREATMENT +hallazgos I-TREATMENT +compatibles I-TREATMENT +con I-TREATMENT +restos/recidiva I-TREATMENT +del I-TREATMENT +PNET I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratar I-TREATMENT +con I-TREATMENT +otros I-TREATMENT +5 I-TREATMENT +ciclos I-TREATMENT +más I-TREATMENT +de I-TREATMENT +quimioterapia, I-TREATMENT +siguiendo I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +esquema I-TREATMENT +anterior, I-TREATMENT +durante I-TREATMENT +otros I-TREATMENT +4 I-TREATMENT +meses. I-TREATMENT + I-TREATMENT +Actualmente B-EVOLUTION +han I-EVOLUTION +pasado I-EVOLUTION +6 I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad, I-EVOLUTION +en I-EVOLUTION +tratamiento I-EVOLUTION +de I-EVOLUTION +rehabilitación I-EVOLUTION +dental. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +19 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +recurrente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hemimandíbula I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +parestesia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +mencionada, I-PRESENT_ILLNESS +especialmente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +labio I-PRESENT_ILLNESS +inferior. I-PRESENT_ILLNESS +Además, I-PRESENT_ILLNESS +describe I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +masticar I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +molares I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +premolares I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +afectado. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +leve I-EXPLORATION +asimetría I-EXPLORATION +facial I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +ubicado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +más I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +mandibular I-EXPLORATION +y I-EXPLORATION +rama I-EXPLORATION +ascendente I-EXPLORATION +izquierda. I-EXPLORATION +El I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +es I-EXPLORATION +indoloro. I-EXPLORATION +Intrabucalmente I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +tabla I-EXPLORATION +ósea I-EXPLORATION +externa I-EXPLORATION +abombada I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +del I-EXPLORATION +segundo I-EXPLORATION +molar. I-EXPLORATION +Situación I-EXPLORATION +similar, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +expansión I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +tablas, I-EXPLORATION +se I-EXPLORATION +pesquisa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rama I-EXPLORATION +ascendente I-EXPLORATION +mandibular. I-EXPLORATION +Tercer I-EXPLORATION +molar I-EXPLORATION +ausente I-EXPLORATION +clínicamente. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +hipótesis I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +mandibular I-EXPLORATION +odontogénico I-EXPLORATION +o I-EXPLORATION +tumor I-EXPLORATION +odontogénico, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +estudio I-EXPLORATION +imagenológico I-EXPLORATION +previo I-EXPLORATION +a I-EXPLORATION +biopsia. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +panorámica I-EXPLORATION +revela I-EXPLORATION +una I-EXPLORATION +extensa I-EXPLORATION +lesión I-EXPLORATION +radiolúcida I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +netos, I-EXPLORATION +uniloculada I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rama I-EXPLORATION +ascendente I-EXPLORATION +mandibular. I-EXPLORATION +Asociada I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +lesión, I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +el I-EXPLORATION +tercer I-EXPLORATION +molar I-EXPLORATION +incluido I-EXPLORATION +en I-EXPLORATION +posición I-EXPLORATION +baja I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +distoversión. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +programa I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +incisional, I-EXPLORATION +durante B-TREATMENT +la I-TREATMENT +cual, I-TREATMENT +y I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +a I-TREATMENT +las I-TREATMENT +características I-TREATMENT +clínicas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +se I-TREATMENT +instala I-TREATMENT +una I-TREATMENT +cánula I-TREATMENT +de I-TREATMENT +descompresión. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +histopatológico I-EXPLORATION +informa I-EXPLORATION +ameloblastoma I-EXPLORATION +uniquístico I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +intramural I-EXPLORATION +tipo I-EXPLORATION +IIIa I-EXPLORATION +de I-EXPLORATION +Ackerman9. I-EXPLORATION + I-EXPLORATION +Después B-TREATMENT +de I-TREATMENT +10 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +seguimiento I-TREATMENT +clínico-radiográfico, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +una I-TREATMENT +cánula I-TREATMENT +de I-TREATMENT +descompresión I-TREATMENT +cuya I-TREATMENT +longitud I-TREATMENT +se I-TREATMENT +reduce I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +gradual, I-TREATMENT +se I-TREATMENT +constata I-TREATMENT +reducción I-TREATMENT +casi I-TREATMENT +total I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +quística I-TREATMENT +ameloblástica, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +efectúa I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +enucleación I-TREATMENT +y I-TREATMENT +curetaje I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +residual, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +exodoncia I-TREATMENT +del I-TREATMENT +tercer I-TREATMENT +molar I-TREATMENT +involucrado. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +derivado B-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +máxilofacial I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Luis I-DERIVED_FROM/TO +Calvo I-DERIVED_FROM/TO +Mackenna, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +lesión I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +zona I-DERIVED_FROM/TO +malar I-DERIVED_FROM/TO +derecha. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos, I-PAST_MEDICAL_HISTORY +relata I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +volumen I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +malar I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +persiste I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +fecha.. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen, I-EXPLORATION +asintomático, I-EXPLORATION +circunscrito, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +con I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +indeterminado. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +intraoral I-EXPLORATION +el I-EXPLORATION +vestíbulo I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +desocupado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +óseo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +más I-EXPLORATION +alta. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +que I-EXPLORATION +compromete I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +malar I-EXPLORATION +derecha, I-EXPLORATION +destruyendo I-EXPLORATION +el I-EXPLORATION +hueso I-EXPLORATION +cigomático, I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +piso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +arco I-EXPLORATION +cigomático. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION + I-EXPLORATION +De I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +como I-EXPLORATION +resultado I-EXPLORATION +HCL, I-EXPLORATION +con I-EXPLORATION +marcadores I-EXPLORATION +inmunohistoquímicos I-EXPLORATION +CD1a I-EXPLORATION +y I-EXPLORATION +S100 I-EXPLORATION +intensamente I-EXPLORATION +positivos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +completo I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +paciente, I-EXPLORATION +sin I-EXPLORATION +evidenciar I-EXPLORATION +compromiso I-EXPLORATION +en I-EXPLORATION +otras I-EXPLORATION +áreas I-EXPLORATION +del I-EXPLORATION +cuerpo. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +lesión I-TREATMENT +fue I-TREATMENT +clasificada I-TREATMENT +como I-TREATMENT +lesión I-TREATMENT +ósea I-TREATMENT +única I-TREATMENT +de I-TREATMENT +sitio I-TREATMENT +especial I-TREATMENT +y I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +el I-TREATMENT +protocolo I-TREATMENT +correspondiente, I-TREATMENT +recibiendo I-TREATMENT +4 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +prednisona I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +vinblastina. I-TREATMENT + I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +como I-TREATMENT +tratamiento I-TREATMENT +local, I-TREATMENT +infiltración I-TREATMENT +con I-TREATMENT +triamcinolona I-TREATMENT +y I-TREATMENT +curetaje I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tercera I-TREATMENT +infiltración. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +realizado I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático, I-EVOLUTION +sin I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +facial I-EVOLUTION +ni I-EVOLUTION +del I-EVOLUTION +reborde I-EVOLUTION +óseo. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +la I-EXPLORATION +regeneración I-EXPLORATION +ósea I-EXPLORATION +del I-EXPLORATION +hueso I-EXPLORATION +malar, I-EXPLORATION +el I-EXPLORATION +arco I-EXPLORATION +cigomático I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +piso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +trasladado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +intubación I-PRESENT_ILLNESS +orotraqueal I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +facial I-PRESENT_ILLNESS +severo I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +intento I-PRESENT_ILLNESS +autolítico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +arma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuego. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +traumática I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +tercios I-EXPLORATION +medio I-EXPLORATION +e I-EXPLORATION +inferior I-EXPLORATION +faciales, I-EXPLORATION +con I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +óseos I-EXPLORATION +y I-EXPLORATION +blandos I-EXPLORATION +(pérdida I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +espesor I-EXPLORATION +completo I-EXPLORATION +del I-EXPLORATION +labio I-EXPLORATION +inferior, I-EXPLORATION +región I-EXPLORATION +perioral, I-EXPLORATION +mentoniana I-EXPLORATION +y I-EXPLORATION +pérdida I-EXPLORATION +parcial I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +labio I-EXPLORATION +superior). I-EXPLORATION +Se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +craneofacial, I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +daño I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +pérdida I-EXPLORATION +extensa I-EXPLORATION +de I-EXPLORATION +sustancia I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +mandibular, I-EXPLORATION +con I-EXPLORATION +fracturas I-EXPLORATION +múltiples I-EXPLORATION +maxilares, I-EXPLORATION +fractura I-EXPLORATION +de I-EXPLORATION +suelos I-EXPLORATION +orbitarios, I-EXPLORATION +fractura I-EXPLORATION +de I-EXPLORATION +huesos I-EXPLORATION +propios I-EXPLORATION +y I-EXPLORATION +tabique I-EXPLORATION +nasal I-EXPLORATION +óseo. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +trasladado I-TREATMENT +a I-TREATMENT +quirófano, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +traqueostomía I-TREATMENT +reglada, I-TREATMENT +limpieza I-TREATMENT +y I-TREATMENT +hemostasia I-TREATMENT +de I-TREATMENT +heridas I-TREATMENT +faciales I-TREATMENT +y I-TREATMENT +retirada I-TREATMENT +de I-TREATMENT +fragmentos I-TREATMENT +óseos I-TREATMENT +conminutos I-TREATMENT +y I-TREATMENT +cuerpos I-TREATMENT +extraños. I-TREATMENT +Seguidamente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +puenteo I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +óseo I-TREATMENT +mediante I-TREATMENT +una I-TREATMENT +placa I-TREATMENT +de I-TREATMENT +reconstrucción I-TREATMENT +mandibular I-TREATMENT +de I-TREATMENT +2, I-TREATMENT +5mm I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +primario I-TREATMENT +de I-TREATMENT +tejidos I-TREATMENT +blados. I-TREATMENT +Se I-TREATMENT +comprobó I-TREATMENT +la I-TREATMENT +estabilidad I-TREATMENT +de I-TREATMENT +fracturas I-TREATMENT +en I-TREATMENT +tercio I-TREATMENT +medio, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +adoptó I-TREATMENT +una I-TREATMENT +actitud I-TREATMENT +expectante. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +reducción I-TREATMENT +nasal I-TREATMENT +cerrada. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cuidados I-EVOLUTION +Intensivos I-EVOLUTION +durante I-EVOLUTION +cuatro I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION +Diez B-TREATMENT +días I-TREATMENT +más I-TREATMENT +tarde I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +secundaria, I-TREATMENT +con I-TREATMENT +retirada I-TREATMENT +de I-TREATMENT +la I-TREATMENT +placa I-TREATMENT +de I-TREATMENT +reconstrucción I-TREATMENT +mandibular, I-TREATMENT +tallado I-TREATMENT +de I-TREATMENT +colgajo I-TREATMENT +osteofasciocutáneo I-TREATMENT +microvascularizado I-TREATMENT +de I-TREATMENT +peroné I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +preformado I-TREATMENT +in I-TREATMENT +situ I-TREATMENT +por I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +adaptación I-TREATMENT +a I-TREATMENT +la I-TREATMENT +placa I-TREATMENT +de I-TREATMENT +reconstrucción I-TREATMENT +mandibular I-TREATMENT +previamente I-TREATMENT +retirada, I-TREATMENT +y I-TREATMENT +fijación I-TREATMENT +a I-TREATMENT +remanentes I-TREATMENT +mandibulares I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +ambos I-TREATMENT +ángulos I-TREATMENT +goniacos I-TREATMENT +y I-TREATMENT +ramas I-TREATMENT +mandibulares. I-TREATMENT +La I-TREATMENT +cobertura I-TREATMENT +externa I-TREATMENT +del I-TREATMENT +peroné I-TREATMENT +fue I-TREATMENT +realizada I-TREATMENT +mediante I-TREATMENT +su I-TREATMENT +paleta I-TREATMENT +cutánea, I-TREATMENT +dispuesta I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +mentoniano I-TREATMENT +y I-TREATMENT +submental, I-TREATMENT +y I-TREATMENT +la I-TREATMENT +cobertura I-TREATMENT +interna I-TREATMENT +mediante I-TREATMENT +despegamiento I-TREATMENT +y I-TREATMENT +avance I-TREATMENT +de I-TREATMENT +mucosa I-TREATMENT +del I-TREATMENT +suelo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +boca I-TREATMENT +anterior. I-TREATMENT +Finalmente, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +microanastomosis I-TREATMENT +de I-TREATMENT +vasos I-TREATMENT +peroneos I-TREATMENT +a I-TREATMENT +vasos I-TREATMENT +faciales. I-TREATMENT +Se I-TREATMENT +levantaron I-TREATMENT +colgajos I-TREATMENT +de I-TREATMENT +espesor I-TREATMENT +completo I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +remanente I-TREATMENT +de I-TREATMENT +mentón I-TREATMENT +pediculados I-TREATMENT +de I-TREATMENT +base I-TREATMENT +superior I-TREATMENT +a I-TREATMENT +modo I-TREATMENT +de I-TREATMENT +colgajos I-TREATMENT +de I-TREATMENT +Karapandzic I-TREATMENT +modificado, I-TREATMENT +con I-TREATMENT +preservación I-TREATMENT +del I-TREATMENT +pedículo I-TREATMENT +facial, I-TREATMENT +y I-TREATMENT +tallado I-TREATMENT +de I-TREATMENT +colgajos I-TREATMENT +de I-TREATMENT +avance I-TREATMENT +de I-TREATMENT +mucosa I-TREATMENT +para I-TREATMENT +creación I-TREATMENT +de I-TREATMENT +neo-bermellón. I-TREATMENT +Ambos I-TREATMENT +colgajos I-TREATMENT +mucocutáneos I-TREATMENT +fueron I-TREATMENT +rotados I-TREATMENT +medialmente I-TREATMENT +para I-TREATMENT +su I-TREATMENT +unión I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +central, I-TREATMENT +neoformando I-TREATMENT +el I-TREATMENT +labio I-TREATMENT +inferior I-TREATMENT +de I-TREATMENT +espesor I-TREATMENT +completo I-TREATMENT +y I-TREATMENT +creando I-TREATMENT +el I-TREATMENT +vestíbulo I-TREATMENT +labial I-TREATMENT +inferior. I-TREATMENT +Seguidamente I-TREATMENT +se I-TREATMENT +empleó I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +Webster I-TREATMENT +izquierdo I-TREATMENT +para I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +labial I-TREATMENT +superior. I-TREATMENT +Además I-TREATMENT +de I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +de I-TREATMENT +tejidos I-TREATMENT +blandos I-TREATMENT +y I-TREATMENT +óseos, I-TREATMENT +en I-TREATMENT +nuestro I-TREATMENT +caso I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +presentaba I-TREATMENT +una I-TREATMENT +macroglosia I-TREATMENT +constitucional, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +realizamos I-TREATMENT +una I-TREATMENT +glosectomía I-TREATMENT +media I-TREATMENT +(resecando I-TREATMENT +el I-TREATMENT +tercio I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +lengua I-TREATMENT +libre) I-TREATMENT +como I-TREATMENT +procedimiento I-TREATMENT +complementario I-TREATMENT +con I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +facilitar I-TREATMENT +la I-TREATMENT +competencia I-TREATMENT +labial, I-TREATMENT +deglución I-TREATMENT +y I-TREATMENT +fonación. I-TREATMENT + I-TREATMENT +Durante B-EXPLORATION +el I-EXPLORATION +postoperatorio, I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +fueron I-EXPLORATION +evaluados I-EXPLORATION +en I-EXPLORATION +términos I-EXPLORATION +de I-EXPLORATION +competencia I-EXPLORATION +labial, I-EXPLORATION +habla, I-EXPLORATION +alimentación I-EXPLORATION +y I-EXPLORATION +estética. I-EXPLORATION +La I-EXPLORATION +competencia I-EXPLORATION +labial I-EXPLORATION +fue I-EXPLORATION +óptima, I-EXPLORATION +sin I-EXPLORATION +conseguir I-EXPLORATION +el I-EXPLORATION +cierre I-EXPLORATION +hermético I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +labios, I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +líquidos I-EXPLORATION +al I-EXPLORATION +beber. I-EXPLORATION +El I-EXPLORATION +habla I-EXPLORATION +fue I-EXPLORATION +evaluada I-EXPLORATION +en I-EXPLORATION +función I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inteligibilidad I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +por I-EXPLORATION +teléfono, I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +positiva. I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +capacidad I-EXPLORATION +de I-EXPLORATION +alimentarse, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +tiene I-EXPLORATION +una I-EXPLORATION +dieta I-EXPLORATION +normal I-EXPLORATION +(triturada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +dentición). I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +estético I-EXPLORATION +fue I-EXPLORATION +aceptable. I-EXPLORATION +Durante B-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +posterior I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +producido I-EVOLUTION +ninguna I-EVOLUTION +complicación I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +seguimiento I-EVOLUTION +y I-EVOLUTION +tratamiento I-EVOLUTION +por I-EVOLUTION +parte I-EVOLUTION +de I-EVOLUTION +psiquiatría. I-EVOLUTION +En I-EVOLUTION +un I-EVOLUTION +futuro I-EVOLUTION +próximo I-EVOLUTION +se I-EVOLUTION +prevee I-EVOLUTION +la I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +realizar I-EVOLUTION +alguna I-EVOLUTION +intervención I-EVOLUTION +adicional I-EVOLUTION +(refinamiento I-EVOLUTION +estético I-EVOLUTION +labial, I-EVOLUTION +rehabilitación I-EVOLUTION +protésica I-EVOLUTION +dental, I-EVOLUTION +etc.). I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +vista I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Carabineros I-PRESENT_ILLNESS +Santiago, I-PRESENT_ILLNESS +Chile, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +parto I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +28 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cesárea. I-PRESENT_ILLNESS +Con B-EXPLORATION +un I-EXPLORATION +peso I-EXPLORATION +de I-EXPLORATION +3.163 I-EXPLORATION +gramos, I-EXPLORATION +talla I-EXPLORATION +49cm I-EXPLORATION +y I-EXPLORATION +perímetro I-EXPLORATION +craneal I-EXPLORATION +cercano I-EXPLORATION +a I-EXPLORATION +35cm. I-EXPLORATION +Al I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +nacimiento I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +lesiones I-EXPLORATION +vesiculosas I-EXPLORATION +en I-EXPLORATION +extremidades I-EXPLORATION +inferiores, I-EXPLORATION +zona I-EXPLORATION +glútea I-EXPLORATION +y I-EXPLORATION +axilas I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +rompen I-EXPLORATION +al I-EXPLORATION +retirar I-EXPLORATION +el I-EXPLORATION +unto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +quedando I-EXPLORATION +lesiones I-EXPLORATION +eritematosas I-EXPLORATION +y I-EXPLORATION +descamativas. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +diagnosticó I-EXPLORATION +en I-EXPLORATION +primera I-EXPLORATION +instancia I-EXPLORATION +epidermolisis I-EXPLORATION +bulosa, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +posteriormente I-EXPLORATION +fue I-EXPLORATION +descartada. I-EXPLORATION +Destacaba I-EXPLORATION +además I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +alopecia I-EXPLORATION +en I-EXPLORATION +vértex I-EXPLORATION +y I-EXPLORATION +paladar I-EXPLORATION +fisurado. I-EXPLORATION + I-EXPLORATION +Se B-DERIVED_FROM/TO +da I-DERIVED_FROM/TO +refiere I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +oftalmología I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +realiza I-DERIVED_FROM/TO +examen I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +fondo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ojo I-DERIVED_FROM/TO +observándose I-DERIVED_FROM/TO +epitelio I-DERIVED_FROM/TO +pigmentario I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +poco I-DERIVED_FROM/TO +pigmento I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +forma I-DERIVED_FROM/TO +generalizada, I-DERIVED_FROM/TO +resto I-DERIVED_FROM/TO +normal. I-DERIVED_FROM/TO +Evaluación B-EXPLORATION +por I-EXPLORATION +neurólogo I-EXPLORATION +normal. I-EXPLORATION +Dermatólogo I-EXPLORATION +plantea I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +IP I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +encontrándose I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +limites I-EXPLORATION +histológicos I-EXPLORATION +normales, I-EXPLORATION +pero I-EXPLORATION +se I-EXPLORATION +recomienda I-EXPLORATION +otra I-EXPLORATION +nueva I-EXPLORATION +muestra. I-EXPLORATION +Visto I-EXPLORATION +por I-EXPLORATION +genetista I-EXPLORATION +clínicamente I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +herencia I-EXPLORATION +ligada I-EXPLORATION +a I-EXPLORATION +X I-EXPLORATION +dominante, I-EXPLORATION +ya B-FAMILY_HISTORY +que I-FAMILY_HISTORY +la I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +presentó I-FAMILY_HISTORY +las I-FAMILY_HISTORY +mismas I-FAMILY_HISTORY +lesiones I-FAMILY_HISTORY +al I-FAMILY_HISTORY +nacimiento. I-FAMILY_HISTORY +Se B-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +también I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +maxilofacial I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +CP. I-DERIVED_FROM/TO +A B-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +edad I-EVOLUTION +fue I-EVOLUTION +operada I-EVOLUTION +de I-EVOLUTION +paladar I-EVOLUTION +fisurado, I-EVOLUTION +reconstituyendo I-EVOLUTION +funcionalmente I-EVOLUTION +los I-EVOLUTION +anillos I-EVOLUTION +musculares I-EVOLUTION +del I-EVOLUTION +velo I-EVOLUTION +palatino I-EVOLUTION +y I-EVOLUTION +evolucionó I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +complicaciones I-EVOLUTION +postoperatorias. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médico-quirúrgicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +remitida B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +consultas I-DERIVED_FROM/TO +externas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Maxilofacial I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Universitario I-DERIVED_FROM/TO +Marqués I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Valdecilla I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +noviembre I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2004 I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +masa I-DERIVED_FROM/TO +indolora I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +región I-DERIVED_FROM/TO +anterior I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +suelo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +boca I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución. I-DERIVED_FROM/TO +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +dentición I-EXPLORATION +mixta I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +sínfisis I-EXPLORATION +mandibular, I-EXPLORATION +con I-EXPLORATION +mucosa I-EXPLORATION +oral I-EXPLORATION +respetada I-EXPLORATION +y I-EXPLORATION +abombamiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +corticales I-EXPLORATION +lingual I-EXPLORATION +y I-EXPLORATION +vestibular, I-EXPLORATION +y I-EXPLORATION +dientes I-EXPLORATION +deciduos I-EXPLORATION +estables I-EXPLORATION +a I-EXPLORATION +ese I-EXPLORATION +nivel. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +presenta I-EXPLORATION +alteraciones I-EXPLORATION +neurológicas I-EXPLORATION +significativas. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ortopantomografía I-EXPLORATION +(OPG) I-EXPLORATION +revela I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +radiolúcida I-EXPLORATION +de I-EXPLORATION +márgenes I-EXPLORATION +mal I-EXPLORATION +definidos I-EXPLORATION +en I-EXPLORATION +sínfisis I-EXPLORATION +mandibular I-EXPLORATION +-de I-EXPLORATION +73 I-EXPLORATION +a I-EXPLORATION +83-, I-EXPLORATION +con I-EXPLORATION +basilar I-EXPLORATION +desestructurada I-EXPLORATION +a I-EXPLORATION +ese I-EXPLORATION +nivel. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +3 I-EXPLORATION +dientes I-EXPLORATION +definitivos I-EXPLORATION +incluidos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +y I-EXPLORATION +cierto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +rizólisis I-EXPLORATION +y I-EXPLORATION +desplazamientos I-EXPLORATION +dentales. I-EXPLORATION +Se I-EXPLORATION +solicita I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC), I-EXPLORATION +que I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +osteolítica, I-EXPLORATION +insuflante I-EXPLORATION +y I-EXPLORATION +multilocular I-EXPLORATION +de I-EXPLORATION +3×1, I-EXPLORATION +8cm, I-EXPLORATION +con I-EXPLORATION +corticales I-EXPLORATION +expandidas I-EXPLORATION +y I-EXPLORATION +adelgazadas, I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas; I-EXPLORATION +asimismo, I-EXPLORATION +se I-EXPLORATION +describe I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +sólida, I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +óseo I-EXPLORATION +aneurismático I-EXPLORATION +sólido. I-EXPLORATION +La I-EXPLORATION +punción-aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF) I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +concluyente. I-EXPLORATION + I-EXPLORATION +Bajo I-EXPLORATION +anestesia I-EXPLORATION +general I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +abordaje I-EXPLORATION +vestibular, I-EXPLORATION +que I-EXPLORATION +permite I-EXPLORATION +visualizar I-EXPLORATION +la I-EXPLORATION +cortical I-EXPLORATION +expandida I-EXPLORATION +y I-EXPLORATION +adelgazada I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +continuidad, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +típico I-EXPLORATION +aspecto I-EXPLORATION +en I-EXPLORATION +«cáscara I-EXPLORATION +de I-EXPLORATION +huevo». I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +expuesta I-EXPLORATION +la I-EXPLORATION +lesión, I-EXPLORATION +se I-EXPLORATION +toma I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +intraoperatoria I-EXPLORATION +que I-EXPLORATION +descarta I-EXPLORATION +patología I-EXPLORATION +ósea I-EXPLORATION +maligna. I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +firme I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +QOA I-TREATMENT +sólido, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +curetaje I-TREATMENT +y I-TREATMENT +exodoncia I-TREATMENT +de I-TREATMENT +los I-TREATMENT +tres I-TREATMENT +dientes I-TREATMENT +definitivos I-TREATMENT +incluidos I-TREATMENT +en I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT +El I-TREATMENT +defecto I-TREATMENT +óseo I-TREATMENT +no I-TREATMENT +precisa I-TREATMENT +reconstrucción, I-TREATMENT +pero I-TREATMENT +a I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +favorecer I-TREATMENT +la I-TREATMENT +remodelación I-TREATMENT +ósea I-TREATMENT +guiada I-TREATMENT +del I-TREATMENT +lecho I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +emplea I-TREATMENT +una I-TREATMENT +lámina I-TREATMENT +de I-TREATMENT +hueso I-TREATMENT +desmineralizado I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cortical I-TREATMENT +externa I-TREATMENT +mandibular. I-TREATMENT + I-TREATMENT +Al B-DERIVED_FROM/TO +alta I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +ortodoncista I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +ferulización I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +arcada I-DERIVED_FROM/TO +inferior, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +objetivo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +asegurar I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +estabilidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +misma, I-DERIVED_FROM/TO +dada I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +importante I-DERIVED_FROM/TO +pérdida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +soporte I-DERIVED_FROM/TO +óseo I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nivel I-DERIVED_FROM/TO +crestal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +sínfisis I-DERIVED_FROM/TO +mandibular. I-DERIVED_FROM/TO +Dicha B-EVOLUTION +fijación I-EVOLUTION +es I-EVOLUTION +mantenida I-EVOLUTION +durante I-EVOLUTION +6 I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +definitivo I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +óseo I-EXPLORATION +aneurismático I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +sólido. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +macroscópico I-EXPLORATION +se I-EXPLORATION +identifican I-EXPLORATION +varios I-EXPLORATION +fragmentos I-EXPLORATION +irregulares I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +pardo-negruzco I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +y I-EXPLORATION +firme; I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +microscópico, I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +pequeños I-EXPLORATION +espacios I-EXPLORATION +vasculares I-EXPLORATION +revestidos I-EXPLORATION +por I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +fibroso, I-EXPLORATION +células I-EXPLORATION +gigantes I-EXPLORATION +y I-EXPLORATION +macrófagos, I-EXPLORATION +con I-EXPLORATION +mitosis I-EXPLORATION +ocasionales, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +atipias I-EXPLORATION +y I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +hemosiderina. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +postoperatoria, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +correcta I-EVOLUTION +apariencia I-EVOLUTION +estética I-EVOLUTION +y I-EVOLUTION +funcional. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +6 I-EVOLUTION +años I-EVOLUTION +en I-EVOLUTION +seguimiento, I-EVOLUTION +no I-EVOLUTION +presenta I-EVOLUTION +signos I-EVOLUTION +clínicos I-EVOLUTION +ni I-EVOLUTION +radiológicos I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +local I-EVOLUTION +y B-TREATMENT +ha I-TREATMENT +iniciado I-TREATMENT +tratamiento I-TREATMENT +ortodóncico I-TREATMENT +para I-TREATMENT +corrección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +malposición I-TREATMENT +dentaria. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +género I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Estomatología I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Facultad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Odontología I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Bauru I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Universidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +São I-PRESENT_ILLNESS +Paulo, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +queja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +"diente I-PRESENT_ILLNESS +dentro I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hueso" I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +realizarse I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +examen I-PRESENT_ILLNESS +radiográfico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rutina. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Clínicamente, B-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +diente I-EXPLORATION +83 I-EXPLORATION +estaba I-EXPLORATION +presente I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +arco I-EXPLORATION +dentario I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +elemento I-EXPLORATION +dentario I-EXPLORATION +43 I-EXPLORATION +estaba I-EXPLORATION +ausente. I-EXPLORATION +Se I-EXPLORATION +confirmó I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +óseo I-EXPLORATION +asintomático, I-EXPLORATION +con I-EXPLORATION +evolución I-EXPLORATION +aproximada I-EXPLORATION +de I-EXPLORATION +cinco I-EXPLORATION +años, I-EXPLORATION +extendiéndose I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +del I-EXPLORATION +diente I-EXPLORATION +32 I-EXPLORATION +al I-EXPLORATION +diente I-EXPLORATION +44. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +visualización I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +radiográfico I-EXPLORATION +panorámico I-EXPLORATION +fue I-EXPLORATION +detectada I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +radiolúcida I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +bien I-EXPLORATION +definidos I-EXPLORATION +con I-EXPLORATION +material I-EXPLORATION +amorfo I-EXPLORATION +radiopaco I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +centro, I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +lobular, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +reabsorción I-EXPLORATION +radicular I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dientes I-EXPLORATION +adyacentes I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +del I-EXPLORATION +elemento I-EXPLORATION +dentario I-EXPLORATION +43 I-EXPLORATION +no I-EXPLORATION +erupcionado. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +presuntivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +odontoma I-EXPLORATION +complejo. I-EXPLORATION + I-EXPLORATION +Bajo B-TREATMENT +anestesia I-TREATMENT +local, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +el I-TREATMENT +acceso I-TREATMENT +por I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +intra-sulcular I-TREATMENT +extendiéndose I-TREATMENT +de I-TREATMENT +la I-TREATMENT +región I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dientes I-TREATMENT +34 I-TREATMENT +al I-TREATMENT +45 I-TREATMENT +con I-TREATMENT +consecuente I-TREATMENT +exposición I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ventana I-TREATMENT +ósea I-TREATMENT +creada I-TREATMENT +con I-TREATMENT +fresa I-TREATMENT +quirúrgica I-TREATMENT +bajo I-TREATMENT +irrigación I-TREATMENT +constante. I-TREATMENT +La I-TREATMENT +lesión I-TREATMENT +fue I-TREATMENT +removida I-TREATMENT +por I-TREATMENT +enucleación I-TREATMENT +con I-TREATMENT +un I-TREATMENT +curetaje I-TREATMENT +agresivo I-TREATMENT +juntamente I-TREATMENT +con I-TREATMENT +el I-TREATMENT +diente I-TREATMENT +43 I-TREATMENT +no I-TREATMENT +erupcionado. I-TREATMENT +Los B-EXPLORATION +cortes I-EXPLORATION +microscópicos I-EXPLORATION +revelaron I-EXPLORATION +la I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +odontogénicas I-EXPLORATION +en I-EXPLORATION +íntimo I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +inúmeros I-EXPLORATION +focos I-EXPLORATION +redondeados I-EXPLORATION +concéntricos I-EXPLORATION +de I-EXPLORATION +mineralización I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +anillos I-EXPLORATION +de I-EXPLORATION +Liesegang, I-EXPLORATION +a I-EXPLORATION +veces I-EXPLORATION +resultando I-EXPLORATION +en I-EXPLORATION +densas I-EXPLORATION +masas I-EXPLORATION +sean I-EXPLORATION +eosinofílicas I-EXPLORATION +o I-EXPLORATION +basofílicas. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +presentaban I-EXPLORATION +puentes I-EXPLORATION +intercelulares I-EXPLORATION +bien I-EXPLORATION +evidentes, I-EXPLORATION +además I-EXPLORATION +del I-EXPLORATION +pleomorfismo, I-EXPLORATION +hipercromatismo I-EXPLORATION +y I-EXPLORATION +variación I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +al I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +núcleos. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +conjuntivo I-EXPLORATION +fibroso, I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +cordones I-EXPLORATION +o I-EXPLORATION +islas I-EXPLORATION +de I-EXPLORATION +epitelio I-EXPLORATION +odontogénico. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +histopatológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +TEOC. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +radiográfico I-EXPLORATION +de I-EXPLORATION +proservación I-EXPLORATION +de I-EXPLORATION +cinco I-EXPLORATION +años I-EXPLORATION +muestra I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +señales I-EXPLORATION +de I-EXPLORATION +recurrencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION + I-EXPLORATION + +Paciente, B-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +derivado B-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +año I-DERIVED_FROM/TO +2004 I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +endocrinología I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +maxilofacial I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tumor I-DERIVED_FROM/TO +maxilar I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +estudio. I-DERIVED_FROM/TO +Sus B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +incluyen I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +veces I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +semana. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +27 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +detecta, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ecotomografía I-PAST_MEDICAL_HISTORY +doppler, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nódulos I-PAST_MEDICAL_HISTORY +bilaterales I-PAST_MEDICAL_HISTORY +compatibles I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +adenoma I-PAST_MEDICAL_HISTORY +paratiroideo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +niveles I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +PTH I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2.448 I-PAST_MEDICAL_HISTORY +pg/ml I-PAST_MEDICAL_HISTORY +(150-500 I-PAST_MEDICAL_HISTORY +pg/ml). I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +estos I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +diagnosticó I-PAST_MEDICAL_HISTORY +hiperparatiroidismo I-PAST_MEDICAL_HISTORY +secundario. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +realiza I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paratiroidectomía I-PAST_MEDICAL_HISTORY +parcial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +indica I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +farmacológico I-PAST_MEDICAL_HISTORY +protocolario, I-PAST_MEDICAL_HISTORY +obteniéndose I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +normalización I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +niveles I-PAST_MEDICAL_HISTORY +séricos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +manteniéndose I-PAST_MEDICAL_HISTORY +altos I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +niveles I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +paratohormona. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +nota I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +volumen I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +maxilar I-PAST_MEDICAL_HISTORY +izquierda, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +crecimiento I-PAST_MEDICAL_HISTORY +lento I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +progresivo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2002. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +consultar I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +servicio, I-EXPLORATION +clínicamente I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +que I-EXPLORATION +compromete I-EXPLORATION +el I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +cara I-EXPLORATION +anterior, I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +paladar I-EXPLORATION +duro, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +indoloro, I-EXPLORATION +cubierto I-EXPLORATION +por I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +normal, I-EXPLORATION +sin I-EXPLORATION +alteración I-EXPLORATION +sensitiva, I-EXPLORATION +que I-EXPLORATION +produce I-EXPLORATION +asimetría I-EXPLORATION +y I-EXPLORATION +deformación I-EXPLORATION +facial I-EXPLORATION +evidente. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +radiográficos I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +osteolíticas I-EXPLORATION +que I-EXPLORATION +afectan I-EXPLORATION +el I-EXPLORATION +cráneo, I-EXPLORATION +la I-EXPLORATION +mandíbula I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +maxilar I-EXPLORATION +izquierdo. I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +muestra I-EXPLORATION +tumoración I-EXPLORATION +exofítica I-EXPLORATION +que I-EXPLORATION +compromete I-EXPLORATION +maxilar I-EXPLORATION +izquierdo, I-EXPLORATION +seno I-EXPLORATION +maxilar, I-EXPLORATION +fosas I-EXPLORATION +nasales I-EXPLORATION +y I-EXPLORATION +piso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +describe I-EXPLORATION +múltiples I-EXPLORATION +trabéculas I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +óseo I-EXPLORATION +inmaduro I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +matriz I-EXPLORATION +fibrosa I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +células I-EXPLORATION +gigantes I-EXPLORATION +multinucleadas. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +muestran I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +calcio I-EXPLORATION +sérico I-EXPLORATION +de I-EXPLORATION +12, I-EXPLORATION +6 I-EXPLORATION +mg/dl I-EXPLORATION +(8,1-10,3), I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina: I-EXPLORATION +218 I-EXPLORATION +UI/L I-EXPLORATION +(73-189 I-EXPLORATION +UI/L), I-EXPLORATION +fósforo I-EXPLORATION +inorgánico: I-EXPLORATION +56, I-EXPLORATION +7 I-EXPLORATION +mg/dl I-EXPLORATION +(2, I-EXPLORATION +5-5 I-EXPLORATION +mg/dl) I-EXPLORATION +y I-EXPLORATION +PTH I-EXPLORATION +intacta: I-EXPLORATION +2, I-EXPLORATION +448 I-EXPLORATION +pg/ml I-EXPLORATION +(150-500 I-EXPLORATION +pg/ml). I-EXPLORATION +Con I-EXPLORATION +todos I-EXPLORATION +estos I-EXPLORATION +antecedentes I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +tumor I-EXPLORATION +pardo I-EXPLORATION +del I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +izquierdo. I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +la I-TREATMENT +paratiroidectomía I-TREATMENT +total I-TREATMENT +y I-TREATMENT +mantener I-TREATMENT +conducta I-TREATMENT +expectante I-TREATMENT +respecto I-TREATMENT +al I-TREATMENT +tumor I-TREATMENT +pardo, I-TREATMENT +esperando I-TREATMENT +una I-TREATMENT +eventual I-TREATMENT +remisión I-TREATMENT +espontánea I-TREATMENT +con I-TREATMENT +la I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +los I-TREATMENT +valores I-TREATMENT +de I-TREATMENT +PTH, I-TREATMENT +calcio, I-TREATMENT +fósforo I-TREATMENT +y I-TREATMENT +fosfatasa I-TREATMENT +alcalina. I-TREATMENT +El I-TREATMENT +plan I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +incluye I-TREATMENT +también I-TREATMENT +controles I-TREATMENT +periódicos I-TREATMENT +clínicos, I-TREATMENT +radiográficos I-TREATMENT +y I-TREATMENT +de I-TREATMENT +laboratorio I-TREATMENT +para I-TREATMENT +evaluar I-TREATMENT +el I-TREATMENT +comportamiento I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +craneomaxilofaciales. I-TREATMENT + I-TREATMENT +Tras B-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +efectuada I-EVOLUTION +la I-EVOLUTION +paratiroidectomía I-EVOLUTION +total I-EVOLUTION +y I-EVOLUTION +alcanzados I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +normales I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +de I-EVOLUTION +PTH, I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +evidencia I-EVOLUTION +remisión I-EVOLUTION +tumoral I-EVOLUTION +maxilar. I-EVOLUTION +Considerando B-TREATMENT +el I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +las I-TREATMENT +estructuras I-TREATMENT +anatómicas I-TREATMENT +vecinas I-TREATMENT +y I-TREATMENT +las I-TREATMENT +posibles I-TREATMENT +complicaciones I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT + I-TREATMENT +Bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +e I-TREATMENT +intubación I-TREATMENT +nasotraqueal I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +incisión I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +interna I-TREATMENT +del I-TREATMENT +labio I-TREATMENT +superior I-TREATMENT +desde I-TREATMENT +la I-TREATMENT +línea I-TREATMENT +media I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +tuberosidad. I-TREATMENT +Se I-TREATMENT +levanta I-TREATMENT +colgajo I-TREATMENT +mucoperióstico I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +penacho I-TREATMENT +suborbitario, I-TREATMENT +exponiéndose I-TREATMENT +ampliamente I-TREATMENT +el I-TREATMENT +tumor. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +gran I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +osteotomía I-TREATMENT +con I-TREATMENT +sierra I-TREATMENT +reciprocante I-TREATMENT +en I-TREATMENT +zona I-TREATMENT +pediculada I-TREATMENT +que I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +adosa I-TREATMENT +a I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +anterior I-TREATMENT +y I-TREATMENT +lateral I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +maxilar, I-TREATMENT +a I-TREATMENT +continuación I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +remodelación I-TREATMENT +ósea I-TREATMENT +con I-TREATMENT +fresas I-TREATMENT +tipo I-TREATMENT +pimpollo, I-TREATMENT +conservando I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +de I-TREATMENT +seno I-TREATMENT +maxilar I-TREATMENT +y I-TREATMENT +penacho I-TREATMENT +suborbitario, I-TREATMENT +sin I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +injerto I-TREATMENT +óseo. I-TREATMENT +Se I-TREATMENT +logra I-TREATMENT +cierre I-TREATMENT +por I-TREATMENT +primera I-TREATMENT +intención. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +es I-EVOLUTION +satisfactoria, I-EVOLUTION +siendo I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +h. I-EVOLUTION + I-EVOLUTION +Se I-EVOLUTION +realizan I-EVOLUTION +controles I-EVOLUTION +postoperatorios I-EVOLUTION +clínicos I-EVOLUTION +y I-EVOLUTION +radiográficos, I-EVOLUTION +se I-EVOLUTION +evidencia I-EVOLUTION +clínicamente I-EVOLUTION +simetría I-EVOLUTION +facial, I-EVOLUTION +sin I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +sensibilidad I-EVOLUTION +y I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +recurrencia I-EVOLUTION +durante I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +años I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +resección I-EVOLUTION +del I-EVOLUTION +tumor. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +73 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +sistémica I-PAST_MEDICAL_HISTORY +actualmente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +médico, I-PAST_MEDICAL_HISTORY +quien B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +valoración I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +ventral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +borde I-PRESENT_ILLNESS +lateral I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lengua, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +exofítico, B-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +granulomatoso, I-EXPLORATION +fácilmente I-EXPLORATION +sangrante, I-EXPLORATION +que I-EXPLORATION +dificulta I-EXPLORATION +considerablemente I-EXPLORATION +la I-EXPLORATION +deglución I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +habla, I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +aparentemente I-EXPLORATION +rápido, I-EXPLORATION +con I-EXPLORATION +medidas I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +× I-EXPLORATION +3 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +violácea, I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +eritematosas, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +rojo I-EXPLORATION +intenso I-EXPLORATION +brillante, I-EXPLORATION +adherido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +lingual I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +pedículo I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm, I-EXPLORATION +refiriendo I-EXPLORATION +sangrados I-EXPLORATION +espontáneos I-EXPLORATION +y I-EXPLORATION +controlables I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +simple, I-EXPLORATION +sin I-EXPLORATION +linfadenopatía I-EXPLORATION +regional I-EXPLORATION +palpable I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +edentulismo I-EXPLORATION +total I-EXPLORATION +adquirido. I-EXPLORATION +Se I-EXPLORATION +obtienen I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +rutina, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +descartan I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +metástasis I-EXPLORATION +a I-EXPLORATION +distancia. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +bajo I-EXPLORATION +anestesia I-EXPLORATION +local I-EXPLORATION +cuyo I-EXPLORATION +estudio I-EXPLORATION +reporta I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +leiomiosarcoma. I-EXPLORATION +En B-TREATMENT +un I-TREATMENT +segundo I-TREATMENT +tiempo I-TREATMENT +quirúrgico, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +con I-TREATMENT +márgenes I-TREATMENT +de I-TREATMENT +seguridad I-TREATMENT +amplios I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +plastia I-TREATMENT +lingual I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +primario I-TREATMENT +del I-TREATMENT +defecto. I-TREATMENT +La B-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +es I-EXPLORATION +enviada I-EXPLORATION +para I-EXPLORATION +valoración I-EXPLORATION +histológica I-EXPLORATION +e I-EXPLORATION +inmunohistoquímica I-EXPLORATION +siendo I-EXPLORATION +confirmado I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +leiomiosarcoma I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +con I-EXPLORATION +márgenes I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +neoplasia. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +alta I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +espinosas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +músculo I-EXPLORATION +liso, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +inmunorreactividad I-EXPLORATION +para I-EXPLORATION +vicentina I-EXPLORATION +y I-EXPLORATION +actina I-EXPLORATION +alfa I-EXPLORATION +músculo I-EXPLORATION +liso, I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +panqueratina, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +para I-EXPLORATION +desmina I-EXPLORATION +y I-EXPLORATION +CD34. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +cursó I-EVOLUTION +un I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +favorable I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +al I-EVOLUTION +5.° I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +internamiento I-EVOLUTION +para I-EVOLUTION +continuar I-EVOLUTION +con I-EVOLUTION +manejo I-EVOLUTION +ambulatorio. I-EVOLUTION +A I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +postoperada I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +adecuada I-EVOLUTION +evolución, I-EVOLUTION +alimentándose I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +adecuada, I-EVOLUTION +sin I-EVOLUTION +problemas I-EVOLUTION +de I-EVOLUTION +fonación I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +intensiva I-EVOLUTION +terapia I-EVOLUTION +de I-EVOLUTION +lenguaje; I-EVOLUTION +no I-EVOLUTION +hay I-EVOLUTION +datos I-EVOLUTION +de I-EVOLUTION +metástasis I-EVOLUTION +corroborados I-EVOLUTION +con I-EVOLUTION +TAC I-EVOLUTION +de I-EVOLUTION +control. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +femenina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cirugía I-PRESENT_ILLNESS +Oral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +odontológica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Corporación I-PRESENT_ILLNESS +Universitaria I-PRESENT_ILLNESS +Rafael I-PRESENT_ILLNESS +Núñez I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +agrandamiento I-PRESENT_ILLNESS +gingival I-PRESENT_ILLNESS +generalizado. I-PRESENT_ILLNESS +Como B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares, I-FAMILY_HISTORY +la I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +y I-FAMILY_HISTORY +un I-FAMILY_HISTORY +hermano I-FAMILY_HISTORY +describieron I-FAMILY_HISTORY +presentar I-FAMILY_HISTORY +aumento I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +volumen I-FAMILY_HISTORY +del I-FAMILY_HISTORY +tejido I-FAMILY_HISTORY +gingival I-FAMILY_HISTORY +de I-FAMILY_HISTORY +forma I-FAMILY_HISTORY +generalizada. I-FAMILY_HISTORY +En B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +manifestó I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +practicó I-PAST_MEDICAL_HISTORY +gingivectomía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tamaño I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +encía I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +resultados I-PAST_MEDICAL_HISTORY +satisfactorios, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +epilépticos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +farmacológico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anticonvulsivante I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +fenitoína, I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +periodo I-PAST_MEDICAL_HISTORY +aproximado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +días; I-PAST_MEDICAL_HISTORY +en B-EXPLORATION +la I-EXPLORATION +revisión I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +y I-EXPLORATION +sistemas I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +clínico I-EXPLORATION +intraoral I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +agrandamiento I-EXPLORATION +gingival I-EXPLORATION +generalizado I-EXPLORATION +comprometiendo I-EXPLORATION +maxilar I-EXPLORATION +y I-EXPLORATION +mandíbula, I-EXPLORATION +cubriendo I-EXPLORATION +más I-EXPLORATION +del I-EXPLORATION +85% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +corona I-EXPLORATION +dentaria I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +dientes I-EXPLORATION +posteriores I-EXPLORATION +y I-EXPLORATION +90% I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +anteriores, I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +un I-EXPLORATION +año I-EXPLORATION +de I-EXPLORATION +evolución, I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +sangrado, I-EXPLORATION +sin I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +placa I-EXPLORATION +bacteriana, I-EXPLORATION +asintomático, I-EXPLORATION +originando I-EXPLORATION +discapacidad I-EXPLORATION +funcional, I-EXPLORATION +estética I-EXPLORATION +y I-EXPLORATION +problemas I-EXPLORATION +psicosociales. I-EXPLORATION +Examen I-EXPLORATION +radiográfico: I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ortopantomografía I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +dientes I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +del I-EXPLORATION +diente I-EXPLORATION +número I-EXPLORATION +73. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +ser I-EXPLORATION +un I-EXPLORATION +crecimiento I-EXPLORATION +gingival I-EXPLORATION +fibroso, I-EXPLORATION +espontáneo, I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño, I-EXPLORATION +sin I-EXPLORATION +asociación I-EXPLORATION +a I-EXPLORATION +síndromes I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +historia I-EXPLORATION +familiar I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +la I-EXPLORATION +madre I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +hermano I-EXPLORATION +presentaron I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +patología, I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +fibromatosis I-EXPLORATION +gingival I-EXPLORATION +hereditaria. I-EXPLORATION + I-EXPLORATION +Procedimiento B-TREATMENT + I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +una I-TREATMENT +gingivectomía I-TREATMENT +y I-TREATMENT +gingivoplastía I-TREATMENT +en I-TREATMENT +2 I-TREATMENT +fases I-TREATMENT +quirúrgicas I-TREATMENT +inicialmente I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mandíbula I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +en I-TREATMENT +el I-TREATMENT +maxilar I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +local. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +incisión I-TREATMENT +primaria I-TREATMENT +a I-TREATMENT +bisel I-TREATMENT +interno I-TREATMENT +a I-TREATMENT +un I-TREATMENT +ángulo I-TREATMENT +de I-TREATMENT +45o I-TREATMENT +hacia I-TREATMENT +el I-TREATMENT +ápice I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dientes, I-TREATMENT +previa I-TREATMENT +localización I-TREATMENT +de I-TREATMENT +los I-TREATMENT +mismos I-TREATMENT +con I-TREATMENT +la I-TREATMENT +sonda I-TREATMENT +periodontal I-TREATMENT +de I-TREATMENT +Williams, I-TREATMENT +aproximadamente I-TREATMENT +a I-TREATMENT +5 I-TREATMENT +mm I-TREATMENT +del I-TREATMENT +surco I-TREATMENT +gingival, I-TREATMENT +con I-TREATMENT +hoja I-TREATMENT +de I-TREATMENT +bisturí I-TREATMENT +del I-TREATMENT +número I-TREATMENT +11 I-TREATMENT +y I-TREATMENT +12 I-TREATMENT +y I-TREATMENT +mango I-TREATMENT +bard I-TREATMENT +parker I-TREATMENT +número I-TREATMENT +3; I-TREATMENT +luego I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +incisión I-TREATMENT +intrasurcular I-TREATMENT +creando I-TREATMENT +un I-TREATMENT +collar I-TREATMENT +de I-TREATMENT +tejido I-TREATMENT +gingival, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +fue I-TREATMENT +removido I-TREATMENT +posteriormente I-TREATMENT +por I-TREATMENT +curetas I-TREATMENT +gracey I-TREATMENT +específicas I-TREATMENT +de I-TREATMENT +cada I-TREATMENT +diente, I-TREATMENT +después I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +reafinado I-TREATMENT +del I-TREATMENT +bisel I-TREATMENT +con I-TREATMENT +el I-TREATMENT +bisturí I-TREATMENT +de I-TREATMENT +Kirklan I-TREATMENT +y I-TREATMENT +Orban I-TREATMENT +para I-TREATMENT +las I-TREATMENT +áreas I-TREATMENT +interproximales I-TREATMENT +y I-TREATMENT +exodoncia I-TREATMENT +del I-TREATMENT +diente I-TREATMENT +73; I-TREATMENT +finalmente I-TREATMENT +se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +hemostasia I-TREATMENT +y I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +tutor I-TREATMENT +en I-TREATMENT +acetato I-TREATMENT +diseñado I-TREATMENT +prequirúrgicamente I-TREATMENT +en I-TREATMENT +modelos I-TREATMENT +de I-TREATMENT +estudios I-TREATMENT +con I-TREATMENT +cemento I-TREATMENT +quirúrgico I-TREATMENT +periodontal, I-TREATMENT +para I-TREATMENT +proteger I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +física I-TREATMENT +la I-TREATMENT +superficie I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +del I-TREATMENT +trauma I-TREATMENT +mecánico I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +cicatrización, I-TREATMENT +evitar I-TREATMENT +la I-TREATMENT +formación I-TREATMENT +de I-TREATMENT +tejido I-TREATMENT +excesivo I-TREATMENT +de I-TREATMENT +granulación I-TREATMENT +y I-TREATMENT +empaquetamiento I-TREATMENT +de I-TREATMENT +alimentos, I-TREATMENT +se I-TREATMENT +ordenó I-TREATMENT +farmacoterapia I-TREATMENT +con I-TREATMENT +antibiótico, I-TREATMENT +analgésico I-TREATMENT +y I-TREATMENT +antiinflamatorio, I-TREATMENT +las I-TREATMENT +indicaciones I-TREATMENT +postoperatorias I-TREATMENT +incluyeron I-TREATMENT +adecuada I-TREATMENT +higiene I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +uso I-TREATMENT +del I-TREATMENT +cepillo, I-TREATMENT +seda I-TREATMENT +dental I-TREATMENT +y I-TREATMENT +enjuagues I-TREATMENT +con I-TREATMENT +colutorios I-TREATMENT +sin I-TREATMENT +alcohol. I-TREATMENT +El I-TREATMENT +mismo I-TREATMENT +procedimiento I-TREATMENT +fue I-TREATMENT +realizado I-TREATMENT +en I-TREATMENT +el I-TREATMENT +maxilar I-TREATMENT +20 I-TREATMENT +días I-TREATMENT +después. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +examen I-EXPLORATION +histopatológico I-EXPLORATION +describe I-EXPLORATION +microscópicamente I-EXPLORATION +fragmentos I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +oral I-EXPLORATION +revestidos I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +paraqueratósico, I-EXPLORATION +hiperplásico, I-EXPLORATION +sobre I-EXPLORATION +estroma I-EXPLORATION +con I-EXPLORATION +abundante I-EXPLORATION +haces I-EXPLORATION +gruesos I-EXPLORATION +de I-EXPLORATION +colágeno I-EXPLORATION +dispuestos I-EXPLORATION +al I-EXPLORATION +azar, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +fibromatosis I-EXPLORATION +gingival. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +el I-EVOLUTION +control I-EVOLUTION +posquirúrgico I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +20 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +cada I-EVOLUTION +procedimiento I-EVOLUTION +(maxilar I-EVOLUTION +y I-EVOLUTION +mandíbula), I-EVOLUTION +se I-EVOLUTION +evidenció I-EVOLUTION +disminución I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +volumen I-EVOLUTION +del I-EVOLUTION +tejido I-EVOLUTION +gingival, I-EVOLUTION +buen I-EVOLUTION +proceso I-EVOLUTION +de I-EVOLUTION +cicatrización, I-EVOLUTION +las I-EVOLUTION +coronas I-EVOLUTION +dentarias I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +encontraron I-EVOLUTION +cubiertas I-EVOLUTION +por I-EVOLUTION +tejido, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +manifestó I-EVOLUTION +mejoras I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +proceso I-EVOLUTION +de I-EVOLUTION +masticación, I-EVOLUTION +que I-EVOLUTION +sonríe I-EVOLUTION +frecuentemente I-EVOLUTION +y I-EVOLUTION +tiene I-EVOLUTION +mayor I-EVOLUTION +relación I-EVOLUTION +social I-EVOLUTION +con I-EVOLUTION +los I-EVOLUTION +compañeros I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +escuela. I-EVOLUTION +También I-EVOLUTION +presentó I-EVOLUTION +alteraciones I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +oclusión I-EVOLUTION +dental, I-EVOLUTION +como I-EVOLUTION +diastemas, I-EVOLUTION +mordida I-EVOLUTION +profunda, I-EVOLUTION +mala I-EVOLUTION +posición I-EVOLUTION +dentaria, I-EVOLUTION +entre I-EVOLUTION +otros, I-EVOLUTION +razón I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +cual I-EVOLUTION +se I-EVOLUTION +remitió I-EVOLUTION +al I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +ortodoncia I-EVOLUTION +para I-EVOLUTION +su I-EVOLUTION +terapéutica. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +22 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +meningioma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +frontal. I-PAST_MEDICAL_HISTORY +En B-DERIVED_FROM/TO +seguimiento I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Neurocirugía I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +entonces I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +signos I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +recidiva I-DERIVED_FROM/TO +locorregional, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +remite I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Maxilofacial I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +reconstrucción I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +partes I-DERIVED_FROM/TO +blandas I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nivel I-DERIVED_FROM/TO +frontal I-DERIVED_FROM/TO +como I-DERIVED_FROM/TO +secuela I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +craniotomía I-DERIVED_FROM/TO +complicada I-DERIVED_FROM/TO +hace I-DERIVED_FROM/TO +años. I-DERIVED_FROM/TO +Ha B-EVOLUTION +presentado I-EVOLUTION +numerosas I-EVOLUTION +infecciones I-EVOLUTION +de I-EVOLUTION +repetición I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +local I-EVOLUTION +con I-EVOLUTION +rechazo I-EVOLUTION +de I-EVOLUTION +plastia I-EVOLUTION +craneal I-EVOLUTION +en I-EVOLUTION +3 I-EVOLUTION +ocasiones I-EVOLUTION +e I-EVOLUTION +intentos I-EVOLUTION +fallidos I-EVOLUTION +de I-EVOLUTION +reconstrucción I-EVOLUTION +con I-EVOLUTION +injertos I-EVOLUTION +cutáneos I-EVOLUTION +y I-EVOLUTION +colgajos I-EVOLUTION +locales. I-EVOLUTION +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +defecto I-EXPLORATION +estético I-EXPLORATION +importante I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +frontal I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +ulceradas I-EXPLORATION +y I-EXPLORATION +supuración. I-EXPLORATION +La I-EXPLORATION +visión I-EXPLORATION +tanto I-EXPLORATION +de I-EXPLORATION +frente I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +perfil I-EXPLORATION +revelan I-EXPLORATION +una I-EXPLORATION +pérdida I-EXPLORATION +severa I-EXPLORATION +de I-EXPLORATION +altura I-EXPLORATION +facial I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +tercio I-EXPLORATION +superior, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +considerable I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +curvatura I-EXPLORATION +y I-EXPLORATION +proyección I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bóveda I-EXPLORATION +craneal. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +mediante I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +(RMN) I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +informaba I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +deformidad I-EXPLORATION +anatómica I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +frontal I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas, I-EXPLORATION +con I-EXPLORATION +captación I-EXPLORATION +heterogénea I-EXPLORATION +y I-EXPLORATION +áreas I-EXPLORATION +hiperintensas I-EXPLORATION +en I-EXPLORATION +secuencias I-EXPLORATION +potenciadas I-EXPLORATION +en I-EXPLORATION +T2, I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +nivel I-EXPLORATION +hidroaéreo I-EXPLORATION +realzadas I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +gadolinio, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +posible I-EXPLORATION +proceso I-EXPLORATION +infeccioso. I-EXPLORATION +Asimismo, I-EXPLORATION +se I-EXPLORATION +indicaba I-EXPLORATION +un I-EXPLORATION +realce I-EXPLORATION +meníngeo I-EXPLORATION +en I-EXPLORATION +localización I-EXPLORATION +supero-anterior I-EXPLORATION +sin I-EXPLORATION +objetivarse I-EXPLORATION +colecciones I-EXPLORATION +extradurales, I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +cerebritis I-EXPLORATION +o I-EXPLORATION +abscesos I-EXPLORATION +intraparenquimatosos I-EXPLORATION +en I-EXPLORATION +probable I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +cambios I-EXPLORATION +posquirúrgicos I-EXPLORATION +secundarios I-EXPLORATION +a I-EXPLORATION +plastia. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +estos I-TREATMENT +datos I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +reconstruir I-TREATMENT +el I-TREATMENT +defecto I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +frontal I-TREATMENT +mediante I-TREATMENT +el I-TREATMENT +empleo I-TREATMENT +de I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +libre I-TREATMENT +microvascularizado I-TREATMENT +anterolateral I-TREATMENT +de I-TREATMENT +muslo I-TREATMENT +(ALT) I-TREATMENT +derecho I-TREATMENT +en I-TREATMENT +un I-TREATMENT +intento I-TREATMENT +de I-TREATMENT +resolver I-TREATMENT +ambos I-TREATMENT +problemas, I-TREATMENT +estético I-TREATMENT +e I-TREATMENT +infeccioso. I-TREATMENT +Para I-TREATMENT +ello I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +exposición I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +frontal I-TREATMENT +mediante I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +coronal I-TREATMENT +empleando I-TREATMENT +una I-TREATMENT +cicatriz I-TREATMENT +previa. I-TREATMENT +Tras I-TREATMENT +acceso I-TREATMENT +al I-TREATMENT +seno I-TREATMENT +frontal I-TREATMENT +remanente, I-TREATMENT +resultado I-TREATMENT +de I-TREATMENT +cirugías I-TREATMENT +previas, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +limpieza I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +y I-TREATMENT +a I-TREATMENT +la I-TREATMENT +reparación I-TREATMENT +de I-TREATMENT +una I-TREATMENT +fístula I-TREATMENT +de I-TREATMENT +pequeño I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +duramadre I-TREATMENT +con I-TREATMENT +un I-TREATMENT +injerto I-TREATMENT +de I-TREATMENT +fascia I-TREATMENT +de I-TREATMENT +músculo I-TREATMENT +temporal. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +del I-TREATMENT +colgajo I-TREATMENT +fasciocutáneo I-TREATMENT +ALT I-TREATMENT +con I-TREATMENT +un I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +x I-TREATMENT +15 I-TREATMENT +cm, I-TREATMENT +siendo I-TREATMENT +desepitelizada I-TREATMENT +un I-TREATMENT +área I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +x I-TREATMENT +5 I-TREATMENT +cm. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +área I-TREATMENT +desepitelizada I-TREATMENT +se I-TREATMENT +conservó I-TREATMENT +tejido I-TREATMENT +celular I-TREATMENT +subcutáneo I-TREATMENT +para I-TREATMENT +recubrimiento I-TREATMENT +y I-TREATMENT +sellado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +duramadre I-TREATMENT +y I-TREATMENT +seno I-TREATMENT +frontal. I-TREATMENT +La I-TREATMENT +anastomosis I-TREATMENT +vascular I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +tras I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +preauricular I-TREATMENT +empleando I-TREATMENT +los I-TREATMENT +vasos I-TREATMENT +temporales I-TREATMENT +superficiales. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +post-intervención I-EVOLUTION +el I-EVOLUTION +colgajo I-EVOLUTION +presentaba I-EVOLUTION +un I-EVOLUTION +aspecto I-EVOLUTION +óptimo, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +excelente I-EVOLUTION +resultado I-EVOLUTION +estético I-EVOLUTION +y I-EVOLUTION +funcional. I-EVOLUTION +No I-EVOLUTION +se I-EVOLUTION +apreciaron I-EVOLUTION +signos I-EVOLUTION +infección, I-EVOLUTION +reabsorción I-EVOLUTION +ni I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +frontal, I-EVOLUTION +habiéndose I-EVOLUTION +preservado I-EVOLUTION +su I-EVOLUTION +tamaño I-EVOLUTION +y I-EVOLUTION +forma I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION +Actualmente, I-EVOLUTION +el I-EVOLUTION +paciente, I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +identidad I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +solución I-EVOLUTION +efectiva I-EVOLUTION +del I-EVOLUTION +problema I-EVOLUTION +fistuloso, I-EVOLUTION +ha I-EVOLUTION +rehusado I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +intervención I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +realización I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +cranioplastia I-EVOLUTION +por I-EVOLUTION +parte I-EVOLUTION +del I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Neurocirugía. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +84 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que B-DERIVED_FROM/TO +nos I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +oral I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +maxilofacial I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +dentista I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +exposición I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hueso I-DERIVED_FROM/TO +crestal I-DERIVED_FROM/TO +mandibular I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +supuración I-DERIVED_FROM/TO +periimplantar I-DERIVED_FROM/TO +3 I-DERIVED_FROM/TO +semanas I-DERIVED_FROM/TO +después I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +colocación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +6 I-DERIVED_FROM/TO +implantes I-DERIVED_FROM/TO +dentales I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +carga I-DERIVED_FROM/TO +inmediata. I-DERIVED_FROM/TO +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +solo I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +osteoporosis. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +tomó I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +medicamento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +regularidad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +nunca I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +bifosfonatos. I-PAST_MEDICAL_HISTORY +Cinco I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colocación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +implantes, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +comenzó I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antirresortivo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +denosumab I-PAST_MEDICAL_HISTORY +60 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +subcutánea I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +tratar I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +osteoporosis. I-PAST_MEDICAL_HISTORY +Solo I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +administró I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +sola I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +60 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +denosumab. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +mostró I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +alveolar I-EXPLORATION +mandibular I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +exposición I-EXPLORATION +ósea I-EXPLORATION +que I-EXPLORATION +correspondían I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +extracciones I-EXPLORATION +dentales I-EXPLORATION +previas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dientes I-EXPLORATION +48 I-EXPLORATION +y I-EXPLORATION +47. I-EXPLORATION +Una I-EXPLORATION +ortopantomografía I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +varias I-EXPLORATION +zonas I-EXPLORATION +osteolíticas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +mandibular I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +implantes. I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +mandibular I-EXPLORATION +para I-EXPLORATION +determinar I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +destrucción I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cortical I-EXPLORATION +vestibular I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +mandibular I-EXPLORATION +derecho, I-EXPLORATION +espacios I-EXPLORATION +trabeculares I-EXPLORATION +dilatados I-EXPLORATION +e I-EXPLORATION +irregulares I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +hipodensas I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +osteonecrosis I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +implantes I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +alveolos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dientes I-EXPLORATION +extraídos. I-EXPLORATION +Una I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +infección I-EXPLORATION +severa I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +mandibular. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +conservador I-TREATMENT +con I-TREATMENT +antibióticos I-TREATMENT +según I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +nuestro I-TREATMENT +servicio I-TREATMENT +(amoxicilina-clavulánico I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +875/125 I-TREATMENT +mg, I-TREATMENT +3 I-TREATMENT +veces/día I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +asociados I-TREATMENT +con I-TREATMENT +enjuagues I-TREATMENT +de I-TREATMENT +clorhexidina I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +12%, I-TREATMENT +2-3 I-TREATMENT +veces/día) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +interrumpió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +denosumab. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +iniciar I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +dolor, I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +supuración I-EVOLUTION +y I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +periimplantitis. I-EVOLUTION +Se B-TREATMENT +inició I-TREATMENT +entonces I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +bajas I-TREATMENT +con I-TREATMENT +teriparatida I-TREATMENT +20 I-TREATMENT +μg I-TREATMENT +subcutánea I-TREATMENT +en I-TREATMENT +inyección I-TREATMENT +diaria I-TREATMENT +durante I-TREATMENT +6 I-TREATMENT +meses. I-TREATMENT +Pasado I-TREATMENT +este I-TREATMENT +tiempo, I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +en I-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +teriparatida, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +los I-TREATMENT +focos I-TREATMENT +de I-TREATMENT +exposición I-TREATMENT +ósea I-TREATMENT +fueron I-TREATMENT +cubiertos I-TREATMENT +por I-TREATMENT +mucosa I-TREATMENT +oral I-TREATMENT +sana, I-TREATMENT +observándose B-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +una I-EXPLORATION +recuperación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +densidad I-EXPLORATION +ósea I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +zonas I-EXPLORATION +osteolíticas I-EXPLORATION +con I-EXPLORATION +cierto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +esclerosis. I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +finalización I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +teriparida, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática, I-EVOLUTION +habiéndose I-EVOLUTION +realizado I-EVOLUTION +la I-EVOLUTION +rehabilitación I-EVOLUTION +protésica I-EVOLUTION +sobre I-EVOLUTION +los I-EVOLUTION +implantes I-EVOLUTION +viables I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +remisión I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +parotídea I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asintomática, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +rápido I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +meses. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +personal I-PAST_MEDICAL_HISTORY +relevante, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +dermatofibrosarcoma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +escapular. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +mide I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +está I-EXPLORATION +mal I-EXPLORATION +delimitada I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +localiza I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cola I-EXPLORATION +parotídea I-EXPLORATION +derecha. I-EXPLORATION +No I-EXPLORATION +presenta I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +facial I-EXPLORATION +ni I-EXPLORATION +adenopatías I-EXPLORATION +palpables I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +cervical. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +realizada I-EXPLORATION +mediante I-EXPLORATION +punción I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF), I-EXPLORATION +obtiene I-EXPLORATION +material I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +benigna, I-EXPLORATION +con I-EXPLORATION +ligera I-EXPLORATION +linfocitosis I-EXPLORATION +sin I-EXPLORATION +componente I-EXPLORATION +epitelial. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +cervicofacial I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +irregulares, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +superficial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +parótida I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +extensión I-EXPLORATION +focal I-EXPLORATION +al I-EXPLORATION +lóbulo I-EXPLORATION +profundo. I-EXPLORATION +Se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hipodensa I-EXPLORATION +de I-EXPLORATION +18 I-EXPLORATION +× I-EXPLORATION +24 I-EXPLORATION +× I-EXPLORATION +34 I-EXPLORATION +mm, I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +fina I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +realza I-EXPLORATION +mínimamente I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION +Así, I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +sospecha I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +tumoración I-EXPLORATION +parotídea I-EXPLORATION +quística I-EXPLORATION +benigna, I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +descartar I-EXPLORATION +otras I-EXPLORATION +posibilidades. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +interviene I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general, I-TREATMENT +mediante I-TREATMENT +incisión I-TREATMENT +de I-TREATMENT +ritidectomía I-TREATMENT +y I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +SMAS. I-TREATMENT +Se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +identificación I-TREATMENT +rutinaria I-TREATMENT +del I-TREATMENT +tronco I-TREATMENT +del I-TREATMENT +nervio I-TREATMENT +facial, I-TREATMENT +con I-TREATMENT +gran I-TREATMENT +dificultad I-TREATMENT +para I-TREATMENT +su I-TREATMENT +localización, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +pone I-TREATMENT +de I-TREATMENT +manifiesto I-TREATMENT +su I-TREATMENT +íntima I-TREATMENT +relación I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tumor. I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +retrógrada I-TREATMENT +de I-TREATMENT +las I-TREATMENT +principales I-TREATMENT +ramas I-TREATMENT +del I-TREATMENT +VII I-TREATMENT +par I-TREATMENT +(marginal, I-TREATMENT +bucal, I-TREATMENT +palpebral I-TREATMENT +y I-TREATMENT +frontal) I-TREATMENT +utilizando I-TREATMENT +microscopio I-TREATMENT +óptico, I-TREATMENT +no I-TREATMENT +es I-TREATMENT +posible I-TREATMENT +separar I-TREATMENT +el I-TREATMENT +tumor I-TREATMENT +del I-TREATMENT +tronco I-TREATMENT +nervioso I-TREATMENT +y I-TREATMENT +del I-TREATMENT +resto I-TREATMENT +de I-TREATMENT +ramas. I-TREATMENT +La I-TREATMENT +lesión I-TREATMENT +está I-TREATMENT +integrada I-TREATMENT +por I-TREATMENT +fascículos I-TREATMENT +fusiformes I-TREATMENT +imbricados I-TREATMENT +entre I-TREATMENT +ramos I-TREATMENT +nerviosos I-TREATMENT +y I-TREATMENT +áreas I-TREATMENT +quísticas, I-TREATMENT +conformando I-TREATMENT +una I-TREATMENT +lesión I-TREATMENT +lobulada I-TREATMENT +bien I-TREATMENT +delimitada I-TREATMENT +respeto I-TREATMENT +al I-TREATMENT +tejido I-TREATMENT +parotídeo. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +drenaje I-TREATMENT +del I-TREATMENT +contenido I-TREATMENT +quístico, I-TREATMENT +con I-TREATMENT +gran I-TREATMENT +reducción I-TREATMENT +del I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mandan I-TREATMENT +2 I-TREATMENT +biopsias I-TREATMENT +intraoperatorias. I-TREATMENT +La B-EXPLORATION +primera I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +tejido I-EXPLORATION +conectivo I-EXPLORATION +inflamatorio I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +segunda, I-EXPLORATION +como I-EXPLORATION +tumor I-EXPLORATION +fusiforme I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +schwannoma. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +explicar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +familia I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +las I-TREATMENT +diferentes I-TREATMENT +opciones I-TREATMENT +terapéuticas, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +no I-TREATMENT +extirpar I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +en I-TREATMENT +su I-TREATMENT +totalidad I-TREATMENT +y I-TREATMENT +esperar I-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +histopatológico I-TREATMENT +definitivo. I-TREATMENT +Se I-TREATMENT +dispone I-TREATMENT +un I-TREATMENT +tubo I-TREATMENT +de I-TREATMENT +silicona I-TREATMENT +en I-TREATMENT +torno I-TREATMENT +a I-TREATMENT +3 I-TREATMENT +de I-TREATMENT +las I-TREATMENT +ramas I-TREATMENT +distales I-TREATMENT +del I-TREATMENT +nervio I-TREATMENT +facial I-TREATMENT +disecadas, I-TREATMENT +para I-TREATMENT +facilitar I-TREATMENT +su I-TREATMENT +ulterior I-TREATMENT +identificación I-TREATMENT +si I-TREATMENT +fuera I-TREATMENT +necesaria I-TREATMENT +una I-TREATMENT +segunda I-TREATMENT +intervención. I-TREATMENT +Se I-TREATMENT +procede I-TREATMENT +al I-TREATMENT +tensado I-TREATMENT +de I-TREATMENT +SMAS I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +por I-TREATMENT +planos, I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +drenaje I-TREATMENT +con I-TREATMENT +vacío I-TREATMENT +y I-TREATMENT +vendaje, I-TREATMENT +según I-TREATMENT +el I-TREATMENT +protocolo I-TREATMENT +habitual. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +parálisis I-EVOLUTION +facial I-EVOLUTION +completa I-EVOLUTION +(grado I-EVOLUTION +VI I-EVOLUTION +en I-EVOLUTION +escala I-EVOLUTION +House-Brackman) I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +recuperación I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +meses I-EVOLUTION +(grado I-EVOLUTION +I, I-EVOLUTION +House-Brackman). I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +también I-EVOLUTION +manifiesta I-EVOLUTION +síntomas I-EVOLUTION +de I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +Frey, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía, I-EVOLUTION +tratándose B-TREATMENT +con I-TREATMENT +toxina I-TREATMENT +botulínica I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +exitosa. I-TREATMENT + I-TREATMENT +El I-TREATMENT +diagnóstico I-TREATMENT +anatomopatológico I-TREATMENT +definitivo I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +schwannoma I-TREATMENT +de I-TREATMENT +nervio I-TREATMENT +periférico. I-TREATMENT +Se I-TREATMENT +discute I-TREATMENT +con I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +extirpación I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración, I-TREATMENT +con I-TREATMENT +sacrificio I-TREATMENT +del I-TREATMENT +nervio I-TREATMENT +facial I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +inmediata I-TREATMENT +con I-TREATMENT +injerto I-TREATMENT +nervioso, I-TREATMENT +pero I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +rechaza I-TREATMENT +esta I-TREATMENT +opción. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +primer I-EXPLORATION +control I-EXPLORATION +posquirúrgico I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +con I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +5 I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cirugía, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +aparece I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +hipercaptante I-EXPLORATION +en I-EXPLORATION +celda I-EXPLORATION +parotídea, I-EXPLORATION +englobada I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +fibrosis. I-EXPLORATION +La I-EXPLORATION +imagen I-EXPLORATION +es I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +fibrosis I-EXPLORATION +inmadura I-EXPLORATION +sin I-EXPLORATION +descartar I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +schwannoma. I-EXPLORATION +Clínicamente, B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presenta I-EVOLUTION +tumoración I-EVOLUTION +palpable I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +intervenida I-EVOLUTION +ni I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +motilidad I-EVOLUTION +facial I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +3 I-EVOLUTION +años. I-EVOLUTION +Los I-EVOLUTION +controles I-EVOLUTION +mediante I-EVOLUTION +RM I-EVOLUTION +anuales I-EVOLUTION +no I-EVOLUTION +muestran I-EVOLUTION +cambios I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +previos. I-EVOLUTION + I-EVOLUTION + +Una B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +femenina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +queja I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +mostrar I-PRESENT_ILLNESS +excesivamente I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +gingival I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +sonreír, I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +objetivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mejorar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +estética I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +sonrisa I-PRESENT_ILLNESS +gingival. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +informa I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +encuentra I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +sonrisa I-PRESENT_ILLNESS +armoniosa, I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +está I-PRESENT_ILLNESS +dispuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +procedimiento I-PRESENT_ILLNESS +invasivo I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +corregir I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +situación I-PRESENT_ILLNESS +bucal. I-PRESENT_ILLNESS +Al B-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +ser I-EXPLORATION +realizada I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +clínica, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +4 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +exposición I-EXPLORATION +gingival. I-EXPLORATION + I-EXPLORATION +Fue I-EXPLORATION +evaluada I-EXPLORATION +la I-EXPLORATION +etiología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sonrisa I-EXPLORATION +gingival, I-EXPLORATION +llegando I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +su I-EXPLORATION +sonrisa I-EXPLORATION +gingival I-EXPLORATION +era I-EXPLORATION +debida I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +hiperactividad I-EXPLORATION +del I-EXPLORATION +músculo I-EXPLORATION +elevador I-EXPLORATION +del I-EXPLORATION +labio I-EXPLORATION +superior. I-EXPLORATION +Entre B-TREATMENT +las I-TREATMENT +opciones I-TREATMENT +para I-TREATMENT +resolver I-TREATMENT +el I-TREATMENT +caso I-TREATMENT +que I-TREATMENT +fueron I-TREATMENT +presentadas I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +(incluyendo I-TREATMENT +ventajas I-TREATMENT +y I-TREATMENT +limitaciones I-TREATMENT +de I-TREATMENT +cada I-TREATMENT +una), I-TREATMENT +fue I-TREATMENT +escogido I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +BTX-A, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +reducir I-TREATMENT +la I-TREATMENT +fuerza I-TREATMENT +de I-TREATMENT +contracción I-TREATMENT +del I-TREATMENT +labio I-TREATMENT +superior. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +la I-TREATMENT +ubicación I-TREATMENT +del I-TREATMENT +punto I-TREATMENT +de I-TREATMENT +aplicación, I-TREATMENT +fue I-TREATMENT +utilizada I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +"Yonsei I-TREATMENT +Point"2, I-TREATMENT +descrita I-TREATMENT +en I-TREATMENT +la I-TREATMENT +figura I-TREATMENT +2. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +utilizó I-TREATMENT +la I-TREATMENT +BTX-A I-TREATMENT +(botox I-TREATMENT +de I-TREATMENT +la I-TREATMENT +casa I-TREATMENT +comercial I-TREATMENT +Allergan) I-TREATMENT +de I-TREATMENT +100 I-TREATMENT +unidades I-TREATMENT +(U) I-TREATMENT +como I-TREATMENT +medicación I-TREATMENT +de I-TREATMENT +elección. I-TREATMENT +La I-TREATMENT +dilución I-TREATMENT +del I-TREATMENT +medicamento I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +como I-TREATMENT +se I-TREATMENT +describe I-TREATMENT +en I-TREATMENT +las I-TREATMENT +instrucciones I-TREATMENT +de I-TREATMENT +uso I-TREATMENT +del I-TREATMENT +mismo. I-TREATMENT +La I-TREATMENT +BTX-A I-TREATMENT +se I-TREATMENT +diluyó I-TREATMENT +con I-TREATMENT +2 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +0, I-TREATMENT +9% I-TREATMENT +sin I-TREATMENT +conservantes I-TREATMENT +y I-TREATMENT +estéril I-TREATMENT +para I-TREATMENT +producir I-TREATMENT +5 I-TREATMENT +U I-TREATMENT +por I-TREATMENT +0, I-TREATMENT +1 I-TREATMENT +ml. I-TREATMENT +Se I-TREATMENT +inyectaron I-TREATMENT +2, I-TREATMENT +5 I-TREATMENT +U I-TREATMENT +en I-TREATMENT +el I-TREATMENT +músculo I-TREATMENT +elevador I-TREATMENT +del I-TREATMENT +labio I-TREATMENT +superior, I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +bilateral. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +evaluó I-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +aplicación. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +exposición I-EVOLUTION +gingival I-EVOLUTION +se I-EVOLUTION +redujo I-EVOLUTION +notablemente I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +evaluación I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refirió I-EVOLUTION +estar I-EVOLUTION +satisfecha I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +resultado I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +sin I-EVOLUTION +la I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +nuevas I-EVOLUTION +aplicaciones I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +medicación I-EVOLUTION +por I-EVOLUTION +6 I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +linfedema I-PRESENT_ILLNESS +facial I-PRESENT_ILLNESS +inexorable. I-PRESENT_ILLNESS +Dos B-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +epidermoide I-PAST_MEDICAL_HISTORY +supraglótico. I-PAST_MEDICAL_HISTORY +Se B-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +laringectomía I-TREATMENT +supraglótica I-TREATMENT +con I-TREATMENT +vaciamiento I-TREATMENT +cervical I-TREATMENT +bilateral I-TREATMENT +y I-TREATMENT +RT. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +farmacológico I-TREATMENT +empleado I-TREATMENT +fue I-TREATMENT +amlodipino, I-TREATMENT +manitol, I-TREATMENT +acetazolamida, I-TREATMENT +furosemida I-TREATMENT +y I-TREATMENT +dexametasona. I-TREATMENT +Le B-EVOLUTION +provocó I-EVOLUTION +tensiones I-EVOLUTION +arteriales I-EVOLUTION +inestables I-EVOLUTION +y I-EVOLUTION +fluctuantes, I-EVOLUTION +hiperglucemia I-EVOLUTION +e I-EVOLUTION +hiponatremia I-EVOLUTION +afectando I-EVOLUTION +al I-EVOLUTION +estado I-EVOLUTION +hemodinámico I-EVOLUTION +del I-EVOLUTION +paciente. I-EVOLUTION +Se B-TREATMENT +utilizó I-TREATMENT +también I-TREATMENT +tratamiento I-TREATMENT +rehabilitador, I-TREATMENT +punciones I-TREATMENT +transcutáneas I-TREATMENT +y I-TREATMENT +cámara I-TREATMENT +hiperbárica, I-TREATMENT +pero I-TREATMENT +sin I-TREATMENT +éxito. I-TREATMENT + I-TREATMENT +En B-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +momento I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +nos I-DERIVED_FROM/TO +remiten I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +presenta I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +edema I-DERIVED_FROM/TO +facial I-DERIVED_FROM/TO +masivo, I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +gran I-DERIVED_FROM/TO +fibrosis I-DERIVED_FROM/TO +cervical, I-DERIVED_FROM/TO +traqueotomía, I-DERIVED_FROM/TO +gastrostomía, I-DERIVED_FROM/TO +disnea I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +saturaciones I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +oxígeno I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +85%, I-DERIVED_FROM/TO +edema I-DERIVED_FROM/TO +bipalpebral I-DERIVED_FROM/TO +bilateral I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +apertura I-DERIVED_FROM/TO +voluntaria I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +párpados, I-DERIVED_FROM/TO +hipoacusia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +transmisión, I-DERIVED_FROM/TO +incompetencia I-DERIVED_FROM/TO +labial I-DERIVED_FROM/TO +e I-DERIVED_FROM/TO +imposibilidad I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +deglución. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +un I-TREATMENT +colgajo I-TREATMENT +miocutáneo I-TREATMENT +deltopectoral I-TREATMENT +diferido I-TREATMENT +con I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +introducir I-TREATMENT +nuevos I-TREATMENT +vasos I-TREATMENT +linfáticos I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mejilla I-TREATMENT +y I-TREATMENT +mejorar I-TREATMENT +su I-TREATMENT +situación. I-TREATMENT + I-TREATMENT +Un I-TREATMENT +colgajo I-TREATMENT +deltopectoral I-TREATMENT +derecho I-TREATMENT +fue I-TREATMENT +tallado, I-TREATMENT +un I-TREATMENT +área I-TREATMENT +distal I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +× I-TREATMENT +5 I-TREATMENT +cm I-TREATMENT +se I-TREATMENT +desepiteliza I-TREATMENT +y I-TREATMENT +se I-TREATMENT +introduce I-TREATMENT +en I-TREATMENT +un I-TREATMENT +bolsillo I-TREATMENT +subdérmico I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mejilla. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +cierre I-TREATMENT +directo I-TREATMENT +del I-TREATMENT +defecto I-TREATMENT +salvo I-TREATMENT +el I-TREATMENT +extremo I-TREATMENT +distal I-TREATMENT +que I-TREATMENT +se I-TREATMENT +cubre I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +desepitelizado I-TREATMENT +como I-TREATMENT +injerto I-TREATMENT +cutáneo I-TREATMENT +libre. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +h I-EVOLUTION +comenzó I-EVOLUTION +a I-EVOLUTION +oír, I-EVOLUTION +a I-EVOLUTION +ver, I-EVOLUTION +mejoró I-EVOLUTION +la I-EVOLUTION +competencia I-EVOLUTION +labial I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +volumen I-EVOLUTION +facial I-EVOLUTION +había I-EVOLUTION +disminuido. I-EVOLUTION +Una I-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +presenta I-EVOLUTION +dificultad I-EVOLUTION +respiratoria I-EVOLUTION +provocada I-EVOLUTION +por I-EVOLUTION +una I-EVOLUTION +atelectasia I-EVOLUTION +basal I-EVOLUTION +derecha I-EVOLUTION +que I-EVOLUTION +empeora I-EVOLUTION +progresivamente. I-EVOLUTION +Se I-EVOLUTION +acompaña I-EVOLUTION +de I-EVOLUTION +fibrilación I-EVOLUTION +auricular, I-EVOLUTION +hiponatremia I-EVOLUTION +e I-EVOLUTION +hiperglucemia. I-EVOLUTION +Finalmente, I-EVOLUTION +fallece I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +31 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +por I-EVOLUTION +fallo I-EVOLUTION +multiorgánico. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +indoeuropeo I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +odontólogo I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +hallazgo I-DERIVED_FROM/TO +incidental, I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +realizar I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +ortopantomografía, I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +imágenes I-DERIVED_FROM/TO +intrasinusales I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +radioopacidad I-DERIVED_FROM/TO +metálica. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +solo I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +herida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +arma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fuego I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +consulta, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +temporal I-PAST_MEDICAL_HISTORY +izquierda. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ocupación I-PRESENT_ILLNESS +pansinusal I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +marcada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +seno I-PRESENT_ILLNESS +maxilar I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rinorrea I-PRESENT_ILLNESS +ocasional I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +nasal I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +volvió I-EXPLORATION +a I-EXPLORATION +resultar I-EXPLORATION +anodina, I-EXPLORATION +sin I-EXPLORATION +abombamiento I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +vestibular I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segundo I-EXPLORATION +cuadrante, I-EXPLORATION +ni I-EXPLORATION +hallazgo I-EXPLORATION +de I-EXPLORATION +fístulas I-EXPLORATION +orosinusales I-EXPLORATION +visibles. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +realizadas I-EXPLORATION +(ortopantomografía, I-EXPLORATION +DentaScan I-EXPLORATION +y I-EXPLORATION +TC I-EXPLORATION +facial) I-EXPLORATION +mostraron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +intrasinusal I-EXPLORATION +de I-EXPLORATION +radiopacidad I-EXPLORATION +metálica I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +único I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +circular I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +superolateral I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +izquierdo, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +reacción I-EXPLORATION +inflamatoria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +sinusal. I-EXPLORATION + I-EXPLORATION +Dados B-TREATMENT +los I-TREATMENT +antecedentes I-TREATMENT +de I-TREATMENT +herida I-TREATMENT +por I-TREATMENT +arma I-TREATMENT +de I-TREATMENT +fuego I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +pensó I-TREATMENT +que I-TREATMENT +pudiera I-TREATMENT +tratarse I-TREATMENT +de I-TREATMENT +cuerpos I-TREATMENT +extraños I-TREATMENT +intrasinusales I-TREATMENT +derivados I-TREATMENT +del I-TREATMENT +mismo, I-TREATMENT +así I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +Cadwell-Luc I-TREATMENT +y I-TREATMENT +antrostomía I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +intraoral I-TREATMENT +para I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +del I-TREATMENT +cuerpo I-TREATMENT +extraño I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mucosa I-TREATMENT +sinusal I-TREATMENT +afecta, I-TREATMENT +sin I-TREATMENT +identificarse I-TREATMENT +fragmentos I-TREATMENT +metálicos I-TREATMENT +o I-TREATMENT +restos I-TREATMENT +óseos. I-TREATMENT +Se B-EXPLORATION +obtuvo I-EXPLORATION +un I-EXPLORATION +material I-EXPLORATION +blanquecino I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +fibroelástica I-EXPLORATION +similar I-EXPLORATION +al I-EXPLORATION +obtenido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +caso I-EXPLORATION +presentado I-EXPLORATION +anterior. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +mucosa I-EXPLORATION +sinusal I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +inflamación I-EXPLORATION +crónica, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +material I-EXPLORATION +blanquecino I-EXPLORATION +formado I-EXPLORATION +por I-EXPLORATION +hifas I-EXPLORATION +ramificadas I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +bola I-EXPLORATION +fúngica I-EXPLORATION +intrasinusal I-EXPLORATION +causada I-EXPLORATION +por I-EXPLORATION +Aspergillus. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +microbiológicos I-EXPLORATION +volvieron I-EXPLORATION +a I-EXPLORATION +resultar I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +este I-EVOLUTION +caso I-EVOLUTION +la I-EVOLUTION +mucosa I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +hallaba I-EVOLUTION +infiltrada I-EVOLUTION +a I-EVOLUTION +ningún I-EVOLUTION +nivel, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +ni I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antifúngico I-EVOLUTION +intravenoso. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +las I-EVOLUTION +revisiones I-EVOLUTION +posteriores I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +complicaciones I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +periodo I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +8 I-EVOLUTION +años. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +femenina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +mandibular I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +rápido, I-PRESENT_ILLNESS +ligero I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lesión. I-PRESENT_ILLNESS +Intraoralmente B-EXPLORATION +expansión I-EXPLORATION +de I-EXPLORATION +corticales I-EXPLORATION +óseas I-EXPLORATION +mandibulares I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +molares. I-EXPLORATION +Una I-EXPLORATION +tomografía I-EXPLORATION +tridimensional I-EXPLORATION +confirma I-EXPLORATION +extensa I-EXPLORATION +destrucción I-EXPLORATION +ósea. I-EXPLORATION +Resultado I-EXPLORATION +histopatológico, I-EXPLORATION +osteoblastoma I-EXPLORATION +benigno I-EXPLORATION +mandibular. I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +amplia I-TREATMENT +destrucción, I-TREATMENT +y I-TREATMENT +el I-TREATMENT +comportamiento I-TREATMENT +local I-TREATMENT +agresivo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +hemimandibulectomía I-TREATMENT +derecha, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +prótesis I-TREATMENT +de I-TREATMENT +reconstrucción I-TREATMENT +mandibular I-TREATMENT +con I-TREATMENT +cóndilo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +lecho I-TREATMENT +quirúrgico. I-TREATMENT +Control B-EVOLUTION +postoperatorio I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +apertura I-EVOLUTION +bucal, I-EVOLUTION +sin I-EVOLUTION +daño I-EVOLUTION +a I-EVOLUTION +estructuras I-EVOLUTION +nerviosas I-EVOLUTION +de I-EVOLUTION +importancia, I-EVOLUTION +conservando I-EVOLUTION +continuidad I-EVOLUTION +de I-EVOLUTION +nervios I-EVOLUTION +sensitivos I-EVOLUTION +(dentario I-EVOLUTION +inferior), I-EVOLUTION +y I-EVOLUTION +motores. I-EVOLUTION +A B-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +a I-TREATMENT +los I-TREATMENT +6 I-TREATMENT +meses I-TREATMENT +posteriores I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +inicial, I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +matriz I-TREATMENT +ósea I-TREATMENT +mezclada I-TREATMENT +con I-TREATMENT +aspirado I-TREATMENT +medular I-TREATMENT +en I-TREATMENT +el I-TREATMENT +lecho I-TREATMENT +quirúrgico, I-TREATMENT +observando B-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +posterior I-EVOLUTION +ligera I-EVOLUTION +formación I-EVOLUTION +ósea I-EVOLUTION +conservando I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +fecha I-EVOLUTION +excelente I-EVOLUTION +oclusión I-EVOLUTION +dental I-EVOLUTION +y I-EVOLUTION +apertura I-EVOLUTION +bucal I-EVOLUTION +adecuadas I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +estética I-EVOLUTION +facial I-EVOLUTION +satisfactorias, I-EVOLUTION +adecuada I-EVOLUTION +sensibilidad I-EVOLUTION +y I-EVOLUTION +motricidad, I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trece I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cefalea I-PAST_MEDICAL_HISTORY +progresiva I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +intensidad I-PAST_MEDICAL_HISTORY +y, I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nuestra I-PAST_MEDICAL_HISTORY +institución, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +obstrucción I-PAST_MEDICAL_HISTORY +nasal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anosmia I-PAST_MEDICAL_HISTORY +derechas. I-PAST_MEDICAL_HISTORY +Durante B-PRESENT_ILLNESS +todo I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +padecimiento I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +proptosis I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diplopia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mirada I-PRESENT_ILLNESS +extrema. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +reveló I-EXPLORATION +proptosis I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +asimetría I-EXPLORATION +facial I-EXPLORATION +por I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +mejilla I-EXPLORATION +ipsilateral. I-EXPLORATION +La I-EXPLORATION +rinoscopía I-EXPLORATION +mostró I-EXPLORATION +abombamiento I-EXPLORATION +septal I-EXPLORATION +con I-EXPLORATION +convexidad I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +tumoral I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +coanal I-EXPLORATION +derecha. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hipodensa, I-EXPLORATION +ovoidea, I-EXPLORATION +ocupando I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +infratemporal, I-EXPLORATION +seno I-EXPLORATION +esfenoidal, I-EXPLORATION +espacio I-EXPLORATION +parafaríngeo I-EXPLORATION +y I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +derechos, I-EXPLORATION +provocando I-EXPLORATION +compresión I-EXPLORATION +y I-EXPLORATION +desplazamientos I-EXPLORATION +rostral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +caudal I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar, I-EXPLORATION +caudal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +apófisis I-EXPLORATION +pterigoides I-EXPLORATION +y I-EXPLORATION +dorsal I-EXPLORATION +del I-EXPLORATION +piso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita, I-EXPLORATION +contactando I-EXPLORATION +incluso I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +clivus; I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +mostró I-EXPLORATION +escasa I-EXPLORATION +captación. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(IRM) I-EXPLORATION +se I-EXPLORATION +mostró I-EXPLORATION +hipointensa I-EXPLORATION +en I-EXPLORATION +T1 I-EXPLORATION +e I-EXPLORATION +hiperintensa I-EXPLORATION +en I-EXPLORATION +T2, I-EXPLORATION +realzándose I-EXPLORATION +intensamente I-EXPLORATION +con I-EXPLORATION +gadolinio. I-EXPLORATION +Sus I-EXPLORATION +bordes I-EXPLORATION +aparecían I-EXPLORATION +bien I-EXPLORATION +definidos I-EXPLORATION +y, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +desplazamientos I-EXPLORATION +ya I-EXPLORATION +escritos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +TC, I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +moldeamiento I-EXPLORATION +del I-EXPLORATION +paladar I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +duro I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +septum I-EXPLORATION +nasal. I-EXPLORATION +También I-EXPLORATION +observamos I-EXPLORATION +adelgazamiento I-EXPLORATION +y I-EXPLORATION +deformidad I-EXPLORATION +del I-EXPLORATION +piso I-EXPLORATION +medio, I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +hacía I-EXPLORATION +difícil I-EXPLORATION +determinar I-EXPLORATION +si I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +se I-EXPLORATION +originaba I-EXPLORATION +en I-EXPLORATION +dicha I-EXPLORATION +área, I-EXPLORATION +o I-EXPLORATION +era I-EXPLORATION +una I-EXPLORATION +extensión I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +infratemporal. I-EXPLORATION +Por I-EXPLORATION +lo I-EXPLORATION +tanto, I-EXPLORATION +los I-EXPLORATION +diagnósticos I-EXPLORATION +probables I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +neurinoma I-EXPLORATION +y I-EXPLORATION +papiloma I-EXPLORATION +invertido I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +esfenoidal. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +mediante I-TREATMENT +incisión I-TREATMENT +sublabial I-TREATMENT +con I-TREATMENT +abordaje I-TREATMENT +intercartilaginoso I-TREATMENT +centrofacial I-TREATMENT +transmaxilar, I-TREATMENT +replegamiento I-TREATMENT +del I-TREATMENT +colgajo I-TREATMENT +miocutáneo I-TREATMENT +y I-TREATMENT +abordaje I-TREATMENT +transmaxilar. I-TREATMENT +Se I-TREATMENT +halló I-TREATMENT +una I-TREATMENT +tumoración I-TREATMENT +de I-TREATMENT +bastante I-TREATMENT +consistencia I-TREATMENT +encapsulada I-TREATMENT +(como I-TREATMENT +tela I-TREATMENT +de I-TREATMENT +hule) I-TREATMENT +de I-TREATMENT +coloración I-TREATMENT +grisácea, I-TREATMENT +escasamente I-TREATMENT +vascularizada I-TREATMENT +que I-TREATMENT +desplazaba I-TREATMENT +estructuras I-TREATMENT +vecinas. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +intracapsular I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +reveló I-EXPLORATION +schwannoma. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +postoperatorio I-EVOLUTION +cursó I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +notable I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +proptosis. I-EVOLUTION +La B-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +exéresis I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION + I-EXPLORATION + +Recien B-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gestación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +parto I-PRESENT_ILLNESS +asistido I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +forceps. I-PRESENT_ILLNESS +Es B-DERIVED_FROM/TO +trasladado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +cefalohematoma I-DERIVED_FROM/TO +parietal I-DERIVED_FROM/TO +izquierdo I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +fractura I-DERIVED_FROM/TO +deprimida I-DERIVED_FROM/TO +parietal I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +hematoma I-DERIVED_FROM/TO +epidural I-DERIVED_FROM/TO +subyacente. I-DERIVED_FROM/TO +La B-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Fue B-TREATMENT +intervenido I-TREATMENT +evacuándose I-TREATMENT +el I-TREATMENT +hematoma I-TREATMENT +y I-TREATMENT +elevándose I-TREATMENT +la I-TREATMENT +fractura I-TREATMENT +deprimida, I-TREATMENT +dejando I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +epidural I-TREATMENT +24 I-TREATMENT +horas. I-TREATMENT +Fue B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +está I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +recién I-PRESENT_ILLNESS +nacida I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +forceps I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +deprimida I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +mostrada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +TAC. I-PRESENT_ILLNESS +Fue B-TREATMENT +intervenida I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +elevando I-TREATMENT +la I-TREATMENT +depresión. I-TREATMENT +Se B-EVOLUTION +remitió I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +domicilio I-EVOLUTION +tras I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +postoperatorio; I-EVOLUTION +tras I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +es I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +definitivamente I-EVOLUTION +con I-EVOLUTION +TAC I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +politraumatismo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +competición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bicicleta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +montaña. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +evento I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +portador I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +casco I-PRESENT_ILLNESS +integral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +armilla I-PRESENT_ILLNESS +protectora I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +impacto I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +cráneo-encefálico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conocimiento I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hiperextensión I-PRESENT_ILLNESS +cervical. I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +llegada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encuentra I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +GCS I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paresia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +VI I-PRESENT_ILLNESS +par I-PRESENT_ILLNESS +craneal I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +TC I-EXPLORATION +craneal I-EXPLORATION +y I-EXPLORATION +cervical I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +lesión I-EXPLORATION +hemorrágica I-EXPLORATION +subdural I-EXPLORATION +retroclival I-EXPLORATION +y I-EXPLORATION +espinal. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +fracturas I-EXPLORATION +de I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +ni I-EXPLORATION +cervicales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +TC I-EXPLORATION +toraco-abdominal I-EXPLORATION +que I-EXPLORATION +descarta I-EXPLORATION +otras I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +con I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +normales. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +estable I-EVOLUTION +neurológicamente I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +manejo I-TREATMENT +conservador I-TREATMENT +con I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +collarín I-TREATMENT +rígido. I-TREATMENT +Se B-EXPLORATION +completa I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +con I-EXPLORATION +resonancia I-EXPLORATION +cráneo-cervical I-EXPLORATION +que I-EXPLORATION +descarta I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +estructuras I-EXPLORATION +ligamentosas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +cráneo-cervical. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +con I-EVOLUTION +15 I-EVOLUTION +puntos I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +escala I-EVOLUTION +de I-EVOLUTION +Glasgow I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +y I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paresia I-EVOLUTION +del I-EVOLUTION +VI I-EVOLUTION +par I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +días. I-EVOLUTION +Tras I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +se I-EVOLUTION +comprueba I-EVOLUTION +mediante I-EVOLUTION +TC I-EVOLUTION +cráneo-cervical I-EVOLUTION +reducción I-EVOLUTION +del I-EVOLUTION +hematoma I-EVOLUTION +subdural I-EVOLUTION +y I-EVOLUTION +mediante I-EVOLUTION +radiografías I-EVOLUTION +funcionales I-EVOLUTION +cervicales I-EVOLUTION +la I-EVOLUTION +estabilidad I-EVOLUTION +atlo-axoidea. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +resolución I-EVOLUTION +completa I-EVOLUTION +del I-EVOLUTION +hematoma I-EVOLUTION +subdural I-EVOLUTION +con I-EVOLUTION +íntegra I-EVOLUTION +recuperación I-EVOLUTION +neurológica. I-EVOLUTION + I-EVOLUTION + +A B-PRESENT_ILLNESS +continuación I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad. I-PRESENT_ILLNESS +Vive B-PAST_MEDICAL_HISTORY +solo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Barcelona I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +pareja. I-PAST_MEDICAL_HISTORY +Trabaja I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ámbito I-PAST_MEDICAL_HISTORY +militar, I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +implica I-PAST_MEDICAL_HISTORY +disponibilidad I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +viajar I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +países I-PAST_MEDICAL_HISTORY +frecuentemente. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +acudir I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +plantea I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cambio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ubicación I-PAST_MEDICAL_HISTORY +estable I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +puesto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trabajo. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +reside I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +ciudad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +está I-PAST_MEDICAL_HISTORY +estrechamente I-PAST_MEDICAL_HISTORY +relacionada I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ámbito I-PAST_MEDICAL_HISTORY +militar. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +entorno I-PAST_MEDICAL_HISTORY +social I-PAST_MEDICAL_HISTORY +está I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +vinculado I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tiempo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ocio, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +entorno I-PAST_MEDICAL_HISTORY +laboral. I-PAST_MEDICAL_HISTORY +Presenta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +bajo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +satisfacción I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +personal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +laboral. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +demanda I-PRESENT_ILLNESS +principal I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +centra I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +problema I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alcoholismo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +bulimia, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +conductas I-PRESENT_ILLNESS +englobadas I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +desorden I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +general. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cliente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +puede I-PAST_MEDICAL_HISTORY +estar I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +seguidos I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +beber I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +establece I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +línea I-PAST_MEDICAL_HISTORY +base I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +consumiciones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bebidas I-PAST_MEDICAL_HISTORY +alcohólicas I-PAST_MEDICAL_HISTORY +diarias, I-PAST_MEDICAL_HISTORY +reflejado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +embriaguez I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +acude I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +primeras I-PAST_MEDICAL_HISTORY +sesiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evaluación. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +aumentó I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +coincidiendo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +período I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +disminución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conductas I-PAST_MEDICAL_HISTORY +bulímicas. I-PAST_MEDICAL_HISTORY +Cuando I-PAST_MEDICAL_HISTORY +acude I-PAST_MEDICAL_HISTORY +solo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +bar I-PAST_MEDICAL_HISTORY +procura I-PAST_MEDICAL_HISTORY +ir I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +lugares I-PAST_MEDICAL_HISTORY +diferentes I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +vean I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +amigos. I-PAST_MEDICAL_HISTORY +Si I-PAST_MEDICAL_HISTORY +bebe I-PAST_MEDICAL_HISTORY +acompañado, I-PAST_MEDICAL_HISTORY +normalmente I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +compañeros I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trabajo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +amiga I-PAST_MEDICAL_HISTORY +suya, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +situaciones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ocio. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +consumo I-EXPLORATION +encajaría I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +trastorno I-EXPLORATION +por I-EXPLORATION +consumo I-EXPLORATION +de I-EXPLORATION +alcohol I-EXPLORATION +definido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +DSM-5 I-EXPLORATION +(APA, I-EXPLORATION +2014) I-EXPLORATION +como I-EXPLORATION +“un I-EXPLORATION +patrón I-EXPLORATION +problemático I-EXPLORATION +de I-EXPLORATION +consumo I-EXPLORATION +de I-EXPLORATION +alcohol I-EXPLORATION +que I-EXPLORATION +provoca I-EXPLORATION +un I-EXPLORATION +deterioro I-EXPLORATION +o I-EXPLORATION +malestar I-EXPLORATION +clínicamente I-EXPLORATION +significativo”. I-EXPLORATION +Incluye I-EXPLORATION +una I-EXPLORATION +serie I-EXPLORATION +de I-EXPLORATION +criterios I-EXPLORATION +para I-EXPLORATION +diagnosticar, I-EXPLORATION +teniendo I-EXPLORATION +que I-EXPLORATION +cumplirse I-EXPLORATION +al I-EXPLORATION +menos I-EXPLORATION +dos I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +durante I-EXPLORATION +un I-EXPLORATION +mínimo I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +meses. I-EXPLORATION +El I-EXPLORATION +cliente I-EXPLORATION +cumple I-EXPLORATION +la I-EXPLORATION +mayoría I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +criterios, I-EXPLORATION +incluido I-EXPLORATION +el I-EXPLORATION +criterio I-EXPLORATION +temporal. I-EXPLORATION + I-EXPLORATION +Por B-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +lado, I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +conductas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bulimia I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +inician I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +19 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +reducen I-PAST_MEDICAL_HISTORY +considerablemente I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +período I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +vuelto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +purgarse I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +darse I-PAST_MEDICAL_HISTORY +atracones I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +frecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +veces I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +semana, I-PAST_MEDICAL_HISTORY +todo I-PAST_MEDICAL_HISTORY +ello I-PAST_MEDICAL_HISTORY +elicitado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +verbalizaciones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fracaso I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +“me I-PAST_MEDICAL_HISTORY +he I-PAST_MEDICAL_HISTORY +pasado”, I-PAST_MEDICAL_HISTORY +“me I-PAST_MEDICAL_HISTORY +he I-PAST_MEDICAL_HISTORY +descontrolado”. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +trastorno I-EXPLORATION +de I-EXPLORATION +bulimia I-EXPLORATION +nerviosa I-EXPLORATION +se I-EXPLORATION +caracteriza I-EXPLORATION +por I-EXPLORATION +episodios I-EXPLORATION +recurrentes I-EXPLORATION +de I-EXPLORATION +atracones I-EXPLORATION +acompañado I-EXPLORATION +de I-EXPLORATION +conductas I-EXPLORATION +compensatorias I-EXPLORATION +inadecuadas, I-EXPLORATION +como I-EXPLORATION +vómito I-EXPLORATION +autoprovocado I-EXPLORATION +o I-EXPLORATION +uso I-EXPLORATION +de I-EXPLORATION +laxantes I-EXPLORATION +(DSM-5; I-EXPLORATION +APA, I-EXPLORATION +2014). I-EXPLORATION +La I-EXPLORATION +gravedad I-EXPLORATION +del I-EXPLORATION +trastorno I-EXPLORATION +se I-EXPLORATION +diagnostica I-EXPLORATION +con I-EXPLORATION +base I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +de I-EXPLORATION +esas I-EXPLORATION +conductas I-EXPLORATION +compensatorias, I-EXPLORATION +pudiendo I-EXPLORATION +ser I-EXPLORATION +de I-EXPLORATION +grado I-EXPLORATION +leve, I-EXPLORATION +medio I-EXPLORATION +o I-EXPLORATION +grave. I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +caso, I-EXPLORATION +el I-EXPLORATION +cliente I-EXPLORATION +cumpliría I-EXPLORATION +criterios I-EXPLORATION +para I-EXPLORATION +ser I-EXPLORATION +diagnosticado I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +grado I-EXPLORATION +leve I-EXPLORATION +de I-EXPLORATION +bulimia I-EXPLORATION +nerviosa. I-EXPLORATION + I-EXPLORATION +Evaluación I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +empleado I-EXPLORATION +la I-EXPLORATION +entrevista I-EXPLORATION +no I-EXPLORATION +estructurada, I-EXPLORATION +complementada I-EXPLORATION +con I-EXPLORATION +autorregistros. I-EXPLORATION +Esta I-EXPLORATION +fase I-EXPLORATION +se I-EXPLORATION +extiende, I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +formal, I-EXPLORATION +durante I-EXPLORATION +las I-EXPLORATION +tres I-EXPLORATION +primeras I-EXPLORATION +sesiones. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +realizada I-EXPLORATION +la I-EXPLORATION +evaluación, I-EXPLORATION +se I-EXPLORATION +establece I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +de I-EXPLORATION +trabajo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +objetivo I-EXPLORATION +central, I-EXPLORATION +que I-EXPLORATION +ser�� I-EXPLORATION +fundamental I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +cumplimiento I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +objetivos: I-EXPLORATION +incrementar I-EXPLORATION +autocontrol. I-EXPLORATION +La B-TREATMENT +periodicidad I-TREATMENT +de I-TREATMENT +las I-TREATMENT +sesiones I-TREATMENT +comienza I-TREATMENT +siendo I-TREATMENT +semanal, I-TREATMENT +pero I-TREATMENT +según I-TREATMENT +avanza I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +espacia I-TREATMENT +a I-TREATMENT +quincenal I-TREATMENT +hasta I-TREATMENT +finalizar I-TREATMENT +con I-TREATMENT +un I-TREATMENT +seguimiento I-TREATMENT +mensual I-TREATMENT +a I-TREATMENT +partir I-TREATMENT +de I-TREATMENT +la I-TREATMENT +octava I-TREATMENT +sesión. I-TREATMENT +Este I-TREATMENT +espaciamiento I-TREATMENT +es I-TREATMENT +importante I-TREATMENT +de I-TREATMENT +cara I-TREATMENT +al I-TREATMENT +análisis I-TREATMENT +de I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +conseguidos I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +intervención. I-TREATMENT + I-TREATMENT +Como I-TREATMENT +el I-TREATMENT +cliente I-TREATMENT +no I-TREATMENT +presenta I-TREATMENT +problemas I-TREATMENT +de I-TREATMENT +salud, I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +en I-TREATMENT +relación I-TREATMENT +al I-TREATMENT +patrón I-TREATMENT +de I-TREATMENT +bebida I-TREATMENT +es I-TREATMENT +modificar I-TREATMENT +las I-TREATMENT +situaciones I-TREATMENT +de I-TREATMENT +consumo I-TREATMENT +en I-TREATMENT +lugar I-TREATMENT +de I-TREATMENT +plantear I-TREATMENT +una I-TREATMENT +reducción I-TREATMENT +del I-TREATMENT +mismo, I-TREATMENT +aunque I-TREATMENT +sí I-TREATMENT +se I-TREATMENT +consigue I-TREATMENT +esa I-TREATMENT +reducción I-TREATMENT +como I-TREATMENT +consecuencia I-TREATMENT +del I-TREATMENT +trabajo I-TREATMENT +realizado. I-TREATMENT +Dado I-TREATMENT +que I-TREATMENT +es I-TREATMENT +una I-TREATMENT +conducta I-TREATMENT +reforzada I-TREATMENT +en I-TREATMENT +su I-TREATMENT +ambiente, I-TREATMENT +sería I-TREATMENT +inadecuado I-TREATMENT +dirigir I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +abstinencia, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +pretende I-TREATMENT +es I-TREATMENT +eliminar I-TREATMENT +el I-TREATMENT +patrón I-TREATMENT +de I-TREATMENT +consumo I-TREATMENT +problemático, I-TREATMENT +sustituyéndolo I-TREATMENT +por I-TREATMENT +uno I-TREATMENT +más I-TREATMENT +controlado I-TREATMENT +que I-TREATMENT +no I-TREATMENT +genere I-TREATMENT +malestar. I-TREATMENT +De I-TREATMENT +este I-TREATMENT +modo I-TREATMENT +el I-TREATMENT +cliente I-TREATMENT +puede I-TREATMENT +conseguir I-TREATMENT +un I-TREATMENT +consumo I-TREATMENT +fuera I-TREATMENT +de I-TREATMENT +los I-TREATMENT +parámetros I-TREATMENT +problemáticos I-TREATMENT +así I-TREATMENT +como I-TREATMENT +mantener I-TREATMENT +el I-TREATMENT +acceso I-TREATMENT +a I-TREATMENT +sus I-TREATMENT +reforzadores I-TREATMENT +sociales I-TREATMENT +relacionados I-TREATMENT +con I-TREATMENT +el I-TREATMENT +consumo I-TREATMENT +de I-TREATMENT +alcohol. I-TREATMENT +Es I-TREATMENT +por I-TREATMENT +ello I-TREATMENT +que I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +se I-TREATMENT +orienta I-TREATMENT +a I-TREATMENT +facilitar I-TREATMENT +la I-TREATMENT +discriminación I-TREATMENT +de I-TREATMENT +cuándo I-TREATMENT +es I-TREATMENT +adecuado I-TREATMENT +beber I-TREATMENT +y I-TREATMENT +cuándo I-TREATMENT +no. I-TREATMENT + I-TREATMENT +Análisis B-PAST_MEDICAL_HISTORY +funcional I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +continuación I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +expone I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +análisis I-PAST_MEDICAL_HISTORY +funcional I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +caso I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +base I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +modelo I-PAST_MEDICAL_HISTORY +propuesto I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Segura, I-PAST_MEDICAL_HISTORY +Sánchez I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Barbado I-PAST_MEDICAL_HISTORY +(1991). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Variables I-PAST_MEDICAL_HISTORY +disposicionales I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Dentro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aprendizaje I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +elevado I-PAST_MEDICAL_HISTORY +cumplimiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +normas, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +reforzado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ámbito I-PAST_MEDICAL_HISTORY +familiar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +laboral, I-PAST_MEDICAL_HISTORY +dadas I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +exigencias I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +demandan I-PAST_MEDICAL_HISTORY +ambos I-PAST_MEDICAL_HISTORY +contextos I-PAST_MEDICAL_HISTORY +relacionados I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +militar. I-PAST_MEDICAL_HISTORY +Esto I-PAST_MEDICAL_HISTORY +significa I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +conducta, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +medida, I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +gobernada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +discriminativos I-PAST_MEDICAL_HISTORY +externos. I-PAST_MEDICAL_HISTORY +Todo I-PAST_MEDICAL_HISTORY +ello, I-PAST_MEDICAL_HISTORY +sumado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ausencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +discriminativos I-PAST_MEDICAL_HISTORY +internos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +prácticamente I-PAST_MEDICAL_HISTORY +inexistente I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +elementos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +(como I-PAST_MEDICAL_HISTORY +vivir I-PAST_MEDICAL_HISTORY +solo, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tener I-PAST_MEDICAL_HISTORY +pareja, I-PAST_MEDICAL_HISTORY +viajar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +frecuencia) I-PAST_MEDICAL_HISTORY +fuera I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ámbito I-PAST_MEDICAL_HISTORY +laboral, I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +precipitado I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ausencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aprendizaje I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conductas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +autocontrol. I-PAST_MEDICAL_HISTORY +Cierto I-PAST_MEDICAL_HISTORY +condicionamiento I-PAST_MEDICAL_HISTORY +aversivo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +falta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fracaso I-PAST_MEDICAL_HISTORY +precipita I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ingesta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +atracones. I-PAST_MEDICAL_HISTORY +Por I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +parte, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ausencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consecuencias I-PAST_MEDICAL_HISTORY +aversivas I-PAST_MEDICAL_HISTORY +ante I-PAST_MEDICAL_HISTORY +conductas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +descontrol I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ámbito I-PAST_MEDICAL_HISTORY +personal I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +contribuye I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +continua I-PAST_MEDICAL_HISTORY +emisión I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +patrón I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +respuesta. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +baja I-PAST_MEDICAL_HISTORY +tasa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +reforzadores I-PAST_MEDICAL_HISTORY +precipita I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cliente I-PAST_MEDICAL_HISTORY +presente I-PAST_MEDICAL_HISTORY +bajo I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ánimo I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +incrementa I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +valor I-PAST_MEDICAL_HISTORY +reforzante I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +conducta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +beber, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +pocos I-PAST_MEDICAL_HISTORY +reforzadores I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +fácil I-PAST_MEDICAL_HISTORY +acceso, I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +afecta I-PAST_MEDICAL_HISTORY +directamente I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +mantenimiento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +problema. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Un I-PAST_MEDICAL_HISTORY +entorno I-PAST_MEDICAL_HISTORY +laboral I-PAST_MEDICAL_HISTORY +percibido I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +poco I-PAST_MEDICAL_HISTORY +demandante I-PAST_MEDICAL_HISTORY +facilita I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol, I-PAST_MEDICAL_HISTORY +dado I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +existen I-PAST_MEDICAL_HISTORY +consecuencias I-PAST_MEDICAL_HISTORY +aversivas I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +entorpezcan I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +labor I-PAST_MEDICAL_HISTORY +profesional. I-PAST_MEDICAL_HISTORY +Otro I-PAST_MEDICAL_HISTORY +factor I-PAST_MEDICAL_HISTORY +añadido I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +sociales I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +producen I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +trabajo I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +desarrollan I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +mayoría I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +torno I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +bebida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +comida. I-PAST_MEDICAL_HISTORY +Todo I-PAST_MEDICAL_HISTORY +ello I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +facilitado I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +asocie I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ocio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tiempo I-PAST_MEDICAL_HISTORY +libre I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol, I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +precipita I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +beba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +solitario I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +tiempo I-PAST_MEDICAL_HISTORY +libre. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Variables B-EXPLORATION +funcionales: I-EXPLORATION +atracones I-EXPLORATION +y I-EXPLORATION +vómitos I-EXPLORATION + I-EXPLORATION +Hipótesis I-EXPLORATION +de I-EXPLORATION +adquisición: I-EXPLORATION +se I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +asociación I-EXPLORATION +pavloviana I-EXPLORATION +previa I-EXPLORATION +entre I-EXPLORATION +ingesta I-EXPLORATION +de I-EXPLORATION +comida I-EXPLORATION +calórica I-EXPLORATION +y I-EXPLORATION +respuestas I-EXPLORATION +de I-EXPLORATION +malestar. I-EXPLORATION +El I-EXPLORATION +ingerir I-EXPLORATION +comida I-EXPLORATION +calórica, I-EXPLORATION +por I-EXPLORATION +poca I-EXPLORATION +que I-EXPLORATION +sea, I-EXPLORATION +elicita I-EXPLORATION +verbalizaciones I-EXPLORATION +de I-EXPLORATION +fracaso I-EXPLORATION +y I-EXPLORATION +culpa I-EXPLORATION +(“me I-EXPLORATION +he I-EXPLORATION +pasado”). I-EXPLORATION +Se I-EXPLORATION +hipotetiza I-EXPLORATION +que I-EXPLORATION +esta I-EXPLORATION +asociación I-EXPLORATION +aversiva I-EXPLORATION +lleva I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +cliente I-EXPLORATION +se I-EXPLORATION +mantenga I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +privación I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +esos I-EXPLORATION +alimentos: I-EXPLORATION +evita I-EXPLORATION +ingerirlos. I-EXPLORATION +Esa I-EXPLORATION +asociación I-EXPLORATION +también I-EXPLORATION +lleva I-EXPLORATION +a I-EXPLORATION +sentimientos I-EXPLORATION +de I-EXPLORATION +culpa I-EXPLORATION +cuando I-EXPLORATION +ingiere I-EXPLORATION +esos I-EXPLORATION +alimentos, I-EXPLORATION +discriminada I-EXPLORATION +tal I-EXPLORATION +conducta I-EXPLORATION +por I-EXPLORATION +aburrimiento. I-EXPLORATION + I-EXPLORATION +Hipótesis I-EXPLORATION +de I-EXPLORATION +mantenimiento: I-EXPLORATION +el I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +privación I-EXPLORATION +del I-EXPLORATION +cliente I-EXPLORATION +aumenta I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +reforzante I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +comida I-EXPLORATION +calórica. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +producido I-EXPLORATION +la I-EXPLORATION +ingesta, I-EXPLORATION +la I-EXPLORATION +culpa I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +malestar I-EXPLORATION +finalmente I-EXPLORATION +elicitan I-EXPLORATION +verbalizaciones I-EXPLORATION +de I-EXPLORATION +permiso I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +anticipación I-EXPLORATION +del I-EXPLORATION +vómito, I-EXPLORATION +que I-EXPLORATION +discriminan I-EXPLORATION +la I-EXPLORATION +conducta I-EXPLORATION +de I-EXPLORATION +atracón, I-EXPLORATION +manteniéndose I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +reforzante I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +comida, I-EXPLORATION +aumentado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +privación. I-EXPLORATION +Esto I-EXPLORATION +lleva I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +serie I-EXPLORATION +de I-EXPLORATION +sensaciones I-EXPLORATION +desagradables, I-EXPLORATION +condicionadas I-EXPLORATION +e I-EXPLORATION +incondicionadas, I-EXPLORATION +que I-EXPLORATION +discriminan I-EXPLORATION +el I-EXPLORATION +vómito I-EXPLORATION +para I-EXPLORATION +reducir I-EXPLORATION +el I-EXPLORATION +malestar I-EXPLORATION +generado I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +mismas. I-EXPLORATION + I-EXPLORATION +Variables I-EXPLORATION +funcionales: I-EXPLORATION +ingesta I-EXPLORATION +de I-EXPLORATION +alcohol I-EXPLORATION + I-EXPLORATION +Hipótesis I-EXPLORATION +de I-EXPLORATION +adquisición: I-EXPLORATION +el I-EXPLORATION +cliente I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +consumo I-EXPLORATION +de I-EXPLORATION +alcohol I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad, I-EXPLORATION +relacionado I-EXPLORATION +con I-EXPLORATION +situaciones I-EXPLORATION +sociales I-EXPLORATION +de I-EXPLORATION +ocio. I-EXPLORATION +El I-EXPLORATION +mantenimiento I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +ocio I-EXPLORATION +puede I-EXPLORATION +llevar I-EXPLORATION +a I-EXPLORATION +percibir I-EXPLORATION +el I-EXPLORATION +alcohol I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +vía I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +obtención I-EXPLORATION +de I-EXPLORATION +refuerzo I-EXPLORATION +social, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +reforzadores I-EXPLORATION +propios I-EXPLORATION +del I-EXPLORATION +alcohol I-EXPLORATION +(sabor, I-EXPLORATION +efectos). I-EXPLORATION +El I-EXPLORATION +consumo I-EXPLORATION +empezó I-EXPLORATION +a I-EXPLORATION +aumentar I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +etapa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +desaparecieron I-EXPLORATION +los I-EXPLORATION +atracones. I-EXPLORATION +El I-EXPLORATION +beber I-EXPLORATION +se I-EXPLORATION +convirtió I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +sustituto I-EXPLORATION +del I-EXPLORATION +comer, I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +consecuentes I-EXPLORATION +refuerzos I-EXPLORATION +negativos I-EXPLORATION +de I-EXPLORATION +sentirse I-EXPLORATION +lleno I-EXPLORATION +sin I-EXPLORATION +comer. I-EXPLORATION +El I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +consumo I-EXPLORATION +comenzó I-EXPLORATION +primero I-EXPLORATION +en I-EXPLORATION +casa, I-EXPLORATION +pasando I-EXPLORATION +posteriormente I-EXPLORATION +a I-EXPLORATION +beber I-EXPLORATION +en I-EXPLORATION +solitario I-EXPLORATION +en I-EXPLORATION +bares I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +obtención I-EXPLORATION +del I-EXPLORATION +refuerzo I-EXPLORATION +social I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +pasar I-EXPLORATION +menos I-EXPLORATION +tiempo I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +vivienda. I-EXPLORATION +Cabe I-EXPLORATION +mencionar I-EXPLORATION +la I-EXPLORATION +influencia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +consumo I-EXPLORATION +de I-EXPLORATION +algunas I-EXPLORATION +variables I-EXPLORATION +disposicionales. I-EXPLORATION +Por I-EXPLORATION +ejemplo, I-EXPLORATION +cierto I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +reforzadores I-EXPLORATION +podría I-EXPLORATION +precipitar I-EXPLORATION +un I-EXPLORATION +mayor I-EXPLORATION +consumo I-EXPLORATION +de I-EXPLORATION +alcohol I-EXPLORATION +porque I-EXPLORATION +llevaría I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +obtención I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +mismos I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +menor I-EXPLORATION +coste. I-EXPLORATION + I-EXPLORATION +Hipótesis I-EXPLORATION +de I-EXPLORATION +mantenimiento: I-EXPLORATION +las I-EXPLORATION +variables I-EXPLORATION +disposicionales I-EXPLORATION +anteriormente I-EXPLORATION +citadas I-EXPLORATION +también I-EXPLORATION +estarían I-EXPLORATION +ejerciendo I-EXPLORATION +cierta I-EXPLORATION +influencia I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +mantenimiento I-EXPLORATION +del I-EXPLORATION +problema. I-EXPLORATION +Cuando I-EXPLORATION +bebe I-EXPLORATION +acompañado I-EXPLORATION +suele I-EXPLORATION +ser I-EXPLORATION +en I-EXPLORATION +situaciones I-EXPLORATION +de I-EXPLORATION +ocio I-EXPLORATION +y I-EXPLORATION +tiempo I-EXPLORATION +libre I-EXPLORATION +asociadas I-EXPLORATION +al I-EXPLORATION +consumo. I-EXPLORATION +En I-EXPLORATION +cambio, I-EXPLORATION +cuando I-EXPLORATION +bebe I-EXPLORATION +en I-EXPLORATION +solitario I-EXPLORATION +lo I-EXPLORATION +hace I-EXPLORATION +por I-EXPLORATION +escapar I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +situación I-EXPLORATION +de I-EXPLORATION +aburrimiento. I-EXPLORATION +El I-EXPLORATION +consumo I-EXPLORATION +también I-EXPLORATION +está I-EXPLORATION +discriminado I-EXPLORATION +por I-EXPLORATION +determinadas I-EXPLORATION +situaciones I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +han I-EXPLORATION +establecido I-EXPLORATION +como I-EXPLORATION +rutinarias. I-EXPLORATION +Hay I-EXPLORATION +una I-EXPLORATION +serie I-EXPLORATION +de I-EXPLORATION +estímulos I-EXPLORATION +que I-EXPLORATION +discriminan I-EXPLORATION +conductas I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +del I-EXPLORATION +consumo I-EXPLORATION +de I-EXPLORATION +alcohol: I-EXPLORATION +comer I-EXPLORATION +sano I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +trabajo, I-EXPLORATION +ir I-EXPLORATION +al I-EXPLORATION +gimnasio, I-EXPLORATION +tener I-EXPLORATION +pareja, I-EXPLORATION +realizar I-EXPLORATION +tareas I-EXPLORATION +del I-EXPLORATION +hogar I-EXPLORATION +nada I-EXPLORATION +más I-EXPLORATION +llegar. I-EXPLORATION +Serán I-EXPLORATION +muy I-EXPLORATION +importantes I-EXPLORATION +de I-EXPLORATION +cara I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intervención. I-EXPLORATION + I-EXPLORATION +Tratamiento B-TREATMENT + I-TREATMENT +Con I-TREATMENT +base I-TREATMENT +en I-TREATMENT +el I-TREATMENT +análisis I-TREATMENT +funcional I-TREATMENT +plasmado I-TREATMENT +anteriormente, I-TREATMENT +se I-TREATMENT +plantean I-TREATMENT +una I-TREATMENT +serie I-TREATMENT +de I-TREATMENT +objetivos I-TREATMENT +de I-TREATMENT +tratamiento: I-TREATMENT + I-TREATMENT +Fomentar I-TREATMENT +un I-TREATMENT +estilo I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +más I-TREATMENT +organizado. I-TREATMENT +Se I-TREATMENT +centra I-TREATMENT +en I-TREATMENT +lograr I-TREATMENT +que I-TREATMENT +el I-TREATMENT +cliente I-TREATMENT +sea I-TREATMENT +capaz I-TREATMENT +de I-TREATMENT +seguir I-TREATMENT +unos I-TREATMENT +horarios I-TREATMENT +estables I-TREATMENT +entre I-TREATMENT +semana, I-TREATMENT +llegando I-TREATMENT +puntual I-TREATMENT +al I-TREATMENT +trabajo I-TREATMENT +y I-TREATMENT +acudiendo I-TREATMENT +al I-TREATMENT +gimnasio, I-TREATMENT +entre I-TREATMENT +otras I-TREATMENT +actividades I-TREATMENT +o I-TREATMENT +tareas. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +busca I-TREATMENT +que I-TREATMENT +el I-TREATMENT +cliente I-TREATMENT +tenga I-TREATMENT +un I-TREATMENT +patrón I-TREATMENT +de I-TREATMENT +comidas I-TREATMENT +más I-TREATMENT +ordenado I-TREATMENT +y I-TREATMENT +planificado, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +más I-TREATMENT +saludable. I-TREATMENT +Este I-TREATMENT +objetivo I-TREATMENT +tiene I-TREATMENT +gran I-TREATMENT +relevancia I-TREATMENT +en I-TREATMENT +el I-TREATMENT +caso, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +se I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +que I-TREATMENT +el I-TREATMENT +descontrol I-TREATMENT +y I-TREATMENT +la I-TREATMENT +desorganización I-TREATMENT +general I-TREATMENT +han I-TREATMENT +precipitado I-TREATMENT +otras I-TREATMENT +conductas I-TREATMENT +problemáticas. I-TREATMENT + I-TREATMENT +Disminuir I-TREATMENT +el I-TREATMENT +consumo I-TREATMENT +de I-TREATMENT +alcohol I-TREATMENT +y I-TREATMENT +aumentar I-TREATMENT +la I-TREATMENT +capacidad I-TREATMENT +de I-TREATMENT +control I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +mismo. I-TREATMENT +La I-TREATMENT +disminución I-TREATMENT +del I-TREATMENT +consumo I-TREATMENT +se I-TREATMENT +orienta I-TREATMENT +a I-TREATMENT +la I-TREATMENT +frecuencia I-TREATMENT +y I-TREATMENT +las I-TREATMENT +situaciones I-TREATMENT +en I-TREATMENT +las I-TREATMENT +que I-TREATMENT +se I-TREATMENT +produce. I-TREATMENT +De I-TREATMENT +esta I-TREATMENT +manera, I-TREATMENT +se I-TREATMENT +cambia I-TREATMENT +de I-TREATMENT +un I-TREATMENT +patrón I-TREATMENT +de I-TREATMENT +consumo I-TREATMENT +desajustado I-TREATMENT +a I-TREATMENT +uno I-TREATMENT +más I-TREATMENT +normalizado, I-TREATMENT +pudiendo I-TREATMENT +beber I-TREATMENT +en I-TREATMENT +situaciones I-TREATMENT +sociales I-TREATMENT +o I-TREATMENT +de I-TREATMENT +ocio I-TREATMENT +en I-TREATMENT +las I-TREATMENT +que I-TREATMENT +sea I-TREATMENT +oportuno. I-TREATMENT +La I-TREATMENT +parte I-TREATMENT +más I-TREATMENT +importante I-TREATMENT +es I-TREATMENT +el I-TREATMENT +control I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +consumo, I-TREATMENT +entendiendo I-TREATMENT +como I-TREATMENT +tal I-TREATMENT +que I-TREATMENT +el I-TREATMENT +cliente I-TREATMENT +pueda I-TREATMENT +decidir I-TREATMENT +beber I-TREATMENT +o I-TREATMENT +no I-TREATMENT +y I-TREATMENT +ser I-TREATMENT +congruente I-TREATMENT +con I-TREATMENT +esa I-TREATMENT +decisión. I-TREATMENT + I-TREATMENT +Eliminar I-TREATMENT +atracones I-TREATMENT +y I-TREATMENT +vómitos. I-TREATMENT +Se I-TREATMENT +centra I-TREATMENT +en I-TREATMENT +la I-TREATMENT +eliminación I-TREATMENT +de I-TREATMENT +las I-TREATMENT +conductas I-TREATMENT +de I-TREATMENT +atracones I-TREATMENT +así I-TREATMENT +como I-TREATMENT +de I-TREATMENT +las I-TREATMENT +purgas I-TREATMENT +subsiguientes. I-TREATMENT +También I-TREATMENT +incluye I-TREATMENT +la I-TREATMENT +introducción I-TREATMENT +de I-TREATMENT +una I-TREATMENT +mayor I-TREATMENT +variedad I-TREATMENT +de I-TREATMENT +alimentos I-TREATMENT +en I-TREATMENT +la I-TREATMENT +dieta. I-TREATMENT + I-TREATMENT +Aumentar I-TREATMENT +las I-TREATMENT +fuentes I-TREATMENT +de I-TREATMENT +reforzadores. I-TREATMENT +Este I-TREATMENT +objetivo I-TREATMENT +resulta I-TREATMENT +central I-TREATMENT +en I-TREATMENT +el I-TREATMENT +caso, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +el I-TREATMENT +déficit I-TREATMENT +en I-TREATMENT +esta I-TREATMENT +área I-TREATMENT +ha I-TREATMENT +podido I-TREATMENT +influir I-TREATMENT +en I-TREATMENT +el I-TREATMENT +aumento I-TREATMENT +del I-TREATMENT +consumo. I-TREATMENT +Se I-TREATMENT +divide I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +subobjetivos: I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +actividades I-TREATMENT +gratificantes I-TREATMENT +en I-TREATMENT +solitario, I-TREATMENT +realizar I-TREATMENT +actividades I-TREATMENT +sociales I-TREATMENT +y I-TREATMENT +de I-TREATMENT +ocio I-TREATMENT +no I-TREATMENT +relacionadas I-TREATMENT +con I-TREATMENT +el I-TREATMENT +alcohol I-TREATMENT +y, I-TREATMENT +por I-TREATMENT +último, I-TREATMENT +buscar I-TREATMENT +pareja. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +lograr I-TREATMENT +estos I-TREATMENT +objetivos, I-TREATMENT +se I-TREATMENT +desarrollan I-TREATMENT +y I-TREATMENT +se I-TREATMENT +ponen I-TREATMENT +en I-TREATMENT +marcha I-TREATMENT +una I-TREATMENT +serie I-TREATMENT +de I-TREATMENT +técnicas I-TREATMENT +de I-TREATMENT +intervención, I-TREATMENT +tanto I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +sesión I-TREATMENT +como I-TREATMENT +fuera, I-TREATMENT +en I-TREATMENT +este I-TREATMENT +último I-TREATMENT +caso I-TREATMENT +pautándolas I-TREATMENT +como I-TREATMENT +tareas I-TREATMENT +para I-TREATMENT +la I-TREATMENT +semana: I-TREATMENT + I-TREATMENT +El I-TREATMENT +objetivo I-TREATMENT +1 I-TREATMENT +se I-TREATMENT +trabaja I-TREATMENT +mediante I-TREATMENT +el I-TREATMENT +establecimiento I-TREATMENT +de I-TREATMENT +un I-TREATMENT +calendario I-TREATMENT +de I-TREATMENT +organización I-TREATMENT +conductual I-TREATMENT +o I-TREATMENT +planning. I-TREATMENT +A I-TREATMENT +través I-TREATMENT +del I-TREATMENT +cumplimiento I-TREATMENT +de I-TREATMENT +este I-TREATMENT +calendario, I-TREATMENT +y I-TREATMENT +por I-TREATMENT +tanto I-TREATMENT +de I-TREATMENT +la I-TREATMENT +consecución I-TREATMENT +del I-TREATMENT +primer I-TREATMENT +objetivo, I-TREATMENT +se I-TREATMENT +facilita I-TREATMENT +el I-TREATMENT +cambio I-TREATMENT +en I-TREATMENT +las I-TREATMENT +demás I-TREATMENT +áreas I-TREATMENT +problemáticas. I-TREATMENT + I-TREATMENT +El I-TREATMENT +objetivo I-TREATMENT +2 I-TREATMENT +se I-TREATMENT +consigue I-TREATMENT +con I-TREATMENT +la I-TREATMENT +implementación I-TREATMENT +de I-TREATMENT +diferentes I-TREATMENT +estrategias. I-TREATMENT +En I-TREATMENT +primer I-TREATMENT +lugar, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +un I-TREATMENT +moldeamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +conducta I-TREATMENT +de I-TREATMENT +beber I-TREATMENT +con I-TREATMENT +control. I-TREATMENT +En I-TREATMENT +segundo I-TREATMENT +lugar, I-TREATMENT +se I-TREATMENT +desarrolla I-TREATMENT +dentro I-TREATMENT +y I-TREATMENT +fuera I-TREATMENT +de I-TREATMENT +sesión I-TREATMENT +un I-TREATMENT +entrenamiento I-TREATMENT +en I-TREATMENT +detección I-TREATMENT +de I-TREATMENT +los I-TREATMENT +estímulos I-TREATMENT +discriminativos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +conducta I-TREATMENT +de I-TREATMENT +beber, I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +interacción I-TREATMENT +terapéutica I-TREATMENT +y I-TREATMENT +de I-TREATMENT +autorregistros. I-TREATMENT +En I-TREATMENT +tercer I-TREATMENT +lugar, I-TREATMENT +se I-TREATMENT +entrena I-TREATMENT +al I-TREATMENT +cliente I-TREATMENT +en I-TREATMENT +autocontrol, I-TREATMENT +buscando I-TREATMENT +que I-TREATMENT +sus I-TREATMENT +propias I-TREATMENT +verbalizaciones I-TREATMENT +adquieran I-TREATMENT +valor I-TREATMENT +discriminativo I-TREATMENT +para I-TREATMENT +guiar I-TREATMENT +su I-TREATMENT +conducta. I-TREATMENT + I-TREATMENT +El I-TREATMENT +objetivo I-TREATMENT +3 I-TREATMENT +se I-TREATMENT +lleva I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +exposición I-TREATMENT +con I-TREATMENT +prevención I-TREATMENT +de I-TREATMENT +respuesta, I-TREATMENT +centrada I-TREATMENT +en I-TREATMENT +el I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cantidad I-TREATMENT +y I-TREATMENT +frecuencia I-TREATMENT +de I-TREATMENT +ingestas I-TREATMENT +calóricas I-TREATMENT +con I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +conductas I-TREATMENT +compensatorias. I-TREATMENT + I-TREATMENT +Los I-TREATMENT +subobjetivos I-TREATMENT +incluidos I-TREATMENT +en I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +4 I-TREATMENT +se I-TREATMENT +consiguen I-TREATMENT +con I-TREATMENT +pautas I-TREATMENT +concretas I-TREATMENT +relacionadas I-TREATMENT +con I-TREATMENT +cada I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +ellos: I-TREATMENT +meter I-TREATMENT +en I-TREATMENT +el I-TREATMENT +calendario I-TREATMENT +momentos I-TREATMENT +determinados I-TREATMENT +para I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +actividades I-TREATMENT +en I-TREATMENT +solitario, I-TREATMENT +pautar I-TREATMENT +actividades I-TREATMENT +en I-TREATMENT +grupo, I-TREATMENT +utilizar I-TREATMENT +páginas I-TREATMENT +de I-TREATMENT +contacto I-TREATMENT +social I-TREATMENT +y I-TREATMENT +páginas I-TREATMENT +para I-TREATMENT +buscar I-TREATMENT +pareja. I-TREATMENT +Durante B-EVOLUTION +la I-EVOLUTION +consecución I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +objetivo, I-EVOLUTION +surgen I-EVOLUTION +nuevas I-EVOLUTION +conductas I-EVOLUTION +problemáticas I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +búsqueda I-EVOLUTION +y I-EVOLUTION +mantenimiento I-EVOLUTION +de I-EVOLUTION +relaciones I-EVOLUTION +de I-EVOLUTION +pareja. I-EVOLUTION +Por I-EVOLUTION +este I-EVOLUTION +motivo, I-EVOLUTION +a I-EVOLUTION +partir I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +novena I-EVOLUTION +sesión I-EVOLUTION +se I-EVOLUTION +evalúan I-EVOLUTION +y I-EVOLUTION +tratan I-EVOLUTION +estas I-EVOLUTION +conductas I-EVOLUTION +como I-EVOLUTION +nueva I-EVOLUTION +demanda, I-EVOLUTION +siendo I-EVOLUTION +de I-EVOLUTION +gran I-EVOLUTION +relevancia I-EVOLUTION +para I-EVOLUTION +el I-EVOLUTION +mantenimiento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +demás I-EVOLUTION +objetivos. I-EVOLUTION + I-EVOLUTION +Un B-TREATMENT +objetivo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +trabaja I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +paralela I-TREATMENT +a I-TREATMENT +los I-TREATMENT +anteriores, I-TREATMENT +y I-TREATMENT +transversalmente I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +terapia, I-TREATMENT +teniendo I-TREATMENT +más I-TREATMENT +peso I-TREATMENT +en I-TREATMENT +las I-TREATMENT +últimas I-TREATMENT +sesiones, I-TREATMENT +es I-TREATMENT +la I-TREATMENT +detección I-TREATMENT +y I-TREATMENT +afrontamiento I-TREATMENT +de I-TREATMENT +situaciones I-TREATMENT +de I-TREATMENT +riesgo, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +conoce I-TREATMENT +en I-TREATMENT +la I-TREATMENT +literatura I-TREATMENT +como I-TREATMENT +prevención I-TREATMENT +de I-TREATMENT +recaídas I-TREATMENT +(Larimer, I-TREATMENT +Palmer I-TREATMENT +y I-TREATMENT +Marlatt, I-TREATMENT +1999). I-TREATMENT +Siguiendo B-EXPLORATION +el I-EXPLORATION +modelo I-EXPLORATION +de I-EXPLORATION +recaídas I-EXPLORATION +presentado I-EXPLORATION +por I-EXPLORATION +Marlatt I-EXPLORATION +y I-EXPLORATION +George I-EXPLORATION +(1984, I-EXPLORATION +citado I-EXPLORATION +en I-EXPLORATION +Echeburúa-Odriozola, I-EXPLORATION +1994), I-EXPLORATION +una I-EXPLORATION +vez I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +persona I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +situación I-EXPLORATION +de I-EXPLORATION +riesgo I-EXPLORATION +puede I-EXPLORATION +llevar I-EXPLORATION +a I-EXPLORATION +cabo I-EXPLORATION +o I-EXPLORATION +no I-EXPLORATION +respuestas I-EXPLORATION +de I-EXPLORATION +afrontamiento. I-EXPLORATION +Si I-EXPLORATION +lo I-EXPLORATION +hace, I-EXPLORATION +su I-EXPLORATION +percepción I-EXPLORATION +de I-EXPLORATION +autoeficacia I-EXPLORATION +aumentará I-EXPLORATION +y I-EXPLORATION +disminuirá I-EXPLORATION +la I-EXPLORATION +probabilidad I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +produzca I-EXPLORATION +una I-EXPLORATION +recaída. I-EXPLORATION +En I-EXPLORATION +cambio, I-EXPLORATION +si I-EXPLORATION +no I-EXPLORATION +aparecen I-EXPLORATION +las I-EXPLORATION +respuestas I-EXPLORATION +adecuadas I-EXPLORATION +se I-EXPLORATION +producirá I-EXPLORATION +el I-EXPLORATION +efecto I-EXPLORATION +contrario. I-EXPLORATION +Se I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +planteamiento I-EXPLORATION +de I-EXPLORATION +Bandura I-EXPLORATION +(2005) I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +eficacia I-EXPLORATION +percibida I-EXPLORATION +o I-EXPLORATION +autoeficacia I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +un I-EXPLORATION +rasgo I-EXPLORATION +global I-EXPLORATION +o I-EXPLORATION +estable I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +persona, I-EXPLORATION +sino I-EXPLORATION +un I-EXPLORATION +conjunto I-EXPLORATION +de I-EXPLORATION +autocreencias I-EXPLORATION +ligadas I-EXPLORATION +a I-EXPLORATION +ámbitos I-EXPLORATION +de I-EXPLORATION +funcionamiento I-EXPLORATION +diferenciado I-EXPLORATION +dependientes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +situación. I-EXPLORATION +Se B-TREATMENT +trabaja I-TREATMENT +en I-TREATMENT +esta I-TREATMENT +línea I-TREATMENT +a I-TREATMENT +partir I-TREATMENT +de I-TREATMENT +la I-TREATMENT +octava I-TREATMENT +sesión, I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +explica I-TREATMENT +la I-TREATMENT +diferencia I-TREATMENT +entre I-TREATMENT +una I-TREATMENT +recaída I-TREATMENT +y I-TREATMENT +una I-TREATMENT +caída, I-TREATMENT +reestructurando I-TREATMENT +verbalizaciones I-TREATMENT +de I-TREATMENT +fracaso I-TREATMENT +o I-TREATMENT +retroceso, I-TREATMENT +quitando I-TREATMENT +valor I-TREATMENT +negativo I-TREATMENT +a I-TREATMENT +las I-TREATMENT +mismas I-TREATMENT +y I-TREATMENT +destacando I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +adecuado I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +semana. I-TREATMENT +De I-TREATMENT +esta I-TREATMENT +manera I-TREATMENT +mejoraría I-TREATMENT +la I-TREATMENT +autoeficacia I-TREATMENT +y I-TREATMENT +sensación I-TREATMENT +de I-TREATMENT +control I-TREATMENT +percibidas I-TREATMENT +por I-TREATMENT +el I-TREATMENT +cliente. I-TREATMENT +En I-TREATMENT +sesiones I-TREATMENT +anteriores, I-TREATMENT +también I-TREATMENT +se I-TREATMENT +trabaja I-TREATMENT +prevención I-TREATMENT +de I-TREATMENT +recaídas, I-TREATMENT +pautando I-TREATMENT +tareas I-TREATMENT +y I-TREATMENT +emitiendo I-TREATMENT +discriminativos I-TREATMENT +en I-TREATMENT +sesión, I-TREATMENT +encaminadas I-TREATMENT +ambas I-TREATMENT +estrategias I-TREATMENT +a I-TREATMENT +que I-TREATMENT +el I-TREATMENT +cliente I-TREATMENT +detecte I-TREATMENT +situaciones I-TREATMENT +de I-TREATMENT +riesgo I-TREATMENT +y I-TREATMENT +emita I-TREATMENT +respuestas I-TREATMENT +de I-TREATMENT +control I-TREATMENT +y I-TREATMENT +afrontamiento I-TREATMENT +en I-TREATMENT +las I-TREATMENT +mismas. I-TREATMENT +Esta I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +es I-TREATMENT +especialmente I-TREATMENT +importante I-TREATMENT +en I-TREATMENT +este I-TREATMENT +tipo I-TREATMENT +de I-TREATMENT +problemática, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +si I-TREATMENT +ante I-TREATMENT +una I-TREATMENT +situación I-TREATMENT +de I-TREATMENT +riesgo I-TREATMENT +el I-TREATMENT +sujeto I-TREATMENT +logra I-TREATMENT +emitir I-TREATMENT +una I-TREATMENT +respuesta I-TREATMENT +adecuada I-TREATMENT +con I-TREATMENT +la I-TREATMENT +que I-TREATMENT +evita I-TREATMENT +el I-TREATMENT +consumo, I-TREATMENT +la I-TREATMENT +sensación I-TREATMENT +de I-TREATMENT +autocontrol I-TREATMENT +y I-TREATMENT +autoeficacia I-TREATMENT +incrementa I-TREATMENT +y I-TREATMENT +la I-TREATMENT +probabilidad I-TREATMENT +de I-TREATMENT +recaída I-TREATMENT +disminuirá I-TREATMENT +significativamente I-TREATMENT +(Becoña-Iglesias I-TREATMENT +y I-TREATMENT +Cortés-Tomás, I-TREATMENT +2008). I-TREATMENT + I-TREATMENT +Resultados B-EVOLUTION + I-EVOLUTION +Para I-EVOLUTION +el I-EVOLUTION +análisis I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +resultados I-EVOLUTION +nos I-EVOLUTION +centramos I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +primeros I-EVOLUTION +objetivos: I-EVOLUTION +conseguir I-EVOLUTION +un I-EVOLUTION +estilo I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +más I-EVOLUTION +organizado, I-EVOLUTION +disminuir I-EVOLUTION +el I-EVOLUTION +consumo I-EVOLUTION +de I-EVOLUTION +alcohol I-EVOLUTION +aprendiendo I-EVOLUTION +a I-EVOLUTION +controlarlo I-EVOLUTION +y I-EVOLUTION +eliminar I-EVOLUTION +vómitos I-EVOLUTION +y I-EVOLUTION +atracones. I-EVOLUTION +El I-EVOLUTION +cuarto I-EVOLUTION +objetivo, I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +fuentes I-EVOLUTION +de I-EVOLUTION +refuerzo, I-EVOLUTION +quedaría I-EVOLUTION +reflejado I-EVOLUTION +dentro I-EVOLUTION +del I-EVOLUTION +establecimiento I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +estilo I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +más I-EVOLUTION +organizado, I-EVOLUTION +trabajado I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +calendario I-EVOLUTION +de I-EVOLUTION +organización I-EVOLUTION +conductual. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +lo I-EVOLUTION +largo I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +cómo I-EVOLUTION +han I-EVOLUTION +evolucionado I-EVOLUTION +las I-EVOLUTION +conductas I-EVOLUTION +problemáticas, I-EVOLUTION +reduciéndose I-EVOLUTION +su I-EVOLUTION +emisión I-EVOLUTION +a I-EVOLUTION +medida I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +terapeuta I-EVOLUTION +pauta I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +consumo I-EVOLUTION +para I-EVOLUTION +las I-EVOLUTION +semanas. I-EVOLUTION +Se I-EVOLUTION +produce I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +y I-EVOLUTION +retirada I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ingesta I-EVOLUTION +de I-EVOLUTION +bebidas I-EVOLUTION +alcohólicas, I-EVOLUTION +obteniendo I-EVOLUTION +unos I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +consumo I-EVOLUTION +más I-EVOLUTION +normalizados. I-EVOLUTION +La I-EVOLUTION +ingesta I-EVOLUTION +de I-EVOLUTION +alcohol I-EVOLUTION +estando I-EVOLUTION +solo I-EVOLUTION +en I-EVOLUTION +casa I-EVOLUTION +se I-EVOLUTION +elimina I-EVOLUTION +a I-EVOLUTION +partir I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sesión I-EVOLUTION +7 I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +comienza I-EVOLUTION +a I-EVOLUTION +controlar I-EVOLUTION +la I-EVOLUTION +ingesta I-EVOLUTION +de I-EVOLUTION +alcohol I-EVOLUTION +estando I-EVOLUTION +fuera I-EVOLUTION +de I-EVOLUTION +casa I-EVOLUTION +en I-EVOLUTION +solitario I-EVOLUTION +entre I-EVOLUTION +la I-EVOLUTION +sesión I-EVOLUTION +7 I-EVOLUTION +y I-EVOLUTION +8, I-EVOLUTION +habiendo I-EVOLUTION +reducido I-EVOLUTION +anteriormente I-EVOLUTION +la I-EVOLUTION +frecuencia. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +segundo I-EVOLUTION +objetivo, I-EVOLUTION +disminuir I-EVOLUTION +y I-EVOLUTION +controlar I-EVOLUTION +el I-EVOLUTION +consumo I-EVOLUTION +de I-EVOLUTION +alcohol, I-EVOLUTION +se I-EVOLUTION +refleja I-EVOLUTION +y I-EVOLUTION +analiza I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +figura I-EVOLUTION +4. I-EVOLUTION +Esta I-EVOLUTION +ingesta I-EVOLUTION +de I-EVOLUTION +bebidas I-EVOLUTION +alcohólicas I-EVOLUTION +disminuye I-EVOLUTION +a I-EVOLUTION +medida I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +pautan I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +consumo. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +figura I-EVOLUTION +4 I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +que I-EVOLUTION +durante I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +sesiones I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +(de I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +1 I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +3, I-EVOLUTION +coincidiendo I-EVOLUTION +con I-EVOLUTION +las I-EVOLUTION +sesiones I-EVOLUTION +4, I-EVOLUTION +5 I-EVOLUTION +y I-EVOLUTION +6) I-EVOLUTION +se I-EVOLUTION +presentan I-EVOLUTION +mayores I-EVOLUTION +unidades I-EVOLUTION +de I-EVOLUTION +alcohol I-EVOLUTION +ingerido I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +menor I-EVOLUTION +variedad, I-EVOLUTION +siendo I-EVOLUTION +el I-EVOLUTION +vino I-EVOLUTION +la I-EVOLUTION +bebida I-EVOLUTION +que I-EVOLUTION +predomina, I-EVOLUTION +cuya I-EVOLUTION +frecuencia I-EVOLUTION +y I-EVOLUTION +cantidad I-EVOLUTION +de I-EVOLUTION +ingesta I-EVOLUTION +es I-EVOLUTION +mayor I-EVOLUTION +en I-EVOLUTION +comparación I-EVOLUTION +con I-EVOLUTION +las I-EVOLUTION +últimas I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION +Los I-EVOLUTION +datos I-EVOLUTION +correspondientes I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +sesiones I-EVOLUTION +7 I-EVOLUTION +y I-EVOLUTION +8 I-EVOLUTION +(semanas I-EVOLUTION +5, I-EVOLUTION +6, I-EVOLUTION +7 I-EVOLUTION +y I-EVOLUTION +8) I-EVOLUTION +reflejan I-EVOLUTION +una I-EVOLUTION +reducción I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +frecuencia I-EVOLUTION +de I-EVOLUTION +consumo I-EVOLUTION +por I-EVOLUTION +días, I-EVOLUTION +disminuyendo I-EVOLUTION +considerablemente I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +fin I-EVOLUTION +de I-EVOLUTION +semana. I-EVOLUTION +Por I-EVOLUTION +último, I-EVOLUTION +los I-EVOLUTION +datos I-EVOLUTION +correspondientes I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +sesión I-EVOLUTION +9 I-EVOLUTION +(de I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +9 I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +15 I-EVOLUTION +del I-EVOLUTION +tratamiento) I-EVOLUTION +indican I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +cliente I-EVOLUTION +no I-EVOLUTION +solo I-EVOLUTION +reduce I-EVOLUTION +el I-EVOLUTION +consumo I-EVOLUTION +de I-EVOLUTION +bebidas I-EVOLUTION +alcohólicas, I-EVOLUTION +sino I-EVOLUTION +que I-EVOLUTION +también I-EVOLUTION +incorpora I-EVOLUTION +mayor I-EVOLUTION +variedad I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +consumo I-EVOLUTION +de I-EVOLUTION +bebidas I-EVOLUTION +no I-EVOLUTION +alcohólicas I-EVOLUTION +y I-EVOLUTION +alcohólicas I-EVOLUTION +con I-EVOLUTION +menor I-EVOLUTION +graduación I-EVOLUTION +en I-EVOLUTION +situaciones I-EVOLUTION +de I-EVOLUTION +ocio, I-EVOLUTION +como I-EVOLUTION +agua I-EVOLUTION +con I-EVOLUTION +gas I-EVOLUTION +o I-EVOLUTION +claras I-EVOLUTION +de I-EVOLUTION +cerveza. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +exceso I-EVOLUTION +percibido I-EVOLUTION +de I-EVOLUTION +consumo I-EVOLUTION +queda I-EVOLUTION +reflejado I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +figura I-EVOLUTION +5, I-EVOLUTION +que I-EVOLUTION +representa I-EVOLUTION +las I-EVOLUTION +verbalizaciones I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +cliente I-EVOLUTION +emite I-EVOLUTION +en I-EVOLUTION +sesión I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +haberse I-EVOLUTION +excedido I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +consumo I-EVOLUTION +de I-EVOLUTION +alcohol I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +registros I-EVOLUTION +relacionados I-EVOLUTION +con I-EVOLUTION +tareas I-EVOLUTION +concretas I-EVOLUTION +que I-EVOLUTION +indicaba I-EVOLUTION +el I-EVOLUTION +terapeuta. I-EVOLUTION +Se I-EVOLUTION +puede I-EVOLUTION +observar I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +marcas I-EVOLUTION +correspondientes I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +sesión I-EVOLUTION +8 I-EVOLUTION +y I-EVOLUTION +9 I-EVOLUTION +(del I-EVOLUTION +día I-EVOLUTION +40 I-EVOLUTION +al I-EVOLUTION +80) I-EVOLUTION +continúa I-EVOLUTION +apareciendo I-EVOLUTION +esa I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +exceso, I-EVOLUTION +pero I-EVOLUTION +esta I-EVOLUTION +vez I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +consumo I-EVOLUTION +menor I-EVOLUTION +y I-EVOLUTION +más I-EVOLUTION +controlado. I-EVOLUTION +Esto I-EVOLUTION +supone I-EVOLUTION +un I-EVOLUTION +cambio I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ingesta I-EVOLUTION +de I-EVOLUTION +bebidas I-EVOLUTION +alcohólicas I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +cuándo I-EVOLUTION +dejar I-EVOLUTION +de I-EVOLUTION +beber. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +figura I-EVOLUTION +3 I-EVOLUTION +podemos I-EVOLUTION +observar I-EVOLUTION +el I-EVOLUTION +cumplimiento I-EVOLUTION +de I-EVOLUTION +actividades I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +calendario I-EVOLUTION +de I-EVOLUTION +organización I-EVOLUTION +conductual, I-EVOLUTION +relacionado I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +objetivo I-EVOLUTION +de I-EVOLUTION +fomentar I-EVOLUTION +un I-EVOLUTION +estilo I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +más I-EVOLUTION +saludable, I-EVOLUTION +incluyendo I-EVOLUTION +reforzadores. I-EVOLUTION +El I-EVOLUTION +número I-EVOLUTION +máximo I-EVOLUTION +de I-EVOLUTION +actividades I-EVOLUTION +diarias I-EVOLUTION +viene I-EVOLUTION +indicado I-EVOLUTION +por I-EVOLUTION +una I-EVOLUTION +puntuación I-EVOLUTION +máxima I-EVOLUTION +de I-EVOLUTION +10 I-EVOLUTION +coincidiendo I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +número I-EVOLUTION +de I-EVOLUTION +ítems I-EVOLUTION +que I-EVOLUTION +debía I-EVOLUTION +cumplir. I-EVOLUTION +Lo I-EVOLUTION +relevante I-EVOLUTION +en I-EVOLUTION +este I-EVOLUTION +caso I-EVOLUTION +es I-EVOLUTION +la I-EVOLUTION +reducción I-EVOLUTION +de I-EVOLUTION +días I-EVOLUTION +que I-EVOLUTION +pueden I-EVOLUTION +indicar I-EVOLUTION +descontrol I-EVOLUTION +no I-EVOLUTION +cumpliendo I-EVOLUTION +ningún I-EVOLUTION +ítem. I-EVOLUTION +En I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +del I-EVOLUTION +1 I-EVOLUTION +al I-EVOLUTION +20, I-EVOLUTION +correspondientes I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +comprendidos I-EVOLUTION +entre I-EVOLUTION +las I-EVOLUTION +sesiones I-EVOLUTION +4, I-EVOLUTION +5 I-EVOLUTION +y I-EVOLUTION +6, I-EVOLUTION +se I-EVOLUTION +observan I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +no I-EVOLUTION +cumplimiento I-EVOLUTION +de I-EVOLUTION +tareas I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +frecuencia I-EVOLUTION +semanal I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +consecutiva. I-EVOLUTION +En I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +correspondientes I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +sesiones I-EVOLUTION +7 I-EVOLUTION +y I-EVOLUTION +8 I-EVOLUTION +(del I-EVOLUTION +día I-EVOLUTION +20 I-EVOLUTION +al I-EVOLUTION +50) I-EVOLUTION +se I-EVOLUTION +produce I-EVOLUTION +una I-EVOLUTION +reducción I-EVOLUTION +considerable I-EVOLUTION +de I-EVOLUTION +días I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +cumple I-EVOLUTION +ningún I-EVOLUTION +ítem, I-EVOLUTION +coincidiendo I-EVOLUTION +estos I-EVOLUTION +días I-EVOLUTION +con I-EVOLUTION +eventos I-EVOLUTION +familiares I-EVOLUTION +y I-EVOLUTION +laborales I-EVOLUTION +que I-EVOLUTION +dificultan I-EVOLUTION +el I-EVOLUTION +cumplimiento, I-EVOLUTION +siendo I-EVOLUTION +más I-EVOLUTION +elevadas I-EVOLUTION +las I-EVOLUTION +puntuaciones, I-EVOLUTION +lo I-EVOLUTION +cual I-EVOLUTION +significa I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +cliente I-EVOLUTION +cumple I-EVOLUTION +la I-EVOLUTION +mayor I-EVOLUTION +parte I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +ítems I-EVOLUTION +diarios I-EVOLUTION +en I-EVOLUTION +estas I-EVOLUTION +semanas. I-EVOLUTION +Por I-EVOLUTION +último, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +período I-EVOLUTION +comprendido I-EVOLUTION +entre I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +50 I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +80, I-EVOLUTION +correspondiente I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +sesión I-EVOLUTION +9, I-EVOLUTION +se I-EVOLUTION +puede I-EVOLUTION +observar I-EVOLUTION +un I-EVOLUTION +cumplimiento I-EVOLUTION +más I-EVOLUTION +estable, I-EVOLUTION +aunque I-EVOLUTION +con I-EVOLUTION +excepciones I-EVOLUTION +de I-EVOLUTION +no I-EVOLUTION +cumplimiento I-EVOLUTION +que I-EVOLUTION +coinciden I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +eventos I-EVOLUTION +sociales I-EVOLUTION +o I-EVOLUTION +viajes I-EVOLUTION +de I-EVOLUTION +trabajo I-EVOLUTION +que I-EVOLUTION +dificultan I-EVOLUTION +la I-EVOLUTION +realización I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +tareas. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +cambio I-EVOLUTION +de I-EVOLUTION +patrón I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +atracones I-EVOLUTION +y I-EVOLUTION +vómitos I-EVOLUTION +es I-EVOLUTION +también I-EVOLUTION +evidente I-EVOLUTION +y I-EVOLUTION +muy I-EVOLUTION +temprano I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tiempo. I-EVOLUTION +Sólo I-EVOLUTION +se I-EVOLUTION +dan I-EVOLUTION +en I-EVOLUTION +dos I-EVOLUTION +ocasiones, I-EVOLUTION +coincidiendo I-EVOLUTION +con I-EVOLUTION +las I-EVOLUTION +semanas I-EVOLUTION +5 I-EVOLUTION +y I-EVOLUTION +6. I-EVOLUTION +La I-EVOLUTION +eliminación I-EVOLUTION +de I-EVOLUTION +atracones I-EVOLUTION +se I-EVOLUTION +trabaja I-EVOLUTION +a I-EVOLUTION +partir I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sexta I-EVOLUTION +sesión, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +logro I-EVOLUTION +total I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +aplicación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +técnica I-EVOLUTION +de I-EVOLUTION +exposición I-EVOLUTION +con I-EVOLUTION +prevención I-EVOLUTION +de I-EVOLUTION +respuesta, I-EVOLUTION +introduciendo I-EVOLUTION +cada I-EVOLUTION +vez I-EVOLUTION +más I-EVOLUTION +alimentos I-EVOLUTION +calóricos I-EVOLUTION +hasta I-EVOLUTION +llegar I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +total I-EVOLUTION +sobre I-EVOLUTION +esta I-EVOLUTION +conducta I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +sesión I-EVOLUTION +9 I-EVOLUTION +y I-EVOLUTION +10. I-EVOLUTION +Los I-EVOLUTION +vómitos I-EVOLUTION +se I-EVOLUTION +eliminan I-EVOLUTION +a I-EVOLUTION +partir I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sesión I-EVOLUTION +3. I-EVOLUTION + I-EVOLUTION +Estos I-EVOLUTION +resultados I-EVOLUTION +indican, I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +tentativa, I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +elevado I-EVOLUTION +cumplimiento I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +pautas, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +un I-EVOLUTION +elevado I-EVOLUTION +compromiso I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +terapia. I-EVOLUTION +Los I-EVOLUTION +resultados I-EVOLUTION +indican I-EVOLUTION +una I-EVOLUTION +notable I-EVOLUTION +mejoría I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +adquisición I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +estilo I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +más I-EVOLUTION +organizado I-EVOLUTION +y I-EVOLUTION +mayor I-EVOLUTION +autocontrol I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +al I-EVOLUTION +consumo I-EVOLUTION +de I-EVOLUTION +alcohol I-EVOLUTION +y I-EVOLUTION +cumplimiento I-EVOLUTION +de I-EVOLUTION +actividades. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +epidermoide I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pulmón I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +microcítico I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +IIIb. I-PAST_MEDICAL_HISTORY +Inició I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +quimioterápico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cisplatino I-PAST_MEDICAL_HISTORY +75 I-PAST_MEDICAL_HISTORY +mg/m2 I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +vinorelbina I-PAST_MEDICAL_HISTORY +oral I-PAST_MEDICAL_HISTORY +60 I-PAST_MEDICAL_HISTORY +mg/m2 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +8, I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +semanas, I-PAST_MEDICAL_HISTORY +combinado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +radioterapia. I-PAST_MEDICAL_HISTORY +Coincidiendo B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +infusión I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +ciclo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cisplatino, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +brusca I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +saturación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +oxígeno I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +70%, I-PRESENT_ILLNESS +que B-TREATMENT +recuperó I-TREATMENT +parcialmente I-TREATMENT +con I-TREATMENT +corticoterapia I-TREATMENT +y I-TREATMENT +oxígeno I-TREATMENT +a I-TREATMENT +alto I-TREATMENT +flujo. I-TREATMENT +La B-EXPLORATION +gravedad I-EXPLORATION +de I-EXPLORATION +dicha I-EXPLORATION +reacción I-EXPLORATION +fue I-EXPLORATION +clasificada I-EXPLORATION +según I-EXPLORATION +la I-EXPLORATION +Common I-EXPLORATION +Toxicity I-EXPLORATION +Criteria I-EXPLORATION +(versión I-EXPLORATION +4.0) I-EXPLORATION +9 I-EXPLORATION +en I-EXPLORATION +RHS I-EXPLORATION +grado I-EXPLORATION +3, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +recomienda I-EXPLORATION +cambiar I-EXPLORATION +el I-EXPLORATION +tratamiento, I-EXPLORATION +opción I-EXPLORATION +a I-EXPLORATION +veces I-EXPLORATION +limitada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +quimiosensibilidad I-EXPLORATION +del I-EXPLORATION +tumor, I-EXPLORATION +o I-EXPLORATION +bien I-EXPLORATION +aplicar I-EXPLORATION +protocolos I-EXPLORATION +de I-EXPLORATION +desensibilización I-EXPLORATION +en I-EXPLORATION +aquellos I-EXPLORATION +pacientes I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +desee I-EXPLORATION +discontinuar I-EXPLORATION +la I-EXPLORATION +terapia. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +cutáneas I-EXPLORATION +con I-EXPLORATION +cisplatino, I-EXPLORATION +para I-EXPLORATION +confirmar I-EXPLORATION +la I-EXPLORATION +posible I-EXPLORATION +asociación I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +reacción I-EXPLORATION +anafiláctica I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +dicho I-EXPLORATION +citostático. I-EXPLORATION +Además, I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +reactividad I-EXPLORATION +cruzada I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +sales I-EXPLORATION +de I-EXPLORATION +platino I-EXPLORATION +cuya I-EXPLORATION +incidencia I-EXPLORATION +aún I-EXPLORATION +no I-EXPLORATION +ha I-EXPLORATION +sido I-EXPLORATION +establecida8, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +dichas I-EXPLORATION +pruebas I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +análogos I-EXPLORATION +de I-EXPLORATION +platino. I-EXPLORATION +Las I-EXPLORATION +soluciones I-EXPLORATION +madre I-EXPLORATION +utilizadas I-EXPLORATION +fueron: I-EXPLORATION +cisplatino I-EXPLORATION +1 I-EXPLORATION +mg/ml, I-EXPLORATION +carboplatino I-EXPLORATION +10 I-EXPLORATION +mg/ml I-EXPLORATION +y I-EXPLORATION +oxaliplatino I-EXPLORATION +5 I-EXPLORATION +mg/ml. I-EXPLORATION +A I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +éstas, I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +diluciones I-EXPLORATION +1/10000, I-EXPLORATION +1/1000, I-EXPLORATION +1/100 I-EXPLORATION +y I-EXPLORATION +1/10 I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +platinos I-EXPLORATION +para I-EXPLORATION +administración I-EXPLORATION +intradérmica. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +cutáneas I-EXPLORATION +realizadas I-EXPLORATION +con I-EXPLORATION +cisplatino I-EXPLORATION +fueron I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +solución I-EXPLORATION +madre I-EXPLORATION +y I-EXPLORATION +negativas I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +diluciones. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +demás I-EXPLORATION +análogos I-EXPLORATION +de I-EXPLORATION +platino, I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +resultaron I-EXPLORATION +todas I-EXPLORATION +negativas, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +protocolizar I-TREATMENT +una I-TREATMENT +pauta I-TREATMENT +de I-TREATMENT +desensibilización I-TREATMENT +para I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +del I-TREATMENT +siguiente I-TREATMENT +ciclo I-TREATMENT +de I-TREATMENT +cisplatino. I-TREATMENT + I-TREATMENT +El I-TREATMENT +PD I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +12 I-TREATMENT +etapas I-TREATMENT +para I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +del I-TREATMENT +fármaco I-TREATMENT +(140 I-TREATMENT +mg). I-TREATMENT +El I-TREATMENT +protocolo I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +ir I-TREATMENT +aumentando I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +progresiva I-TREATMENT +la I-TREATMENT +velocidad I-TREATMENT +de I-TREATMENT +infusión I-TREATMENT +y I-TREATMENT +la I-TREATMENT +concentración I-TREATMENT +del I-TREATMENT +fármaco. I-TREATMENT +Se I-TREATMENT +prepararon I-TREATMENT +tres I-TREATMENT +soluciones I-TREATMENT +de I-TREATMENT +las I-TREATMENT +siguientes I-TREATMENT +diluciones: I-TREATMENT +1/100; I-TREATMENT +1/10 I-TREATMENT +y I-TREATMENT +1/1, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +volumen I-TREATMENT +total I-TREATMENT +de I-TREATMENT +250 I-TREATMENT +ml. I-TREATMENT +La I-TREATMENT +primera I-TREATMENT +solución I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +en I-TREATMENT +los I-TREATMENT +cuatro I-TREATMENT +primeros I-TREATMENT +pasos, I-TREATMENT +la I-TREATMENT +segunda I-TREATMENT +en I-TREATMENT +los I-TREATMENT +cuatro I-TREATMENT +siguientes, I-TREATMENT +y I-TREATMENT +la I-TREATMENT +tercera I-TREATMENT +solución I-TREATMENT +en I-TREATMENT +los I-TREATMENT +últimos I-TREATMENT +cuatro I-TREATMENT +pasos. I-TREATMENT +La I-TREATMENT +velocidad I-TREATMENT +de I-TREATMENT +infusión I-TREATMENT +se I-TREATMENT +incrementó I-TREATMENT +cada I-TREATMENT +quince I-TREATMENT +minutos, I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +que I-TREATMENT +con I-TREATMENT +cada I-TREATMENT +paso I-TREATMENT +se I-TREATMENT +administraba I-TREATMENT +el I-TREATMENT +doble I-TREATMENT +que I-TREATMENT +en I-TREATMENT +el I-TREATMENT +paso I-TREATMENT +anterior. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +último I-TREATMENT +paso I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +velocidad I-TREATMENT +constante I-TREATMENT +hasta I-TREATMENT +acabar I-TREATMENT +de I-TREATMENT +administrar I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +total. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +tabla I-TREATMENT +1 I-TREATMENT +se I-TREATMENT +resumen I-TREATMENT +las I-TREATMENT +soluciones I-TREATMENT +y I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +administración I-TREATMENT +del I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +desensibilización. I-TREATMENT + I-TREATMENT +La I-TREATMENT +administración I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +en I-TREATMENT +hospital I-TREATMENT +de I-TREATMENT +día I-TREATMENT +bajo I-TREATMENT +estrecha I-TREATMENT +monitorización I-TREATMENT +y I-TREATMENT +supervisión I-TREATMENT +médica, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +duración I-TREATMENT +total I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +37 I-TREATMENT +minutos. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +ninguna I-EVOLUTION +RHS I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +infusión I-EVOLUTION +del I-EVOLUTION +citostático I-EVOLUTION +mediante I-EVOLUTION +el I-EVOLUTION +PD I-EVOLUTION +ni I-EVOLUTION +posteriormente. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +DM I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II, I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +urotelial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vejiga I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +RTU, I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +adyuvante I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +mitomicina I-PAST_MEDICAL_HISTORY +intravesical I-PAST_MEDICAL_HISTORY +semanal, I-PAST_MEDICAL_HISTORY +seguido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mantenimiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +instilaciones I-PAST_MEDICAL_HISTORY +vesicales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mitomicina I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +mensuales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tras B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +quinta I-PRESENT_ILLNESS +instilación I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mantenimiento, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +dilatación I-PRESENT_ILLNESS +uretral, I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +intensa I-PRESENT_ILLNESS +reacción I-PRESENT_ILLNESS +cutánea I-PRESENT_ILLNESS +genital I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +toxicodermia I-PRESENT_ILLNESS +sistémica, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +posible I-PRESENT_ILLNESS +reacción I-PRESENT_ILLNESS +alérgica I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +mitomicina. I-PRESENT_ILLNESS +Se B-TREATMENT +le I-TREATMENT +pautó I-TREATMENT +tratamiento I-TREATMENT +sintomático I-TREATMENT +con I-TREATMENT +corticoides, I-TREATMENT +siendo B-DERIVED_FROM/TO +referido I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +dermatología I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +hospital, I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realizó I-DERIVED_FROM/TO +seguimiento I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +evolución. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Dos B-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +periodo I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +la I-EVOLUTION +erupción I-EVOLUTION +había I-EVOLUTION +mostrado I-EVOLUTION +un I-EVOLUTION +progreso I-EVOLUTION +favorable, I-EVOLUTION +aunque I-EVOLUTION +sin I-EVOLUTION +llegar I-EVOLUTION +a I-EVOLUTION +resolverse I-EVOLUTION +por I-EVOLUTION +completo, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +acudió I-EVOLUTION +al I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +urgencias I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones, I-EVOLUTION +siendo I-EVOLUTION +diagnosticado I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +sobreinfección I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +mismas. I-EVOLUTION +Se B-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +sistémico I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +empírica I-TREATMENT +(ciprofloxacino I-TREATMENT +500mg I-TREATMENT +v.o. I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas), I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +corticoides I-TREATMENT +tópicos. I-TREATMENT +Pese B-EVOLUTION +al I-EVOLUTION +tratamiento, I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +acudir I-EVOLUTION +a I-EVOLUTION +urgencias I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +eritema I-EVOLUTION +con I-EVOLUTION +enrojecimiento I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +genital, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +incremento I-EVOLUTION +del I-EVOLUTION +perímetro I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +miembros I-EVOLUTION +inferiores. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +úlcera I-EXPLORATION +extensa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +pene I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +escroto, I-EXPLORATION +con I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +temperatura I-EXPLORATION +local I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +necrótica I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pene; I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +edema I-EXPLORATION +(con I-EXPLORATION +fóvea) I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rodilla. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +valoración I-TREATMENT +del I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +Cirugía I-TREATMENT +Plástica, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +para I-TREATMENT +desbridar I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +necrotizado. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +ingreso I-EVOLUTION +se I-EVOLUTION +registraron I-EVOLUTION +varios I-EVOLUTION +picos I-EVOLUTION +febriles, I-EVOLUTION +siendo B-TREATMENT +reintervenido I-TREATMENT +en I-TREATMENT +varias I-TREATMENT +ocasiones I-TREATMENT +para I-TREATMENT +desbridar I-TREATMENT +más I-TREATMENT +tejido I-TREATMENT +fibrótico-granulomatoso, I-TREATMENT +hasta I-TREATMENT +albugínea I-TREATMENT +testicular I-TREATMENT +y I-TREATMENT +cuerpos I-TREATMENT +cavernosos, I-TREATMENT +recibiendo I-TREATMENT +curas I-TREATMENT +periódicas I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +mes. I-TREATMENT +El B-EXPLORATION +cultivo I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +herida I-EXPLORATION +reveló I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +sobreinfección I-EXPLORATION +se I-EXPLORATION +debía I-EXPLORATION +a I-EXPLORATION +Enterococcus I-EXPLORATION +tecalis, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +fosfomicina I-TREATMENT +oral I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1.000 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +horas I-TREATMENT +durante I-TREATMENT +24 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +resolución I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sobreinfección, I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +una I-TREATMENT +cirugía I-TREATMENT +plástica I-TREATMENT +de I-TREATMENT +reconstrucción, I-TREATMENT +utilizando I-TREATMENT +piel I-TREATMENT +sana I-TREATMENT +del I-TREATMENT +escroto I-TREATMENT +para I-TREATMENT +cubrir I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +desprovistas I-TREATMENT +en I-TREATMENT +pene I-TREATMENT +y I-TREATMENT +testículos; I-TREATMENT +así I-TREATMENT +mismo, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +uretroplastia I-TREATMENT +para I-TREATMENT +reconstruir I-TREATMENT +la I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +la I-TREATMENT +uretra I-TREATMENT +que I-TREATMENT +había I-TREATMENT +sido I-TREATMENT +dañada. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +HIV+, B-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +(único I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antirretroviral), I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +acude B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +tos I-EXPLORATION +seca, I-EXPLORATION +crepitantes I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +bases I-EXPLORATION +y I-EXPLORATION +febrícula. I-EXPLORATION +La B-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +no I-FAMILY_HISTORY +presentó I-FAMILY_HISTORY +otros I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés, I-FAMILY_HISTORY +enfermedades I-FAMILY_HISTORY +respiratorias I-FAMILY_HISTORY +en I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +cercanos, I-FAMILY_HISTORY +ni I-FAMILY_HISTORY +viajes I-FAMILY_HISTORY +recientes. I-FAMILY_HISTORY +No B-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +adenomegalias, I-EXPLORATION +insuficiencia I-EXPLORATION +cardiaca I-EXPLORATION +o I-EXPLORATION +troboembolismo I-EXPLORATION +venoso I-EXPLORATION +profundo. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +último I-EXPLORATION +control, I-EXPLORATION +6 I-EXPLORATION +meses I-EXPLORATION +previos I-EXPLORATION +al I-EXPLORATION +ingreso, I-EXPLORATION +presentó I-EXPLORATION +49 I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +106/L I-EXPLORATION +CD4 I-EXPLORATION +(33%) I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +de I-EXPLORATION +51.000 I-EXPLORATION +copias. I-EXPLORATION +Al I-EXPLORATION +ingreso, I-EXPLORATION +estas I-EXPLORATION +cifras I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +129 I-EXPLORATION +x I-EXPLORATION +106/L I-EXPLORATION +CD4 I-EXPLORATION +(16%) I-EXPLORATION +y I-EXPLORATION +330.000 I-EXPLORATION +copias. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +inicial I-EVOLUTION +fue I-EVOLUTION +tórpida, I-EVOLUTION +con I-EVOLUTION +dificultad I-EVOLUTION +respiratoria I-EVOLUTION +progresiva. I-EVOLUTION +La B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +reticular-intersticial, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +gammagrafía I-EXPLORATION +pulmonar I-EXPLORATION +descartó I-EXPLORATION +un I-EXPLORATION +tromboembolismo I-EXPLORATION +pulmonar. I-EXPLORATION +Se I-EXPLORATION +recogieron I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +esputo I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +con I-EXPLORATION +lavado I-EXPLORATION +broncoalveolar I-EXPLORATION +(BAL). I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +cotrimoxazol I-TREATMENT ++ I-TREATMENT +levofloxacino I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +intravenosa, I-TREATMENT +pero I-TREATMENT +ante I-TREATMENT +el I-TREATMENT +hallazgo I-TREATMENT +posterior I-TREATMENT +de I-TREATMENT +P. I-TREATMENT +jirovecii I-TREATMENT +en I-TREATMENT +el I-TREATMENT +BAL, I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +la I-TREATMENT +quinolona. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +antibiótico I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +mejoró I-EVOLUTION +notablemente, I-EVOLUTION +disminuyó I-EVOLUTION +la I-EVOLUTION +demanda I-EVOLUTION +de I-EVOLUTION +O2 I-EVOLUTION +y B-TREATMENT +en I-TREATMENT +el I-TREATMENT +sexto I-TREATMENT +día I-TREATMENT +se I-TREATMENT +pasó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +11 I-EVOLUTION +días, I-EVOLUTION +apareció I-EVOLUTION +una I-EVOLUTION +erupción I-EVOLUTION +cutánea I-EVOLUTION +eritematosa I-EVOLUTION +en I-EVOLUTION +espalda I-EVOLUTION +y I-EVOLUTION +cuello, I-EVOLUTION +no I-EVOLUTION +pruriginosa, I-EVOLUTION +junto I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +de I-EVOLUTION +39o I-EVOLUTION +C. I-EVOLUTION +Ante B-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +sugestivo I-TREATMENT +de I-TREATMENT +reacción I-TREATMENT +alérgica I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +cotrimoxazol I-TREATMENT +y I-TREATMENT +se I-TREATMENT +pasó I-TREATMENT +a I-TREATMENT +pentamidina I-TREATMENT +IV. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +de I-TREATMENT +la I-TREATMENT +neumonía I-TREATMENT +y I-TREATMENT +la I-TREATMENT +desaparición I-TREATMENT +del I-TREATMENT +rash I-TREATMENT +y I-TREATMENT +la I-TREATMENT +fiebre I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +h, I-TREATMENT +se I-TREATMENT +valoró I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +administrar I-TREATMENT +trimetroprim I-TREATMENT +y I-TREATMENT +dapsona I-TREATMENT +oral, I-TREATMENT +como I-TREATMENT +alternativa I-TREATMENT +a I-TREATMENT +cotrimoxazol, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +plantear I-TREATMENT +la I-TREATMENT +continuación I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +ambulatoria. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +administración I-EVOLUTION +de I-EVOLUTION +dapsona, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +el I-EVOLUTION +rash I-EVOLUTION +morbiliforme I-EVOLUTION +y B-TREATMENT +fiebre, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +finalizó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +pentamidina I-TREATMENT +IV I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +ingresado B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +raíz I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +hipoglucemia I-PRESENT_ILLNESS +severa I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +antidiabéticos I-PRESENT_ILLNESS +orales. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +presentaba I-EXPLORATION +traumatismo I-EXPLORATION +con I-EXPLORATION +herida I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +del I-EXPLORATION +pie I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +tuvo I-EXPLORATION +como I-EXPLORATION +consecuencia I-EXPLORATION +una I-EXPLORATION +úlcera I-EXPLORATION +por I-EXPLORATION +presión I-EXPLORATION +talar I-EXPLORATION +izquierda I-EXPLORATION +diagnosticada I-EXPLORATION +como I-EXPLORATION +pie I-EXPLORATION +diabético. I-EXPLORATION +Mediante I-EXPLORATION +cultivo I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +que I-EXPLORATION +era I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +PAMR I-EXPLORATION +y I-EXPLORATION +SARM. I-EXPLORATION + I-EXPLORATION +Posteriormente I-EXPLORATION +mediante I-EXPLORATION +antibiograma I-EXPLORATION +se I-EXPLORATION +valoró I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +PAMR I-EXPLORATION +era I-EXPLORATION +sensible I-EXPLORATION +únicamente I-EXPLORATION +a I-EXPLORATION +colistina I-EXPLORATION +(CMI I-EXPLORATION +< I-EXPLORATION +2) I-EXPLORATION +e I-EXPLORATION +intermedio I-EXPLORATION +a I-EXPLORATION +amikacina I-EXPLORATION +(CMI I-EXPLORATION += I-EXPLORATION +16) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +SARM I-EXPLORATION +era I-EXPLORATION +sensible I-EXPLORATION +entre I-EXPLORATION +otros I-EXPLORATION +a I-EXPLORATION +cotrimoxazol I-EXPLORATION +(CMI I-EXPLORATION +≤ I-EXPLORATION +1/19). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +crema I-TREATMENT +de I-TREATMENT +colistina I-TREATMENT +0, I-TREATMENT +1% I-TREATMENT +con I-TREATMENT +una I-TREATMENT +aplicación I-TREATMENT +diaria I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cura I-TREATMENT +y I-TREATMENT +además I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +cotrimoxazol I-TREATMENT +800/160mg I-TREATMENT +oral I-TREATMENT +cada I-TREATMENT +doce I-TREATMENT +horas I-TREATMENT +para I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +del I-TREATMENT +SARM. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +úlcera I-EVOLUTION +fue I-EVOLUTION +favorable. I-EVOLUTION +Según B-TREATMENT +criterio I-TREATMENT +médico, I-TREATMENT +se I-TREATMENT +finalizó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +tópico I-TREATMENT +con I-TREATMENT +colistina I-TREATMENT +tras I-TREATMENT +23 I-TREATMENT +días, I-TREATMENT +realizando B-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +úlcera I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +4 I-EXPLORATION +días I-EXPLORATION +cuyo I-EXPLORATION +resultado I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +a I-EXPLORATION +PAMR, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento. I-TREATMENT +La B-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +úlcera I-EVOLUTION +al I-EVOLUTION +finalizar I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +tópico I-EVOLUTION +con I-EVOLUTION +colistina I-EVOLUTION +fue I-EVOLUTION +notable. I-EVOLUTION +Se B-TREATMENT +continuó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +al I-TREATMENT +persistir I-TREATMENT +el I-TREATMENT +SARM. I-TREATMENT + I-TREATMENT +No I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +en I-TREATMENT +ninguno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +casos I-TREATMENT +tratamiento I-TREATMENT +sistémico I-TREATMENT +con I-TREATMENT +colistina I-TREATMENT +intravenosa. I-TREATMENT + I-TREATMENT +En I-TREATMENT +conclusión, I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +sugieren I-TREATMENT +que I-TREATMENT +el I-TREATMENT +preparado I-TREATMENT +de I-TREATMENT +colistina I-TREATMENT +0, I-TREATMENT +1% I-TREATMENT +elaborado I-TREATMENT +por I-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +farmacia I-TREATMENT +podría I-TREATMENT +ser I-TREATMENT +útil I-TREATMENT +para I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +úlceras I-TREATMENT +infectadas I-TREATMENT +por I-TREATMENT +PAMR I-TREATMENT +negativizando I-TREATMENT +el I-TREATMENT +cultivo I-TREATMENT +del I-TREATMENT +exudado I-TREATMENT +en I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +casos. I-TREATMENT + I-TREATMENT +No B-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +disponer I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +cultivo I-EVOLUTION +posterior I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +en I-EVOLUTION +uno I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +pacientes, I-EVOLUTION +aunque I-EVOLUTION +a I-EVOLUTION +criterio I-EVOLUTION +médico I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +crecimiento I-EVOLUTION +de I-EVOLUTION +bordes I-EVOLUTION +y I-EVOLUTION +tejido I-EVOLUTION +de I-EVOLUTION +granulación, I-EVOLUTION +indicativos I-EVOLUTION +de I-EVOLUTION +mejoría I-EVOLUTION +clínica. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +casos I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +infección I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +falta I-EVOLUTION +de I-EVOLUTION +información I-EVOLUTION +en I-EVOLUTION +cuanto I-EVOLUTION +a I-EVOLUTION +eficacia I-EVOLUTION +y I-EVOLUTION +resultados I-EVOLUTION +plantea I-EVOLUTION +la I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +seguir I-EVOLUTION +investigando I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +campo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +colistina I-EVOLUTION +tópica I-EVOLUTION +para I-EVOLUTION +llegar I-EVOLUTION +a I-EVOLUTION +conclusiones I-EVOLUTION +más I-EVOLUTION +sólidas I-EVOLUTION +sobre I-EVOLUTION +las I-EVOLUTION +posibilidades I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +utilización I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION +P. I-EVOLUTION +March I-EVOLUTION +López1, I-EVOLUTION +S. I-EVOLUTION +Redondo I-EVOLUTION +Capafons2, I-EVOLUTION +D. I-EVOLUTION +Cruz I-EVOLUTION +Guerrero3 I-EVOLUTION +y I-EVOLUTION +R. I-EVOLUTION +Garriga I-EVOLUTION +Biosca2 I-EVOLUTION +1Farmacéutico I-EVOLUTION +Residente. I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Farmacia. I-EVOLUTION +Hospital I-EVOLUTION +Universitari I-EVOLUTION +Mútua I-EVOLUTION +Terrassa I-EVOLUTION +(Barcelona). I-EVOLUTION +España. I-EVOLUTION +2Farmacéutica I-EVOLUTION +Adjunta. I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Farmacia. I-EVOLUTION +Hospital I-EVOLUTION +Universitari I-EVOLUTION +Mútua I-EVOLUTION +Terrassa I-EVOLUTION +(Barcelona). I-EVOLUTION +España. I-EVOLUTION +3Médico I-EVOLUTION +Adjunto. I-EVOLUTION +Centre I-EVOLUTION +Soci-Sanitari I-EVOLUTION +Residencia I-EVOLUTION +L´Ametlla I-EVOLUTION +del I-EVOLUTION +Vallés. I-EVOLUTION +Fundació I-EVOLUTION +Vallparadis. I-EVOLUTION +Grup I-EVOLUTION +Mútua I-EVOLUTION +Terrassa. I-EVOLUTION +Terrassa I-EVOLUTION +(Barcelona). I-EVOLUTION +España. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +segunda I-PRESENT_ILLNESS +instilación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +gemcitabina I-PRESENT_ILLNESS +intravesical I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +local I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +quemazón I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tenesmo I-PRESENT_ILLNESS +vesical I-PRESENT_ILLNESS +(grado I-PRESENT_ILLNESS +2) I-PRESENT_ILLNESS +5, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +obligó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +interrupción I-PRESENT_ILLNESS +inmediata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +administración, I-PRESENT_ILLNESS +persistiendo I-PRESENT_ILLNESS +disuria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +suprapúbico I-PRESENT_ILLNESS +que B-TREATMENT +mejoró I-TREATMENT +durante I-TREATMENT +las I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +siguientes I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +antiinflamatorio I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +a I-TREATMENT +petición I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +Dos I-TREATMENT +semanas I-TREATMENT +después I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +intravesical I-TREATMENT +con I-TREATMENT +MMC, I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +tolerancia I-TREATMENT +tras I-TREATMENT +cuatro I-TREATMENT +instilaciones. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Neurocirugía I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hematoma I-PRESENT_ILLNESS +cerebral I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +rotura I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aneurisma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +arteria I-PRESENT_ILLNESS +cerebral I-PRESENT_ILLNESS +media I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Se B-TREATMENT +realiza I-TREATMENT +un I-TREATMENT +clipaje I-TREATMENT +de I-TREATMENT +aneurisma I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +para I-TREATMENT +la I-TREATMENT +evacuación I-TREATMENT +del I-TREATMENT +hematoma I-TREATMENT +y I-TREATMENT +una I-TREATMENT +craniectomía I-TREATMENT +frontotemporal I-TREATMENT +izquierda I-TREATMENT +descompresiva, I-TREATMENT +dejándose I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +ventricular I-TREATMENT +externo. I-TREATMENT +Desde B-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +presenta I-EVOLUTION +fiebre I-EVOLUTION +persistente, I-EVOLUTION +siendo I-EVOLUTION +diagnosticada I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +posible I-EVOLUTION +Síndrome I-EVOLUTION +de I-EVOLUTION +Respuesta I-EVOLUTION +Inflamatoria I-EVOLUTION +Sistémica I-EVOLUTION +con I-EVOLUTION +sospecha I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +foco I-EVOLUTION +pulmonar, I-EVOLUTION +posiblemente I-EVOLUTION +por I-EVOLUTION +neumonía I-EVOLUTION +aspirativa. I-EVOLUTION +Recibe B-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +1.000 I-TREATMENT +mg/12 I-TREATMENT +h I-TREATMENT +durante I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +meropenem I-TREATMENT +1.000 I-TREATMENT +mg/8 I-TREATMENT +h I-TREATMENT +durante I-TREATMENT +14 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +es I-EVOLUTION +diagnosticada I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +infección I-EVOLUTION +por I-EVOLUTION +Enterococcus I-EVOLUTION +faecalis I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +herida I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +craniectomía I-EVOLUTION +y B-EXPLORATION +7 I-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +practica I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +cerebral I-EXPLORATION +cuyo I-EXPLORATION +resultado I-EXPLORATION +es I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +meningoencefalitis, I-EXPLORATION +pese I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo I-EXPLORATION +(LCR) I-EXPLORATION +son I-EXPLORATION +negativos. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +1.000 I-TREATMENT +mg/8 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +cefepima I-TREATMENT +2.000 I-TREATMENT +mg/8 I-TREATMENT +h I-TREATMENT +durante I-TREATMENT +23 I-TREATMENT +días. I-TREATMENT +A B-EXPLORATION +los I-EXPLORATION +45 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +se I-EXPLORATION +diagnostica, I-EXPLORATION +tras I-EXPLORATION +extraer I-EXPLORATION +nuevos I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +LCR, I-EXPLORATION +una I-EXPLORATION +ventriculitis I-EXPLORATION +por I-EXPLORATION +E. I-EXPLORATION +faecalis I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +derivación I-EXPLORATION +externa I-EXPLORATION +y I-EXPLORATION +es I-EXPLORATION +tratada I-EXPLORATION +con I-EXPLORATION +meropenem I-EXPLORATION +1.000 I-EXPLORATION +mg/8 I-EXPLORATION +h I-EXPLORATION +durante I-EXPLORATION +13 I-EXPLORATION +días I-EXPLORATION +y I-EXPLORATION +ampicilina I-EXPLORATION +2.000 I-EXPLORATION +mg/24 I-EXPLORATION +h I-EXPLORATION +durante I-EXPLORATION +24 I-EXPLORATION +días. I-EXPLORATION +Tras I-EXPLORATION +59 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +aísla I-EXPLORATION +Candida I-EXPLORATION +albicans I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +con I-EXPLORATION +candidemia I-EXPLORATION +asociada I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +añade I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +fluconazol I-TREATMENT +400 I-TREATMENT +mg/12 I-TREATMENT +h I-TREATMENT +durante I-TREATMENT +17 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Los B-EXPLORATION +cultivos I-EXPLORATION +posteriores I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +y I-EXPLORATION +sangre I-EXPLORATION +para I-EXPLORATION +los I-EXPLORATION +patógenos I-EXPLORATION +mencionados I-EXPLORATION +resultan I-EXPLORATION +negativos, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +infiere I-EXPLORATION +la I-EXPLORATION +resolución I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +infecciones I-EXPLORATION +previas; I-EXPLORATION +sin B-EVOLUTION +embargo I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +fiebre I-EVOLUTION +elevada I-EVOLUTION +y B-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION ++70 I-EXPLORATION +se I-EXPLORATION +aísla, I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +secreciones I-EXPLORATION +respiratorias, I-EXPLORATION +P. I-EXPLORATION +aeruginosa I-EXPLORATION +multirresistente, I-EXPLORATION +sensible I-EXPLORATION +únicamente I-EXPLORATION +a I-EXPLORATION +ceftazidima I-EXPLORATION +(CMI I-EXPLORATION +≤ I-EXPLORATION +4 I-EXPLORATION +mg/L) I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +colistina I-EXPLORATION +(CMI I-EXPLORATION +≤ I-EXPLORATION +2 I-EXPLORATION +mg/L) I-EXPLORATION +(EUCAST-2012, I-EXPLORATION +www.eucast.org). I-EXPLORATION +Asimismo, I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION ++73 I-EXPLORATION +se I-EXPLORATION +aísla I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +Stenotrophomonas I-EXPLORATION +maltophilia, I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +betalactámicos, I-EXPLORATION +aminoglucósidos I-EXPLORATION +y I-EXPLORATION +fluoroquinolonas, I-EXPLORATION +sensible I-EXPLORATION +solo I-EXPLORATION +a I-EXPLORATION +cotrimoxazol I-EXPLORATION +(CMI I-EXPLORATION +≤ I-EXPLORATION +2/38 I-EXPLORATION +mg/L) I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +CMI I-EXPLORATION +de I-EXPLORATION +colistina I-EXPLORATION +≤ I-EXPLORATION +2 I-EXPLORATION +mg/L. I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +para I-EXPLORATION +este I-EXPLORATION +último I-EXPLORATION +antimicrobiano I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +S. I-EXPLORATION +maltophilia I-EXPLORATION +se I-EXPLORATION +utilizó I-EXPLORATION +el I-EXPLORATION +definido I-EXPLORATION +por I-EXPLORATION +EUCAST I-EXPLORATION +para I-EXPLORATION +Acinetobacter I-EXPLORATION +spp I-EXPLORATION +(sensibilidad, I-EXPLORATION +≤ I-EXPLORATION +2 I-EXPLORATION +mg/L). I-EXPLORATION +Tras B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cotrimoxazol I-TREATMENT +iv I-TREATMENT +800/160 I-TREATMENT +mg/12 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +con I-TREATMENT +ceftazidima I-TREATMENT +iv I-TREATMENT +2.000 I-TREATMENT +mg/8 I-TREATMENT +h, I-TREATMENT +el I-TREATMENT +día I-TREATMENT ++75 I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +continúa I-TREATMENT +con I-TREATMENT +fiebre, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +plantea I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +rescate I-TREATMENT +con I-TREATMENT +colistina I-TREATMENT +iv I-TREATMENT +2 I-TREATMENT +MUI/8 I-TREATMENT +h, I-TREATMENT +colistina I-TREATMENT +intraventricular I-TREATMENT +60.000 I-TREATMENT +UI/12 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +cotrimoxazol I-TREATMENT +iv I-TREATMENT +1.600/320 I-TREATMENT +mg/12 I-TREATMENT +h. I-TREATMENT +Transcurridos B-EXPLORATION +7 I-EXPLORATION +días I-EXPLORATION +con I-EXPLORATION +dicho I-EXPLORATION +tratamiento, I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION ++82 I-EXPLORATION +crece, I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +LCR, I-EXPLORATION +S. I-EXPLORATION +maltophilia I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +minociclina I-EXPLORATION +(CMI I-EXPLORATION +≤ I-EXPLORATION +4 I-EXPLORATION +mg/L, I-EXPLORATION +CLSI-2012) I-EXPLORATION +y I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +colistina I-EXPLORATION +(CMI I-EXPLORATION +> I-EXPLORATION +4 I-EXPLORATION +mg/L) I-EXPLORATION +2. I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +confirmación I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +valor I-EXPLORATION +mediante I-EXPLORATION +una I-EXPLORATION +tira I-EXPLORATION +de I-EXPLORATION +gradiente I-EXPLORATION +preformado I-EXPLORATION +de I-EXPLORATION +CMI, I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +debe I-EXPLORATION +al I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +subpoblación I-EXPLORATION +diferente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mayoritaria. I-EXPLORATION +Ante B-TREATMENT +esta I-TREATMENT +situación I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +colistina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +administra I-TREATMENT +minociclina I-TREATMENT +200 I-TREATMENT +mg/12 I-TREATMENT +h I-TREATMENT +por I-TREATMENT +sonda I-TREATMENT +nasogástrica, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +cotrimoxazol I-TREATMENT +iv I-TREATMENT +1.600/320 I-TREATMENT +mg/12 I-TREATMENT +h. I-TREATMENT +Posteriormente, I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +dieta I-TREATMENT +absoluta I-TREATMENT +como I-TREATMENT +consecuencia I-TREATMENT +de I-TREATMENT +una I-TREATMENT +hemorragia I-TREATMENT +digestiva, I-TREATMENT +el I-TREATMENT +día I-TREATMENT ++94 I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +minociclina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +pauta I-TREATMENT +tigeciclina I-TREATMENT +iv I-TREATMENT +50 I-TREATMENT +mg/12 I-TREATMENT +h. I-TREATMENT +Finalmente B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fallece I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +95 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +por I-EVOLUTION +infecciones I-EVOLUTION +intercurrentes. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +fumadora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dos/tres I-PAST_MEDICAL_HISTORY +cigarrillos/día I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +veinte I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Menarquia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Primer I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Cinco I-PAST_MEDICAL_HISTORY +gestaciones I-PAST_MEDICAL_HISTORY +(tres I-PAST_MEDICAL_HISTORY +cesáreas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +abortos). I-PAST_MEDICAL_HISTORY +Uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +anticonceptivos I-PAST_MEDICAL_HISTORY +orales I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +diciembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2013 I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +oncología I-PRESENT_ILLNESS +y B-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presenta I-EXPLORATION +edema I-EXPLORATION +cutáneo I-EXPLORATION +que I-EXPLORATION +engloba I-EXPLORATION +a I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +mama I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +piel I-EXPLORATION +tensa, I-EXPLORATION +vesiculosa, I-EXPLORATION +areola I-EXPLORATION +y I-EXPLORATION +pezón I-EXPLORATION +retraídos, I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +axilares I-EXPLORATION +derecha I-EXPLORATION +e I-EXPLORATION +izquierda I-EXPLORATION +dolorosas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +Presenta I-EXPLORATION +molestia I-EXPLORATION +en I-EXPLORATION +mama I-EXPLORATION +derecha, I-EXPLORATION +zona I-EXPLORATION +costal I-EXPLORATION +y I-EXPLORATION +submamaria. I-EXPLORATION +ECOG I-EXPLORATION +2 I-EXPLORATION +como I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizaron I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +necesarias I-EXPLORATION +para I-EXPLORATION +determinar I-EXPLORATION +el I-EXPLORATION +estadio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neoplasia. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +presentó I-EXPLORATION +Fe: I-EXPLORATION +26 I-EXPLORATION +μg/dL I-EXPLORATION +(RN: I-EXPLORATION +50-170 I-EXPLORATION +μg/dL), I-EXPLORATION +IST: I-EXPLORATION +9% I-EXPLORATION +(RN: I-EXPLORATION +25-50 I-EXPLORATION +%). I-EXPLORATION +Ca I-EXPLORATION +15 I-EXPLORATION +3: I-EXPLORATION +92, I-EXPLORATION +2 I-EXPLORATION +UI/mL I-EXPLORATION +(RN: I-EXPLORATION +< I-EXPLORATION +32, I-EXPLORATION +4 I-EXPLORATION +UI/mL) I-EXPLORATION +con I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +hemograma I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +BAG I-EXPLORATION +(biopsia I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +gruesa), I-EXPLORATION +Punch I-EXPLORATION +cutáneo I-EXPLORATION +y I-EXPLORATION +Hercep I-EXPLORATION +Test®: I-EXPLORATION +positivo I-EXPLORATION +(HER I-EXPLORATION +2 I-EXPLORATION ++). I-EXPLORATION +El I-EXPLORATION +PET-TAC I-EXPLORATION +describió I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +tumoral I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mama I-EXPLORATION +derecha, I-EXPLORATION +en I-EXPLORATION +adenopatías I-EXPLORATION +axilares I-EXPLORATION +derechas I-EXPLORATION +e I-EXPLORATION +izquierda, I-EXPLORATION +adenopatía I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +mamaria I-EXPLORATION +interna I-EXPLORATION +derecha, I-EXPLORATION +en I-EXPLORATION +vértebras I-EXPLORATION +óseas I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +inferior I-EXPLORATION +(VI) I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +derecho I-EXPLORATION +hepático. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +lo I-EXPLORATION +tanto I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +fue I-EXPLORATION +diagnosticada I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +ductal I-EXPLORATION +infiltrante I-EXPLORATION +G2 I-EXPLORATION +cT4d I-EXPLORATION +cN1 I-EXPLORATION +M1 I-EXPLORATION +(óseas, I-EXPLORATION +ganglionares I-EXPLORATION +y I-EXPLORATION +hepáticas) I-EXPLORATION +estadio I-EXPLORATION +IV, I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +mamario I-EXPLORATION +y I-EXPLORATION +ferropenia, I-EXPLORATION +secundarios I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +enfermedad I-EXPLORATION +principal. I-EXPLORATION +Como B-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +elección I-TREATMENT +se I-TREATMENT +propuso I-TREATMENT +pertuzumab I-TREATMENT +para I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +del I-TREATMENT +CM I-TREATMENT +HER2 I-TREATMENT ++ I-TREATMENT +metastásico I-TREATMENT +o I-TREATMENT +localmente I-TREATMENT +recurrente I-TREATMENT +no I-TREATMENT +resecable, I-TREATMENT +en I-TREATMENT +combinación I-TREATMENT +con I-TREATMENT +trastuzumab I-TREATMENT +y I-TREATMENT +docetaxel4. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecocardiografía I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +monitorización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +cardíaca I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +FEVI I-EXPLORATION +63, I-EXPLORATION +9% I-EXPLORATION +normal, I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +podía I-EXPLORATION +verse I-EXPLORATION +afectada I-EXPLORATION +por I-EXPLORATION +trastuzumab I-EXPLORATION +y I-EXPLORATION +pertuzumab, I-EXPLORATION +y I-EXPLORATION +RMN I-EXPLORATION +(resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear) I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +metástasis I-EXPLORATION +cerebrales I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +considera I-EXPLORATION +un I-EXPLORATION +criterio I-EXPLORATION +para I-EXPLORATION +excluir I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +del I-EXPLORATION +beneficio I-EXPLORATION +de I-EXPLORATION +pertuzumab. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +planteado I-TREATMENT +fue: I-TREATMENT +pertuzumab I-TREATMENT +840mg I-TREATMENT +(inicio) I-TREATMENT +/420 I-TREATMENT +mg I-TREATMENT +(mantenimiento), I-TREATMENT +trastuzumab I-TREATMENT +8mg/kg I-TREATMENT +(inicio) I-TREATMENT +/6mg/kg I-TREATMENT +(mantenimiento), I-TREATMENT +docetaxel I-TREATMENT +75mg/m2, I-TREATMENT +cada I-TREATMENT +21 I-TREATMENT +días5. I-TREATMENT +Las I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +antineoplásicos I-TREATMENT +fueron I-TREATMENT +calculadas I-TREATMENT +según I-TREATMENT +peso I-TREATMENT +(88kg) I-TREATMENT +y I-TREATMENT +superficie I-TREATMENT +corporal I-TREATMENT +(1, I-TREATMENT +95 I-TREATMENT +m2). I-TREATMENT +El I-TREATMENT +inicio I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +fue I-TREATMENT +interrumpido I-TREATMENT +por I-TREATMENT +una I-TREATMENT +reacción I-TREATMENT +inmediata I-TREATMENT +sistémica I-TREATMENT +a I-TREATMENT +la I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +docetaxel I-TREATMENT +con I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +disnea I-TREATMENT +y I-TREATMENT +mareos I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +paracetamol, I-TREATMENT +hidrocortisona, I-TREATMENT +lorazepam I-TREATMENT +y I-TREATMENT +posterior I-TREATMENT +valoración I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Alergia I-TREATMENT +que I-TREATMENT +pautó I-TREATMENT +un I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +desensibilización I-TREATMENT +para I-TREATMENT +administrar I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +docetaxel. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +ingresó I-TREATMENT +en I-TREATMENT +UCI I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +programada I-TREATMENT +al I-TREATMENT +día I-TREATMENT +siguiente I-TREATMENT +para I-TREATMENT +su I-TREATMENT +administración I-TREATMENT +y I-TREATMENT +completar I-TREATMENT +así I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +QT. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +la I-TREATMENT +pauta I-TREATMENT +de I-TREATMENT +desensibilización I-TREATMENT +se I-TREATMENT +utilizaron I-TREATMENT +tres I-TREATMENT +soluciones I-TREATMENT +del I-TREATMENT +medicamento I-TREATMENT +(cada I-TREATMENT +una I-TREATMENT +de I-TREATMENT +250 I-TREATMENT +mL I-TREATMENT +ClNa I-TREATMENT +0, I-TREATMENT +9%): I-TREATMENT +A, I-TREATMENT +B I-TREATMENT +y I-TREATMENT +C I-TREATMENT +que I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +en I-TREATMENT +doce I-TREATMENT +pasos I-TREATMENT +consecutivos I-TREATMENT +con I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +velocidad I-TREATMENT +de I-TREATMENT +infusión. I-TREATMENT +La I-TREATMENT +solución I-TREATMENT +A I-TREATMENT +contenía I-TREATMENT +una I-TREATMENT +dilución I-TREATMENT +1/100 I-TREATMENT +de I-TREATMENT +la I-TREATMENT +concentración I-TREATMENT +objetivo I-TREATMENT +final I-TREATMENT +(pasos I-TREATMENT +1-4) I-TREATMENT +y I-TREATMENT +la I-TREATMENT +solución I-TREATMENT +B I-TREATMENT +una I-TREATMENT +dilución I-TREATMENT +1/10 I-TREATMENT +de I-TREATMENT +la I-TREATMENT +concentración I-TREATMENT +objetivo I-TREATMENT +final I-TREATMENT +(pasos I-TREATMENT +5-8). I-TREATMENT +De I-TREATMENT +la I-TREATMENT +solución I-TREATMENT +C I-TREATMENT +(150 I-TREATMENT +mg/250 I-TREATMENT +mL) I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +restante, I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +calculada I-TREATMENT +restando I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +acumulada I-TREATMENT +a I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +que I-TREATMENT +había I-TREATMENT +que I-TREATMENT +administrar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT +Cada I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +pasos I-TREATMENT +1 I-TREATMENT +a I-TREATMENT +11 I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +en I-TREATMENT +15 I-TREATMENT +minutos I-TREATMENT +(la I-TREATMENT +dosis I-TREATMENT +se I-TREATMENT +incrementó I-TREATMENT +en I-TREATMENT +un I-TREATMENT +2 I-TREATMENT +- I-TREATMENT +2, I-TREATMENT +5 I-TREATMENT +veces I-TREATMENT +con I-TREATMENT +cada I-TREATMENT +paso) I-TREATMENT +y I-TREATMENT +el I-TREATMENT +paso I-TREATMENT +12 I-TREATMENT +se I-TREATMENT +prolongó I-TREATMENT +para I-TREATMENT +completar I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +150 I-TREATMENT +mg. I-TREATMENT +El I-TREATMENT +tiempo I-TREATMENT +total I-TREATMENT +de I-TREATMENT +desensibilización I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +5, I-TREATMENT +8 I-TREATMENT +horas. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +respuesta I-EVOLUTION +parcial I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +ciclo I-EVOLUTION +con I-EVOLUTION +evidente I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mama I-EVOLUTION +afectada I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +volumen I-EVOLUTION +sin I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +del I-EVOLUTION +aspecto I-EVOLUTION +necrótico I-EVOLUTION +previo. I-EVOLUTION +Tras B-EXPLORATION +el I-EXPLORATION +sexto I-EXPLORATION +ciclo I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +PET-TAC I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +actividad I-EXPLORATION +metabólica I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mama I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +axilares, I-EXPLORATION +como I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +óseo I-EXPLORATION +y I-EXPLORATION +hepático, I-EXPLORATION +con I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +muy I-EXPLORATION +buena I-EXPLORATION +respuesta I-EXPLORATION +metabólica I-EXPLORATION +y I-EXPLORATION +funcional I-EXPLORATION +al I-EXPLORATION +tratamiento. I-EXPLORATION +Actualmente B-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +octavo I-EVOLUTION +ciclo I-EVOLUTION +no I-EVOLUTION +presenta I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +Kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +ADPV, I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hepatopatía I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +VHC I-PRESENT_ILLNESS +(genotipo I-PRESENT_ILLNESS +1a, I-PRESENT_ILLNESS +polimorfismo I-PRESENT_ILLNESS +IL-B28 I-PRESENT_ILLNESS +CC), I-PRESENT_ILLNESS +fibrosis I-PRESENT_ILLNESS +grado I-PRESENT_ILLNESS +F4 I-PRESENT_ILLNESS +(Fibroscan I-PRESENT_ILLNESS +36, I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +KPa), I-PRESENT_ILLNESS +carga I-PRESENT_ILLNESS +viral I-PRESENT_ILLNESS +(CV) I-PRESENT_ILLNESS +14.440 I-PRESENT_ILLNESS +UI I-PRESENT_ILLNESS +RNA/ml, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +datos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipertensión I-PRESENT_ILLNESS +portal, I-PRESENT_ILLNESS +probable I-PRESENT_ILLNESS +esteatohepatitis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +origen I-PRESENT_ILLNESS +mixto, I-PRESENT_ILLNESS +Child I-PRESENT_ILLNESS +A5 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +elevación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alfafetoproteína. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destacan I-PAST_MEDICAL_HISTORY +hemocromatosis I-PAST_MEDICAL_HISTORY +(mutación I-PAST_MEDICAL_HISTORY +H63D I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +heterocigosis) I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sobrecarga I-PAST_MEDICAL_HISTORY +férrica I-PAST_MEDICAL_HISTORY +controlada I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +realización I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sangrías, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +insulina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +metformina, I-PAST_MEDICAL_HISTORY +esofagitis I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pequeño I-PAST_MEDICAL_HISTORY +cordón I-PAST_MEDICAL_HISTORY +varicoso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ansiedad. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +analíticos I-EXPLORATION +se I-EXPLORATION +objetivan I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +valores: I-EXPLORATION +Hemoglobina I-EXPLORATION +13, I-EXPLORATION +2 I-EXPLORATION +g/dl, I-EXPLORATION +Hematocrito I-EXPLORATION +39, I-EXPLORATION +3%, I-EXPLORATION +Leucocitos I-EXPLORATION +6070, I-EXPLORATION +Plaquetas I-EXPLORATION +90000, I-EXPLORATION +INR I-EXPLORATION +1, I-EXPLORATION +04, I-EXPLORATION +Creatinina I-EXPLORATION +0, I-EXPLORATION +9 I-EXPLORATION +mg/dl, I-EXPLORATION +Bilirrubina I-EXPLORATION +total I-EXPLORATION +1, I-EXPLORATION +4 I-EXPLORATION +mg/dl, I-EXPLORATION +Albúmina I-EXPLORATION +3, I-EXPLORATION +1 I-EXPLORATION +g/dl, I-EXPLORATION +ASAT I-EXPLORATION +106 I-EXPLORATION +UI/L, I-EXPLORATION +ALAT I-EXPLORATION +108 I-EXPLORATION +UI/L, I-EXPLORATION +Fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +144 I-EXPLORATION +UI/L, I-EXPLORATION +Gamma-GT I-EXPLORATION +553 I-EXPLORATION +UI/L I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +MELD I-EXPLORATION +(Model I-EXPLORATION +for I-EXPLORATION +End I-EXPLORATION +Stage I-EXPLORATION +Liver I-EXPLORATION +Disease) I-EXPLORATION +de I-EXPLORATION +8. I-EXPLORATION + I-EXPLORATION +Respondedor B-TREATMENT +nulo I-TREATMENT +a I-TREATMENT +IFN I-TREATMENT +en I-TREATMENT +monoterapia I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +a I-TREATMENT +P-INF I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +RBV I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +es I-TREATMENT +candidato I-TREATMENT +a I-TREATMENT +triple I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +boceprevir. I-TREATMENT +Inicia I-TREATMENT +lead I-TREATMENT +in I-TREATMENT +con I-TREATMENT +RBV I-TREATMENT +oral I-TREATMENT +1000 I-TREATMENT +mg/día I-TREATMENT +y I-TREATMENT +P-INF I-TREATMENT +α2b I-TREATMENT +subcutáneo I-TREATMENT +120 I-TREATMENT +mcg/semana. I-TREATMENT +No I-TREATMENT +superó I-TREATMENT +la I-TREATMENT +fase I-TREATMENT +de I-TREATMENT +lead I-TREATMENT +in I-TREATMENT +(CV=33.680 I-TREATMENT +UI I-TREATMENT +RNA/ml), I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +la I-TREATMENT +5a I-TREATMENT +semana, I-TREATMENT +sin I-TREATMENT +haber I-TREATMENT +iniciado I-TREATMENT +boceprevir. I-TREATMENT + I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +última I-EVOLUTION +inyección I-EVOLUTION +de I-EVOLUTION +P-INF I-EVOLUTION +α2b I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +acudió I-EVOLUTION +a I-EVOLUTION +urgencias I-EVOLUTION +objetivando I-EVOLUTION +hematoma I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +local I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cara I-EVOLUTION +anterior I-EVOLUTION +del I-EVOLUTION +muslo I-EVOLUTION +derecho I-EVOLUTION +con I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +y I-EVOLUTION +temperatura I-EVOLUTION +local, I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +al I-EVOLUTION +mover I-EVOLUTION +la I-EVOLUTION +cadera I-EVOLUTION +derecha, I-EVOLUTION +administrándose I-EVOLUTION +analgésicos I-EVOLUTION +y I-EVOLUTION +antibióticos I-EVOLUTION +(amoxicilina-clavulánico I-EVOLUTION +1g/62, I-EVOLUTION +5mg/8 I-EVOLUTION +horas I-EVOLUTION +oral). I-EVOLUTION +Dos I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +regresó I-EVOLUTION +a I-EVOLUTION +urgencias I-EVOLUTION +presentando I-EVOLUTION +impotencia I-EVOLUTION +funcional I-EVOLUTION +y I-EVOLUTION +sensación I-EVOLUTION +distérmica. I-EVOLUTION +Mediante B-EXPLORATION +ecografía I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +hipoecogénica I-EXPLORATION +ovoidea I-EXPLORATION +de I-EXPLORATION +21x19x9 I-EXPLORATION +mm. I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +imagen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +infección I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +absceso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +musculo I-EXPLORATION +abductor I-EXPLORATION +largo I-EXPLORATION +del I-EXPLORATION +muslo I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +inferiormente I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +compartimento I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +medio I-EXPLORATION +del I-EXPLORATION +mismo. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +antibióticos I-TREATMENT +(piperacilina/tazobactam I-TREATMENT +4g/0, I-TREATMENT +5g/8 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +daptomicina I-TREATMENT +500mg/24 I-TREATMENT +horas I-TREATMENT +intravenosos, I-TREATMENT +durante I-TREATMENT +3 I-TREATMENT +días) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +desbridamiento I-TREATMENT +quirúrgico. I-TREATMENT +Tras B-EVOLUTION +una I-EVOLUTION +cirugía I-EVOLUTION +con I-EVOLUTION +complicaciones, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +ingresó I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +cuidados I-EVOLUTION +intensivos I-EVOLUTION +(UCI). I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +UCI I-EVOLUTION +presentó I-EVOLUTION +shock I-EVOLUTION +séptico I-EVOLUTION +complicado I-EVOLUTION +con I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +disfunción I-EVOLUTION +multiorgánica. I-EVOLUTION +En B-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +del I-EXPLORATION +absceso I-EXPLORATION +muscular I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +Staphylococcus I-EXPLORATION +aureus I-EXPLORATION +meticilin-sensible, I-EXPLORATION +que B-TREATMENT +se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +linezolid I-TREATMENT +(600mg/12 I-TREATMENT +horas I-TREATMENT +intravenoso) I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +con I-TREATMENT +cloxacilina I-TREATMENT +(1g/6 I-TREATMENT +horas I-TREATMENT +intravenoso) I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Posteriormente B-EVOLUTION +desarrolló I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +distress I-EVOLUTION +respiratorio I-EVOLUTION +agudo I-EVOLUTION +que B-TREATMENT +precisó I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasiva; I-TREATMENT +neumonía B-EVOLUTION +por I-EVOLUTION +Escherichia I-EVOLUTION +Coli I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +ventilación I-EVOLUTION +mecánica I-EVOLUTION +que I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +con B-TREATMENT +meropenem I-TREATMENT +(1000mg/8 I-TREATMENT +horas I-TREATMENT +intravenoso) I-TREATMENT +y I-TREATMENT +levofloxacino I-TREATMENT +(500 I-TREATMENT +mg/24 I-TREATMENT +horas I-TREATMENT +intravenoso) I-TREATMENT +durante I-TREATMENT +10 I-TREATMENT +días; I-TREATMENT +insuficiencia B-EVOLUTION +renal I-EVOLUTION +(IR) I-EVOLUTION +con I-EVOLUTION +oliguria I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +hemofiltración I-TREATMENT +venosa I-TREATMENT +continua; I-TREATMENT +anemia B-EVOLUTION +y I-EVOLUTION +trombopenia I-EVOLUTION +graves I-EVOLUTION +que B-TREATMENT +requirieron I-TREATMENT +transfusiones I-TREATMENT +de I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes I-TREATMENT +y I-TREATMENT +plaquetas; I-TREATMENT +hiperfosfatemia; B-EVOLUTION +hiperglucemia I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +insulina; I-TREATMENT +colonización B-EVOLUTION +por I-EVOLUTION +Candida I-EVOLUTION +Albicans I-EVOLUTION +en I-EVOLUTION +orina, I-EVOLUTION +secreciones I-EVOLUTION +y I-EVOLUTION +heces; I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +alta I-EVOLUTION +(HDA) I-EVOLUTION +y I-EVOLUTION +melenas; I-EVOLUTION +varices I-EVOLUTION +esofágicas I-EVOLUTION +grado I-EVOLUTION +III I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +mostraban I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +sangrado I-EVOLUTION +activo I-EVOLUTION +pero B-TREATMENT +que I-TREATMENT +requirieron I-TREATMENT +ligadura I-TREATMENT +con I-TREATMENT +bandas I-TREATMENT +elásticas I-TREATMENT +y I-TREATMENT +aumento I-TREATMENT +transitorio I-TREATMENT +de I-TREATMENT +enzimas I-TREATMENT +hepáticas I-TREATMENT +y I-TREATMENT +bilirrubina I-TREATMENT +(17, I-TREATMENT +2 I-TREATMENT +mg/dL). I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +continuó I-EVOLUTION +con I-EVOLUTION +deterioro I-EVOLUTION +gasométrico I-EVOLUTION +y I-EVOLUTION +radiológico, I-EVOLUTION +con I-EVOLUTION +infiltrados I-EVOLUTION +alveolo-intersticiales I-EVOLUTION +basales I-EVOLUTION +y I-EVOLUTION +bilaterales I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +aisló I-EVOLUTION +Klebsiella I-EVOLUTION +Pneumoniae I-EVOLUTION +productora I-EVOLUTION +de I-EVOLUTION +betalactamasas I-EVOLUTION +de I-EVOLUTION +amplio I-EVOLUTION +espectro I-EVOLUTION +sensible I-EVOLUTION +a I-EVOLUTION +colistina. I-EVOLUTION +A I-EVOLUTION +pesar I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +dirigido I-EVOLUTION +(colistina I-EVOLUTION +intravenosa I-EVOLUTION +e I-EVOLUTION +inhalada I-EVOLUTION +ajustada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal) I-EVOLUTION +durante I-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +más, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +insuficiencia I-EVOLUTION +respiratoria I-EVOLUTION +aguda I-EVOLUTION +grave, I-EVOLUTION +disfunción I-EVOLUTION +multiorgánica I-EVOLUTION +con I-EVOLUTION +acidosis I-EVOLUTION +láctica I-EVOLUTION +grave I-EVOLUTION +y I-EVOLUTION +shock I-EVOLUTION +séptico I-EVOLUTION +refractario I-EVOLUTION +siendo I-EVOLUTION +finalmente I-EVOLUTION +exitus. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumadora, B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas I-PAST_MEDICAL_HISTORY +conocidas, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colon I-PAST_MEDICAL_HISTORY +irritable, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +depresivo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +migrañas, I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuello I-PAST_MEDICAL_HISTORY +uterino I-PAST_MEDICAL_HISTORY +aparentemente I-PAST_MEDICAL_HISTORY +localizado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +julio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2012. I-PAST_MEDICAL_HISTORY +Se B-TREATMENT +realizó I-TREATMENT +histerectomía, I-TREATMENT +doble I-TREATMENT +annexectomía I-TREATMENT +y I-TREATMENT +estadificación I-TREATMENT +ganglionar I-TREATMENT +quirúrgica I-TREATMENT +retroperitoneal. I-TREATMENT +La B-EXPLORATION +estadificación I-EXPLORATION +final I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +pT3N1 I-EXPLORATION +(ganglios I-EXPLORATION +pélvicos). I-EXPLORATION +A B-TREATMENT +continuación I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cisplatino I-TREATMENT +(40 I-TREATMENT +mg/m2 I-TREATMENT +semanales) I-TREATMENT +concomitante I-TREATMENT +a I-TREATMENT +radioterapia. I-TREATMENT +Por I-TREATMENT +alta I-TREATMENT +probabilidad I-TREATMENT +de I-TREATMENT +recaída I-TREATMENT +recibió I-TREATMENT +posteriormente I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +carboplatino I-TREATMENT +(5 I-TREATMENT +mg/AUC) I-TREATMENT +y I-TREATMENT +paclitaxel I-TREATMENT +(175 I-TREATMENT +mg/m2), I-TREATMENT +recibiendo I-TREATMENT +cinco I-TREATMENT +ciclos I-TREATMENT +en I-TREATMENT +total I-TREATMENT +con I-TREATMENT +varias I-TREATMENT +reducciones I-TREATMENT +de I-TREATMENT +dosis I-TREATMENT +por I-TREATMENT +diferentes I-TREATMENT +toxicidades I-TREATMENT +(plaquetopenia I-TREATMENT +grado I-TREATMENT +IV, I-TREATMENT +oclusión I-TREATMENT +intestinal I-TREATMENT +y I-TREATMENT +neurotoxicidad I-TREATMENT +grado I-TREATMENT +II). I-TREATMENT +Permaneció B-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +hasta I-EVOLUTION +octubre I-EVOLUTION +de I-EVOLUTION +2014, I-EVOLUTION +fecha I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +detecta I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +de I-EVOLUTION +implantes I-EVOLUTION +peritoneales I-EVOLUTION +e I-EVOLUTION +implantes I-EVOLUTION +metastásicos I-EVOLUTION +esplénicos. I-EVOLUTION +Inicia B-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +con I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +bevacizumab I-TREATMENT +(15 I-TREATMENT +mg/kg), I-TREATMENT +cisplatino I-TREATMENT +(50 I-TREATMENT +mg/m2) I-TREATMENT +y I-TREATMENT +paclitaxel I-TREATMENT +(175 I-TREATMENT +mg/m2), I-TREATMENT +cada I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT +El B-EVOLUTION +día I-EVOLUTION +posterior I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +administración I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +urgencias I-EVOLUTION +con I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +agudo I-EVOLUTION +y I-EVOLUTION +náuseas I-EVOLUTION +sin I-EVOLUTION +vómitos, I-EVOLUTION +no I-EVOLUTION +presentado I-EVOLUTION +fiebre. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +detecta I-EXPLORATION +abdomen I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +diseminado I-EXPLORATION +tanto I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +superficial I-EXPLORATION +como I-EXPLORATION +profundo, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +peritonismo. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +perforación I-EXPLORATION +de I-EXPLORATION +implante I-EXPLORATION +peritoneal I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +sigma, I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +burbujas I-EXPLORATION +aéreas I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +superior I-EXPLORATION +e I-EXPLORATION +inferior, I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +peritonitis I-EXPLORATION +fecaloidea. I-EXPLORATION +Se B-TREATMENT +procede I-TREATMENT +a I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +urgente I-TREATMENT +(sigmoidectomía I-TREATMENT +y I-TREATMENT +colostomía I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +ciego). I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +LLC I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +B I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +evidencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +progresión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +progresión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +adenopatías I-PRESENT_ILLNESS +inguinales, I-PRESENT_ILLNESS +axiales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cervicales. I-PRESENT_ILLNESS +Recibe B-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +con I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +rituximab I-TREATMENT +(375 I-TREATMENT +mg/m2 I-TREATMENT +IV I-TREATMENT +de I-TREATMENT +inicio, I-TREATMENT +500 I-TREATMENT +mg/m2 I-TREATMENT +IV I-TREATMENT +dosis I-TREATMENT +sucesivas), I-TREATMENT +fludarabina I-TREATMENT +(25 I-TREATMENT +mg/m2 I-TREATMENT +IV) I-TREATMENT +y I-TREATMENT +ciclofosfamida I-TREATMENT +(250 I-TREATMENT +mg/m2 I-TREATMENT +i.v.), I-TREATMENT +alcanzando I-TREATMENT +remisión I-TREATMENT +parcial I-TREATMENT +con I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad, I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +cariotipo I-TREATMENT +complejo I-TREATMENT +y I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +deleción I-TREATMENT +del I-TREATMENT +gen I-TREATMENT +p53. I-TREATMENT +Por I-TREATMENT +estas I-TREATMENT +características I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +idelalisib I-TREATMENT +(150 I-TREATMENT +mg/12 I-TREATMENT +horas I-TREATMENT +v.o.) I-TREATMENT +combinado I-TREATMENT +con I-TREATMENT +rituximab I-TREATMENT +(dosis I-TREATMENT +inicial I-TREATMENT +de I-TREATMENT +375 I-TREATMENT +mg/m2 I-TREATMENT +IV, I-TREATMENT +dosis I-TREATMENT +posteriores I-TREATMENT +de I-TREATMENT +500 I-TREATMENT +mg/m2 I-TREATMENT +IV). I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +ingresa I-EVOLUTION +por I-EVOLUTION +diarrea I-EVOLUTION +líquida I-EVOLUTION +de I-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +evolución, I-EVOLUTION +con I-EVOLUTION +7-8 I-EVOLUTION +deposiciones I-EVOLUTION +al I-EVOLUTION +día, I-EVOLUTION +sin I-EVOLUTION +productos I-EVOLUTION +patológicos, I-EVOLUTION +acompañada I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +mesogástrico I-EVOLUTION +continuo I-EVOLUTION +que I-EVOLUTION +cede I-EVOLUTION +parcialmente I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +deposición, I-EVOLUTION +con I-EVOLUTION +febrícula I-EVOLUTION +pero I-EVOLUTION +sin I-EVOLUTION +náuseas I-EVOLUTION +ni I-EVOLUTION +vómitos. I-EVOLUTION +Los B-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +coprocultivos I-EXPLORATION +y I-EXPLORATION +hemocultivos I-EXPLORATION +realizados I-EXPLORATION +son I-EXPLORATION +negativos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +ascendente I-EXPLORATION +de I-EXPLORATION +calibre I-EXPLORATION +aumentado, I-EXPLORATION +engrosamiento I-EXPLORATION +mural I-EXPLORATION +y I-EXPLORATION +realce I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +colitis I-EXPLORATION +inflamatoria. I-EXPLORATION +Se I-EXPLORATION +suspende I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +idelalisib I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +inicia I-EXPLORATION +sueroterapia I-EXPLORATION +y I-EXPLORATION +analgesia. I-EXPLORATION +Evoluciona B-TREATMENT +con I-TREATMENT +pico I-TREATMENT +febril I-TREATMENT +y I-TREATMENT +deterioro I-TREATMENT +general, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +añade I-TREATMENT +ciprofloxacino I-TREATMENT +(400 I-TREATMENT +mg/12 I-TREATMENT +h I-TREATMENT +IV), I-TREATMENT +sustituyéndose I-TREATMENT +posteriormente I-TREATMENT +por I-TREATMENT +piperacilina/tazobactam I-TREATMENT +(4 I-TREATMENT +g/6 I-TREATMENT +h I-TREATMENT +IV). I-TREATMENT + I-TREATMENT +Como B-EVOLUTION +complicaciones I-EVOLUTION +derivadas I-EVOLUTION +del I-EVOLUTION +ingreso, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +desarrolla I-EVOLUTION +un I-EVOLUTION +neumotórax I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +canalización I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +vía I-EVOLUTION +central I-EVOLUTION +y, I-EVOLUTION +durante I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +en I-EVOLUTION +UCI, I-EVOLUTION +presenta I-EVOLUTION +diarrea I-EVOLUTION +cuantiosa I-EVOLUTION +con I-EVOLUTION +alteraciones I-EVOLUTION +hidroelectrolíticas I-EVOLUTION +que I-EVOLUTION +requieren I-EVOLUTION +reposición I-EVOLUTION +volémica I-EVOLUTION +y I-EVOLUTION +electrolítica I-EVOLUTION +y I-EVOLUTION +aporte I-EVOLUTION +de I-EVOLUTION +nutrición I-EVOLUTION +parenteral. I-EVOLUTION + I-EVOLUTION +A B-TREATMENT +la I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +se I-TREATMENT +origina I-TREATMENT +alteración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal I-TREATMENT +y, I-TREATMENT +debido I-TREATMENT +al I-TREATMENT +deterioro I-TREATMENT +clínico I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +digestivo, I-TREATMENT +recibe I-TREATMENT +corticoides I-TREATMENT +(budesónida I-TREATMENT +9 I-TREATMENT +mg/24 I-TREATMENT +h I-TREATMENT +VO I-TREATMENT +que I-TREATMENT +es I-TREATMENT +sustituida I-TREATMENT +por I-TREATMENT +metilprednisolona I-TREATMENT +60 I-TREATMENT +mg/24 I-TREATMENT +h I-TREATMENT +IV I-TREATMENT +por I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +diarrea) I-TREATMENT +y I-TREATMENT +rifaximina I-TREATMENT +(200 I-TREATMENT +mg/6 I-TREATMENT +h I-TREATMENT +VO). I-TREATMENT +Tras B-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +con I-EVOLUTION +corticoides I-EVOLUTION +sistémicos I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +(llegando I-EVOLUTION +a I-EVOLUTION +desaparecer), I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +número I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +cantidad I-EVOLUTION +de I-EVOLUTION +deposiciones I-EVOLUTION +y I-EVOLUTION +recuperación I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general. I-EVOLUTION +En B-TREATMENT +el I-TREATMENT +momento I-TREATMENT +del I-TREATMENT +alta I-TREATMENT +hospitalaria I-TREATMENT +se I-TREATMENT +mantiene I-TREATMENT +prednisona I-TREATMENT +(50 I-TREATMENT +mg/24 I-TREATMENT +h I-TREATMENT +VO) I-TREATMENT +hasta I-TREATMENT +resolución I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas. I-TREATMENT + I-TREATMENT +A I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +del I-TREATMENT +alta I-TREATMENT +hospitalaria I-TREATMENT +reanuda I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +idelalisib I-TREATMENT +(100 I-TREATMENT +mg/12 I-TREATMENT +h I-TREATMENT +VO) I-TREATMENT +y I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +después I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +reingresa I-TREATMENT +por I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +episodio I-TREATMENT +de I-TREATMENT +colitis, I-TREATMENT +aunque I-TREATMENT +más I-TREATMENT +leve I-TREATMENT +que I-TREATMENT +el I-TREATMENT +primero. I-TREATMENT +Se I-TREATMENT +suspende I-TREATMENT +idelalisib I-TREATMENT +definitivamente I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +sueroterapia I-TREATMENT +de I-TREATMENT +soporte. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +continúa I-TREATMENT +con I-TREATMENT +diarrea I-TREATMENT +profusa I-TREATMENT +(10 I-TREATMENT +deposiciones I-TREATMENT +líquidas I-TREATMENT +diarias) I-TREATMENT +y I-TREATMENT +pico I-TREATMENT +febril, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +antibioterapia I-TREATMENT +con I-TREATMENT +levofloxacino I-TREATMENT +(500 I-TREATMENT +mg/24 I-TREATMENT +h I-TREATMENT +IV), I-TREATMENT +que I-TREATMENT +es I-TREATMENT +sustituido I-TREATMENT +por I-TREATMENT +meropenem I-TREATMENT +(1 I-TREATMENT +g/8h I-TREATMENT +IV). I-TREATMENT +Los B-EXPLORATION +coprocultivos I-EXPLORATION +y I-EXPLORATION +hemocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Después B-TREATMENT +de I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +corticoides I-TREATMENT +sistémicos I-TREATMENT +a I-TREATMENT +1 I-TREATMENT +mg/kg/día, I-TREATMENT +presentando I-TREATMENT +mejoría I-TREATMENT +del I-TREATMENT +estado I-TREATMENT +general, I-TREATMENT +con I-TREATMENT +disminución I-TREATMENT +del I-TREATMENT +número I-TREATMENT +de I-TREATMENT +deposiciones I-TREATMENT +al I-TREATMENT +cabo I-TREATMENT +de I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +tratamiento, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +es I-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +hospitalaria I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +oral I-TREATMENT +hasta I-TREATMENT +resolución I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +bebedor B-PAST_MEDICAL_HISTORY +moderado, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +hipertensiva, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +moderada, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardiaca I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +fallo I-PAST_MEDICAL_HISTORY +sistólico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ventrículo I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +transitorio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +paroxística I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +amiodarona I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2013. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +torasemida I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +QD, I-PAST_MEDICAL_HISTORY +acenocumarol I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +QD, I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +QD, I-PAST_MEDICAL_HISTORY +bisoprolol I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +QD I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +omeprazol I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +QD. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +abril I-EXPLORATION +de I-EXPLORATION +2015 I-EXPLORATION +presentó I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +hipertiroidismo I-EXPLORATION +primario: I-EXPLORATION +T4 I-EXPLORATION +libre I-EXPLORATION +25, I-EXPLORATION +5 I-EXPLORATION +pg/ml I-EXPLORATION +y I-EXPLORATION +hormona I-EXPLORATION +estimulante I-EXPLORATION +de I-EXPLORATION +tiroides I-EXPLORATION +(TSH) I-EXPLORATION +0, I-EXPLORATION +002 I-EXPLORATION +Ul/ml. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +gammagrafía I-EXPLORATION +tiroidea I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +bocio I-EXPLORATION +difuso I-EXPLORATION +hipercaptador. I-EXPLORATION +Respecto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +autoinmunidad I-EXPLORATION +tiroidea I-EXPLORATION +presentó I-EXPLORATION +anticuerpos I-EXPLORATION +antitiroglobulina, I-EXPLORATION +anticuerpos I-EXPLORATION +antiperoxidasa I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +receptor I-EXPLORATION +TSH I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +orientó I-TREATMENT +como I-TREATMENT +un I-TREATMENT +hipertiroidismo I-TREATMENT +inducido I-TREATMENT +por I-TREATMENT +amiodarona I-TREATMENT +tipo I-TREATMENT +l5, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +este I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tiamazol, I-TREATMENT +5 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas. I-TREATMENT +Se I-TREATMENT +incrementó I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +bisoprolol I-TREATMENT +de I-TREATMENT +2, I-TREATMENT +5 I-TREATMENT +mg I-TREATMENT +a I-TREATMENT +5 I-TREATMENT +mg I-TREATMENT +QD I-TREATMENT +para I-TREATMENT +el I-TREATMENT +control I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fibrilación I-TREATMENT +auricular. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tiamazol, I-TREATMENT +en B-EXPLORATION +consultas I-EXPLORATION +de I-EXPLORATION +Endocrinología, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +enzimas I-EXPLORATION +hepáticas: I-EXPLORATION +glutamato-oxalacetato I-EXPLORATION +transaminasa I-EXPLORATION +(GOT) I-EXPLORATION +100 I-EXPLORATION +Ul/L, I-EXPLORATION +glutamato-piruvato I-EXPLORATION +transaminasa I-EXPLORATION +(GPT) I-EXPLORATION +109 I-EXPLORATION +Ul/L, I-EXPLORATION +GGT I-EXPLORATION +1177 I-EXPLORATION +Ul/L, I-EXPLORATION +lactato I-EXPLORATION +deshidrogenasa I-EXPLORATION +(LDH) I-EXPLORATION +742 I-EXPLORATION +Ul/L, I-EXPLORATION +FA I-EXPLORATION +247 I-EXPLORATION +Ul/L; I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +permanecieron I-EXPLORATION +normales I-EXPLORATION +los I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +bilirrubina I-EXPLORATION +directa, I-EXPLORATION +0, I-EXPLORATION +3 I-EXPLORATION +mg/dL, I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +total, I-EXPLORATION +0, I-EXPLORATION +7 I-EXPLORATION +mg/dL. I-EXPLORATION +Se B-DERIVED_FROM/TO +ingresó I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +Medicina I-DERIVED_FROM/TO +Interna I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +estudiar I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +posible I-DERIVED_FROM/TO +colestasis I-DERIVED_FROM/TO +disociada I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +citolisis. I-DERIVED_FROM/TO +Se B-EXPLORATION +descartaron I-EXPLORATION +causas I-EXPLORATION +autoinmunes I-EXPLORATION +e I-EXPLORATION +infecciosas. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +hepatotropos I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +Ante B-TREATMENT +estos I-TREATMENT +resultados I-TREATMENT +se I-TREATMENT +asoció I-TREATMENT +la I-TREATMENT +colestasis I-TREATMENT +disociada I-TREATMENT +al I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +tiamazol, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +y I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +una I-TREATMENT +mejoría I-TREATMENT +progresiva I-TREATMENT +de I-TREATMENT +los I-TREATMENT +niveles I-TREATMENT +enzimáticos I-TREATMENT +hasta I-TREATMENT +su I-TREATMENT +completa I-TREATMENT +normalización I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +después. I-TREATMENT + I-TREATMENT +Los B-EVOLUTION +valores I-EVOLUTION +de I-EVOLUTION +hormonas I-EVOLUTION +tiroideas I-EVOLUTION +se I-EVOLUTION +normalizaron, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +recomendó I-EVOLUTION +control I-EVOLUTION +cada I-EVOLUTION +6-12 I-EVOLUTION +meses I-EVOLUTION +sin I-EVOLUTION +que I-EVOLUTION +precisase I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +niño I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ocho I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +del B-PAST_MEDICAL_HISTORY +ámbito I-PAST_MEDICAL_HISTORY +rural, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +inicial I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +fue I-EXPLORATION +negativa, I-EXPLORATION +a I-EXPLORATION +excepción I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +erosiones I-EXPLORATION +en I-EXPLORATION +antebrazo, I-EXPLORATION +brazo I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +piernas, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +pústula I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +externa I-EXPLORATION +de I-EXPLORATION +brazo I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +adenopatía I-EXPLORATION +axilar I-EXPLORATION +izquierda. I-EXPLORATION +Los I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +iniciales I-EXPLORATION +incluyeron, I-EXPLORATION +leucocitosis I-EXPLORATION +12.400 I-EXPLORATION +con I-EXPLORATION +69% I-EXPLORATION +de I-EXPLORATION +granulocitos, I-EXPLORATION +8% I-EXPLORATION +de I-EXPLORATION +monocitos, I-EXPLORATION +23% I-EXPLORATION +de I-EXPLORATION +linfocitos, I-EXPLORATION +VSG I-EXPLORATION +63 I-EXPLORATION +mm/h, I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +heces I-EXPLORATION +negativos, I-EXPLORATION +tuberculina I-EXPLORATION +2UI I-EXPLORATION +PPD I-EXPLORATION +negativa, I-EXPLORATION +orina I-EXPLORATION +normal, I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +senos I-EXPLORATION +normal, I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +normales. I-EXPLORATION +Mantienen I-EXPLORATION +los I-EXPLORATION +picos I-EXPLORATION +febriles I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +frecuencia I-EXPLORATION +diaria. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +fiebre I-TREATMENT +botonosa, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +doxiciclina I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +habitual, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +a I-TREATMENT +los I-TREATMENT +seis I-TREATMENT +días I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +negatividad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +serología I-TREATMENT +de I-TREATMENT +Rickettsia I-TREATMENT +conorii. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +paciente I-EXPLORATION +continúa I-EXPLORATION +presentando I-EXPLORATION +picos I-EXPLORATION +febriles, I-EXPLORATION +programándose I-EXPLORATION +nuevos I-EXPLORATION +estudios I-EXPLORATION +complementarios, I-EXPLORATION +que I-EXPLORATION +revelaron I-EXPLORATION +un I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +normal, I-EXPLORATION +VSG I-EXPLORATION +92 I-EXPLORATION +mm/h, I-EXPLORATION +citomorfología I-EXPLORATION +normal, I-EXPLORATION +PCR I-EXPLORATION +3 I-EXPLORATION +mg/dl, I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +normales, I-EXPLORATION +aglutinaciones I-EXPLORATION +a I-EXPLORATION +Salmonella I-EXPLORATION +y I-EXPLORATION +Brucella I-EXPLORATION +negativas, I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +Epstein I-EXPLORATION +Barr, I-EXPLORATION +Citomegalovirus, I-EXPLORATION +Hepatitis, I-EXPLORATION +HIV, I-EXPLORATION +Borrelia I-EXPLORATION +burgdorferi I-EXPLORATION +negativas. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +revela I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +hipoecoicas, I-EXPLORATION +la I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +bazo I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hígado I-EXPLORATION +imagen I-EXPLORATION +similar I-EXPLORATION +única I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +corrobora I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +ecográficos I-EXPLORATION +y I-EXPLORATION +sugiere I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +microabscesos I-EXPLORATION +o I-EXPLORATION +Enfermedad I-EXPLORATION +por I-EXPLORATION +Arañazo I-EXPLORATION +de I-EXPLORATION +Gato; I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +serología I-EXPLORATION +a I-EXPLORATION +Bartonella I-EXPLORATION +Henselae, I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +positiva, I-EXPLORATION +iniciándose B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +eritromicina. I-TREATMENT + I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +picos I-TREATMENT +febriles I-TREATMENT +y I-TREATMENT +dolor I-TREATMENT +abdominal, I-TREATMENT +se I-TREATMENT +sustituye I-TREATMENT +la I-TREATMENT +eritromicina I-TREATMENT +por I-TREATMENT +rifampicina I-TREATMENT +más I-TREATMENT +gentamicina, I-TREATMENT +constatándose B-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +iniciado I-EVOLUTION +dicho I-EVOLUTION +tratamiento I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fiebre, I-EVOLUTION +cuya I-EVOLUTION +duración I-EVOLUTION +total I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +28 I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38º I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +escasa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +blanquecina. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +sólo I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +hipertrofia I-EXPLORATION +en I-EXPLORATION +amígdala I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +adenopatías I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +yugular I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +(3x3 I-EXPLORATION +cm). I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +faringoamigdalitis I-TREATMENT +bacteriana I-TREATMENT +se I-TREATMENT +pautó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amoxicilina I-TREATMENT +e I-TREATMENT +ibuprofeno. I-TREATMENT +No B-EXPLORATION +obstante, I-EXPLORATION +ante I-EXPLORATION +el I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +adenopatías I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +solicitar I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +mononucleosis I-EXPLORATION +infecciosa I-EXPLORATION +(MI) I-EXPLORATION +y I-EXPLORATION +analítica I-EXPLORATION +general. I-EXPLORATION + I-EXPLORATION +Acude B-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +14 I-EVOLUTION +días I-EVOLUTION +por I-EVOLUTION +fiebre I-EVOLUTION +alta, I-EVOLUTION +malestar I-EVOLUTION +general, I-EVOLUTION +cansancio I-EVOLUTION +intenso I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +región I-EVOLUTION +laterocervical I-EVOLUTION +izquierda. I-EVOLUTION +En B-EXPLORATION +este I-EXPLORATION +momento I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +gran I-EXPLORATION +adenopatía I-EXPLORATION +submaxilar I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +dolorosa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +supraclavicular I-EXPLORATION +izquierda. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +adenopatías I-EXPLORATION +en I-EXPLORATION +otros I-EXPLORATION +grupos I-EXPLORATION +ganglionares, I-EXPLORATION +hepatoesplenomegalia, I-EXPLORATION +lesiones I-EXPLORATION +cutáneas I-EXPLORATION +o I-EXPLORATION +afectación I-EXPLORATION +articular. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +lesiones I-EXPLORATION +locales, I-EXPLORATION +la I-EXPLORATION +otoscopia I-EXPLORATION +es I-EXPLORATION +normal, I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +faríngea I-EXPLORATION +y I-EXPLORATION +tiroidea I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destaca: I-EXPLORATION +LDH I-EXPLORATION +1400 I-EXPLORATION +UI/l, I-EXPLORATION +Got I-EXPLORATION +56, I-EXPLORATION +gpt I-EXPLORATION +47 I-EXPLORATION +UI/l, I-EXPLORATION +no I-EXPLORATION +existe I-EXPLORATION +leucocitosis, I-EXPLORATION +sólo I-EXPLORATION +una I-EXPLORATION +leve I-EXPLORATION +linfocitosis. I-EXPLORATION +Test I-EXPLORATION +de I-EXPLORATION +MI: I-EXPLORATION +negativo. I-EXPLORATION +Se I-EXPLORATION +solicita I-EXPLORATION +test I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana I-EXPLORATION +(VIH), I-EXPLORATION +análisis I-EXPLORATION +anatomopatológico I-EXPLORATION +mediante I-EXPLORATION +punción I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +nuevo I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +MI. I-EXPLORATION +Para I-EXPLORATION +evitar I-EXPLORATION +demoras I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +acude I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +centro I-EXPLORATION +privado I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +PAAF I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +cirujanos I-EXPLORATION +encargados I-EXPLORATION +de I-EXPLORATION +realizarla, I-EXPLORATION +ante I-EXPLORATION +el I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +adenopatías, I-EXPLORATION +deciden I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +biopsia. I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +del I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +MI I-EXPLORATION +es I-EXPLORATION +nuevamente I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +persistiendo I-EVOLUTION +febrícula I-EVOLUTION +durante I-EVOLUTION +20 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +lenta I-EVOLUTION +y I-EVOLUTION +paulatina I-EVOLUTION +del I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +adenopatías. I-EVOLUTION +El B-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +se I-EXPLORATION +informa I-EXPLORATION +como: I-EXPLORATION +linfadenitis I-EXPLORATION +histiocitaria I-EXPLORATION +necrotizante I-EXPLORATION +o I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Kikuchi. I-EXPLORATION +Ante I-EXPLORATION +este I-EXPLORATION +resultado I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +analítica I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +posibles I-EXPLORATION +procesos I-EXPLORATION +asociados I-EXPLORATION +a I-EXPLORATION +esta I-EXPLORATION +enfermedad. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +son I-EXPLORATION +los I-EXPLORATION +siguientes: I-EXPLORATION +factor I-EXPLORATION +reumatoide I-EXPLORATION +negativo, I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(ANAs) I-EXPLORATION +negativos, I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +hipercolesterolemia, I-PAST_MEDICAL_HISTORY +hiperuricemia, I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +33 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +bebedor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +25-30 I-PAST_MEDICAL_HISTORY +unidades I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +semana; I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +paroxística I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +última I-PAST_MEDICAL_HISTORY +revisión I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +problema I-PAST_MEDICAL_HISTORY +cardiológico, I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +todas I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +pruebas I-PAST_MEDICAL_HISTORY +complementarias I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraban I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +rangos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +normalidad I-PAST_MEDICAL_HISTORY +(incluidas I-PAST_MEDICAL_HISTORY +hormonas I-PAST_MEDICAL_HISTORY +tiroideas). I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +seguía I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +clortalidona I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +atorvastatina I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +acetilsalicílico I-PAST_MEDICAL_HISTORY +200 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +amiodarona I-PAST_MEDICAL_HISTORY +400 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +excepto I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +sábados I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +domingos. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +constitucional I-PRESENT_ILLNESS +dominado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +apetito I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +adelgazamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +kilogramos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +(que I-PRESENT_ILLNESS +suponen I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +10% I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +corporal). I-PRESENT_ILLNESS +Además I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +cinturas I-PRESENT_ILLNESS +escapular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pélvica, I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +llamativa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +primera. I-PRESENT_ILLNESS +Otro I-PRESENT_ILLNESS +dato I-PRESENT_ILLNESS +destacable I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +aquejaba I-PRESENT_ILLNESS +insomnio I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +nerviosismo. I-PRESENT_ILLNESS +Una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +autolimitado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +consistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +líquidas I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +patológicos I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +nos I-EXPLORATION +encontramos I-EXPLORATION +ante I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +buenas I-EXPLORATION +constantes I-EXPLORATION +(TA I-EXPLORATION +120/70 I-EXPLORATION +mm I-EXPLORATION +Hg, I-EXPLORATION +Tª I-EXPLORATION +36, I-EXPLORATION +5 I-EXPLORATION +ºC I-EXPLORATION +y I-EXPLORATION +78 I-EXPLORATION +lpm, I-EXPLORATION +peso I-EXPLORATION +74 I-EXPLORATION +kg), I-EXPLORATION +eupneico, I-EXPLORATION +bien I-EXPLORATION +nutrido I-EXPLORATION +y I-EXPLORATION +coloreado, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +bocio. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +cardiopulmonar I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +alteraciones. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +palpaba I-EXPLORATION +el I-EXPLORATION +hígado I-EXPLORATION +a I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +costal, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +blanda I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos. I-EXPLORATION +Presentaba I-EXPLORATION +un I-EXPLORATION +discreto I-EXPLORATION +edema I-EXPLORATION +pretibial I-EXPLORATION +bilateral I-EXPLORATION +que I-EXPLORATION +dejaba I-EXPLORATION +fovea I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +con I-EXPLORATION +pulsos I-EXPLORATION +periféricos I-EXPLORATION +conservados I-EXPLORATION +y I-EXPLORATION +simétricos. I-EXPLORATION +Ante I-EXPLORATION +esta I-EXPLORATION +situación I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +algunas I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +cuyos I-EXPLORATION +resultados I-EXPLORATION +fueron I-EXPLORATION +los I-EXPLORATION +siguientes: I-EXPLORATION +Hemograma: I-EXPLORATION +4.640 I-EXPLORATION +leucocitos/ I-EXPLORATION +mm3 I-EXPLORATION +con I-EXPLORATION +fórmula I-EXPLORATION +normal, I-EXPLORATION +4, I-EXPLORATION +17 I-EXPLORATION +millones I-EXPLORATION +de I-EXPLORATION +hematíes/ I-EXPLORATION +mm3, I-EXPLORATION +Hb I-EXPLORATION +12, I-EXPLORATION +7g/dl, I-EXPLORATION +Hto I-EXPLORATION +36, I-EXPLORATION +3%, I-EXPLORATION +VCM I-EXPLORATION +87, I-EXPLORATION +1, I-EXPLORATION +HCM I-EXPLORATION +30, I-EXPLORATION +5, I-EXPLORATION +231.000 I-EXPLORATION +plaquetas/mm3. I-EXPLORATION +VSG I-EXPLORATION +23 I-EXPLORATION +mm/h. I-EXPLORATION +Bioquímica: I-EXPLORATION +glucosa I-EXPLORATION +83 I-EXPLORATION +mg/dl, I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +7 I-EXPLORATION +mg/dl, I-EXPLORATION +urea I-EXPLORATION +54 I-EXPLORATION +mg/dl, I-EXPLORATION +ácido I-EXPLORATION +úrico I-EXPLORATION +7, I-EXPLORATION +10 I-EXPLORATION +mg/dl, I-EXPLORATION +GGT I-EXPLORATION +91 I-EXPLORATION +mg/dl, I-EXPLORATION +GPT I-EXPLORATION +143 I-EXPLORATION +mg/dl, I-EXPLORATION +GOT I-EXPLORATION +95 I-EXPLORATION +mg/dl, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +59 I-EXPLORATION +mg/dl, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +0, I-EXPLORATION +50 I-EXPLORATION +mg/dl, I-EXPLORATION +colesterol I-EXPLORATION +140 I-EXPLORATION +mg/dl, I-EXPLORATION +triglicéridos I-EXPLORATION +221 I-EXPLORATION +mg/dl, I-EXPLORATION +HDL I-EXPLORATION +colesterol I-EXPLORATION +24 I-EXPLORATION +mg/dl, I-EXPLORATION +colesterol I-EXPLORATION +VLDL I-EXPLORATION +44 I-EXPLORATION +mg/dl, I-EXPLORATION +colesterol I-EXPLORATION +LDL I-EXPLORATION +72 I-EXPLORATION +mg/dl. I-EXPLORATION +Ferritina I-EXPLORATION +1.172 I-EXPLORATION +mg/ml, I-EXPLORATION +hierro I-EXPLORATION +47 I-EXPLORATION +µg/dl, I-EXPLORATION +Transferrina I-EXPLORATION +148 I-EXPLORATION +mg/dl I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +saturación I-EXPLORATION +25%. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION +Serología I-EXPLORATION +de I-EXPLORATION +hepatitis: I-EXPLORATION +Ac I-EXPLORATION +HVC I-EXPLORATION +(-), I-EXPLORATION +Ac I-EXPLORATION +HB I-EXPLORATION +core I-EXPLORATION +(-), I-EXPLORATION +AcHBs I-EXPLORATION +(- I-EXPLORATION +) I-EXPLORATION +y I-EXPLORATION +HAV I-EXPLORATION +Ig I-EXPLORATION +M I-EXPLORATION +(-) I-EXPLORATION +Serología I-EXPLORATION +de I-EXPLORATION +CMV I-EXPLORATION +: I-EXPLORATION +Ig I-EXPLORATION +M I-EXPLORATION +(-) I-EXPLORATION +e I-EXPLORATION +Ig I-EXPLORATION +G I-EXPLORATION +(+). I-EXPLORATION +Marcadores I-EXPLORATION +tumorales: I-EXPLORATION +alfa-fetoproteína, I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario I-EXPLORATION +y I-EXPLORATION +antígeno I-EXPLORATION +prostático I-EXPLORATION +específico I-EXPLORATION +total I-EXPLORATION +negativos. I-EXPLORATION +Ecografía I-EXPLORATION +abdominal: I-EXPLORATION +alteración I-EXPLORATION +difusa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ecogenicidad I-EXPLORATION +hepática I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +esteatosis I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +ocupantes I-EXPLORATION +de I-EXPLORATION +espacio I-EXPLORATION +ni I-EXPLORATION +otros I-EXPLORATION +hallazgos. I-EXPLORATION +Colonoscopia I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +cecal I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +Hormonas I-EXPLORATION +tiroideas: I-EXPLORATION +TSH I-EXPLORATION +0, I-EXPLORATION +01 I-EXPLORATION +mUI/l I-EXPLORATION +(0,20-5,00), I-EXPLORATION +T4 I-EXPLORATION +libre I-EXPLORATION +9, I-EXPLORATION +86 I-EXPLORATION +ng/dl I-EXPLORATION +(0,85-2,1). I-EXPLORATION + I-EXPLORATION +DISCUSIÓN I-EXPLORATION +Nos I-EXPLORATION +encontramos I-EXPLORATION +ante I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +constitucional I-EXPLORATION +y I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática. I-EXPLORATION +Debemos I-EXPLORATION +tener I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +que I-EXPLORATION +un I-EXPLORATION +incremento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +transaminasas I-EXPLORATION +es I-EXPLORATION +un I-EXPLORATION +fenómeno I-EXPLORATION +inespecífico1 I-EXPLORATION +que I-EXPLORATION +puede I-EXPLORATION +ocurrir I-EXPLORATION +en I-EXPLORATION +gran I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +situaciones I-EXPLORATION +patológicas I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +siempre I-EXPLORATION +traduce I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +hepática. I-EXPLORATION +La I-EXPLORATION +valoración I-EXPLORATION +e I-EXPLORATION +interpretación I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +hipertransaminasemia I-EXPLORATION +han I-EXPLORATION +de I-EXPLORATION +hacerse I-EXPLORATION +siempre I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +contexto I-EXPLORATION +clínico I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +y I-EXPLORATION +han I-EXPLORATION +de I-EXPLORATION +tenerse I-EXPLORATION +siempre I-EXPLORATION +presentes I-EXPLORATION +tanto I-EXPLORATION +la I-EXPLORATION +importancia I-EXPLORATION +cuantitativa I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +elevación I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +persiste I-EXPLORATION +la I-EXPLORATION +anomalía. I-EXPLORATION +La I-EXPLORATION +alta I-EXPLORATION +prevalencia I-EXPLORATION +de I-EXPLORATION +enolismo I-EXPLORATION +y I-EXPLORATION +hepatitis I-EXPLORATION +víricas I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +entorno I-EXPLORATION +hacen I-EXPLORATION +que I-EXPLORATION +estas I-EXPLORATION +etiologías I-EXPLORATION +deban I-EXPLORATION +descartarse I-EXPLORATION +de I-EXPLORATION +entrada2. I-EXPLORATION +Iniciamos I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +confirmación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +alteraciones I-EXPLORATION +bioquímicas I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +paso I-EXPLORATION +siempre I-EXPLORATION +debe I-EXPLORATION +ser I-EXPLORATION +repetir I-EXPLORATION +la I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio3 I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +cualquier I-EXPLORATION +error. I-EXPLORATION +A B-PAST_MEDICAL_HISTORY +continuación I-PAST_MEDICAL_HISTORY +realizamos I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +anamnesis I-PAST_MEDICAL_HISTORY +exhaustiva I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +encontramos I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +moderado I-PAST_MEDICAL_HISTORY +(insuficiente I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +justificar I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hepatopatía I-PAST_MEDICAL_HISTORY +alcohólica), I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +atorvastatina I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +puede I-PAST_MEDICAL_HISTORY +aumentar I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +transaminasas I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +alteración I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +general, I-PAST_MEDICAL_HISTORY +así B-FAMILY_HISTORY +como I-FAMILY_HISTORY +la I-FAMILY_HISTORY +ausencia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +datos I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés, I-FAMILY_HISTORY +prácticas B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo, I-PAST_MEDICAL_HISTORY +transfusiones I-PAST_MEDICAL_HISTORY +sanguíneas, I-PAST_MEDICAL_HISTORY +etc. I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +continuación I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +hizo I-EXPLORATION +una I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +completa I-EXPLORATION +sin I-EXPLORATION +obtener I-EXPLORATION +datos I-EXPLORATION +reseñables I-EXPLORATION +salvo I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +hepatomegalia. I-EXPLORATION +Con I-EXPLORATION +las I-EXPLORATION +serologías I-EXPLORATION +(primero I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hepatitis I-EXPLORATION +y I-EXPLORATION +posteriormente I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +virus I-EXPLORATION +hepatotropos I-EXPLORATION +como I-EXPLORATION +son I-EXPLORATION +el I-EXPLORATION +citomegalovirus I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein-Barr) I-EXPLORATION +descartamos I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +hepatitis I-EXPLORATION +vírica I-EXPLORATION +y I-EXPLORATION +otros I-EXPLORATION +cuadros I-EXPLORATION +infecciosos I-EXPLORATION +parecían I-EXPLORATION +poco I-EXPLORATION +probables I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +del I-EXPLORATION +paciente. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +ecogénica I-EXPLORATION +del I-EXPLORATION +hígado I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +esteatosis I-EXPLORATION +hepática I-EXPLORATION +(no I-EXPLORATION +debemos I-EXPLORATION +olvidar I-EXPLORATION +que I-EXPLORATION +nuestro I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +hipercolesterolemia I-EXPLORATION +y I-EXPLORATION +consume I-EXPLORATION +alcohol) I-EXPLORATION +que, I-EXPLORATION +si I-EXPLORATION +bien I-EXPLORATION +podría I-EXPLORATION +justificar I-EXPLORATION +las I-EXPLORATION +alteraciones I-EXPLORATION +hepáticas, I-EXPLORATION +no I-EXPLORATION +parece I-EXPLORATION +justificar I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +deterioro I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +diarrea. I-EXPLORATION + I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +del I-EXPLORATION +paciente, I-EXPLORATION +la I-EXPLORATION +alteración I-EXPLORATION +del I-EXPLORATION +hábito I-EXPLORATION +intestinal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ferritina, I-EXPLORATION +otra I-EXPLORATION +opción I-EXPLORATION +diagnóstica I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +nos I-EXPLORATION +plantea I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +etiología I-EXPLORATION +tumoral, I-EXPLORATION +aunque I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +habíamos I-EXPLORATION +descartado I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +ocupantes I-EXPLORATION +de I-EXPLORATION +espacio, I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +ello I-EXPLORATION +decidimos I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +que I-EXPLORATION +descarta I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +neoformación. I-EXPLORATION +Otra I-EXPLORATION +posibilidad I-EXPLORATION +sería I-EXPLORATION +la I-EXPLORATION +hemocromatosis I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +hay I-EXPLORATION +otros I-EXPLORATION +datos I-EXPLORATION +sugestivos I-EXPLORATION +(articulares, I-EXPLORATION +miocárdicos, I-EXPLORATION +gonadales, I-EXPLORATION +cutáneos, I-EXPLORATION +etc.) I-EXPLORATION +ni I-EXPLORATION +antecedentes I-EXPLORATION +familiares I-EXPLORATION +sugestivos I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +transferrina I-EXPLORATION +tampoco I-EXPLORATION +apoya I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +puesto I-EXPLORATION +que I-EXPLORATION +debería I-EXPLORATION +estar I-EXPLORATION +elevada. I-EXPLORATION +Antes I-EXPLORATION +de I-EXPLORATION +recurrir I-EXPLORATION +a I-EXPLORATION +otros I-EXPLORATION +estudios I-EXPLORATION +más I-EXPLORATION +complejos I-EXPLORATION +y I-EXPLORATION +costosos, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +repetir I-EXPLORATION +la I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +hormonas I-EXPLORATION +tiroideas, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +tener I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +rigurosamente I-EXPLORATION +normal I-EXPLORATION +cinco I-EXPLORATION +meses I-EXPLORATION +antes, I-EXPLORATION +porque I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +continuaba I-EXPLORATION +en I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +amiodarona. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +hipertiroidismo I-EXPLORATION +en I-EXPLORATION +paciente I-EXPLORATION +tratado I-EXPLORATION +con I-EXPLORATION +amiodarona. I-EXPLORATION +La B-TREATMENT +actitud I-TREATMENT +que I-TREATMENT +seguimos I-TREATMENT +fue I-TREATMENT +retirar I-TREATMENT +el I-TREATMENT +fármaco I-TREATMENT +e I-TREATMENT +iniciar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +metimazol I-TREATMENT +y I-TREATMENT +betabloqueantes I-TREATMENT +para I-TREATMENT +controlar I-TREATMENT +su I-TREATMENT +arritmia. I-TREATMENT + I-TREATMENT +La I-TREATMENT +amiodarona I-TREATMENT +es I-TREATMENT +un I-TREATMENT +antiarrítmico I-TREATMENT +de I-TREATMENT +clase I-TREATMENT +III I-TREATMENT +cuya I-TREATMENT +estructura I-TREATMENT +molecular I-TREATMENT +es I-TREATMENT +muy I-TREATMENT +similar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +triiodotironina. I-TREATMENT +Contiene I-TREATMENT +dos I-TREATMENT +átomos I-TREATMENT +de I-TREATMENT +yodo, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +le I-TREATMENT +confiere I-TREATMENT +un I-TREATMENT +37, I-TREATMENT +2% I-TREATMENT +del I-TREATMENT +peso I-TREATMENT +en I-TREATMENT +yodo. I-TREATMENT +Esto I-TREATMENT +supone I-TREATMENT +que I-TREATMENT +con I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +mantenimiento I-TREATMENT +de I-TREATMENT +200 I-TREATMENT +a I-TREATMENT +600 I-TREATMENT +mg I-TREATMENT +se I-TREATMENT +aporten I-TREATMENT +75 I-TREATMENT +a I-TREATMENT +225 I-TREATMENT +mg/día I-TREATMENT +de I-TREATMENT +yodo4. I-TREATMENT +Este I-TREATMENT +exceso I-TREATMENT +de I-TREATMENT +yodo I-TREATMENT +puede I-TREATMENT +tener I-TREATMENT +consecuencias I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +fisiología I-TREATMENT +tiroidea. I-TREATMENT +Por I-TREATMENT +otra I-TREATMENT +parte I-TREATMENT +debemos I-TREATMENT +tener I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +que I-TREATMENT +es I-TREATMENT +una I-TREATMENT +molécula I-TREATMENT +muy I-TREATMENT +lipofílica, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +le I-TREATMENT +confiere I-TREATMENT +una I-TREATMENT +vida I-TREATMENT +media I-TREATMENT +muy I-TREATMENT +prolongada I-TREATMENT +(22-55 I-TREATMENT +días), I-TREATMENT +pudiendo I-TREATMENT +detectarse I-TREATMENT +en I-TREATMENT +plasma I-TREATMENT +hasta I-TREATMENT +9 I-TREATMENT +meses I-TREATMENT +después I-TREATMENT +de I-TREATMENT +retirado I-TREATMENT +el I-TREATMENT +fármaco. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amiodarona I-TREATMENT +provoca I-TREATMENT +una I-TREATMENT +serie I-TREATMENT +de I-TREATMENT +cambios I-TREATMENT +en I-TREATMENT +las I-TREATMENT +hormonas I-TREATMENT +tiroideas I-TREATMENT +que I-TREATMENT +consisten I-TREATMENT +en I-TREATMENT +un I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +T4 I-TREATMENT +total I-TREATMENT +y I-TREATMENT +libre I-TREATMENT +y I-TREATMENT +de I-TREATMENT +rT3, I-TREATMENT +una I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +la I-TREATMENT +T3 I-TREATMENT +total, I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +un I-TREATMENT +aumento I-TREATMENT +inicial I-TREATMENT +y I-TREATMENT +precoz I-TREATMENT +de I-TREATMENT +TSH I-TREATMENT +que I-TREATMENT +tiende I-TREATMENT +a I-TREATMENT +normalizarse, I-TREATMENT +aunque I-TREATMENT +en I-TREATMENT +ocasiones I-TREATMENT +persiste I-TREATMENT +aumentado I-TREATMENT +tras I-TREATMENT +tratamientos I-TREATMENT +crónicos. I-TREATMENT +Estos I-TREATMENT +cambios I-TREATMENT +se I-TREATMENT +producen I-TREATMENT +en I-TREATMENT +más I-TREATMENT +del I-TREATMENT +50% I-TREATMENT +de I-TREATMENT +los I-TREATMENT +pacientes I-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amiodarona, I-TREATMENT +sin I-TREATMENT +ninguna I-TREATMENT +relevancia I-TREATMENT +clínica I-TREATMENT +(estado I-TREATMENT +eutiroideo). I-TREATMENT +La I-TREATMENT +incidencia I-TREATMENT +de I-TREATMENT +disfunción I-TREATMENT +tiroidea I-TREATMENT +oscila I-TREATMENT +entre I-TREATMENT +un I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +un I-TREATMENT +24%5. I-TREATMENT +En I-TREATMENT +nuestro I-TREATMENT +medio I-TREATMENT +la I-TREATMENT +incidencia I-TREATMENT +de I-TREATMENT +tirotoxicosis I-TREATMENT +por I-TREATMENT +amiodarona I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +en I-TREATMENT +torno I-TREATMENT +al I-TREATMENT +1, I-TREATMENT +5% I-TREATMENT +y I-TREATMENT +es I-TREATMENT +más I-TREATMENT +frecuente I-TREATMENT +en I-TREATMENT +zonas I-TREATMENT +con I-TREATMENT +déficit I-TREATMENT +de I-TREATMENT +yodo. I-TREATMENT +Se B-EXPLORATION +han I-EXPLORATION +descrito I-EXPLORATION +dos I-EXPLORATION +mecanismos I-EXPLORATION +fisiopatológicos I-EXPLORATION +diferentes6: I-EXPLORATION +Tipo I-EXPLORATION +I: I-EXPLORATION +se I-EXPLORATION +produce I-EXPLORATION +sobre I-EXPLORATION +tiroides I-EXPLORATION +con I-EXPLORATION +patología I-EXPLORATION +subyacente I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mecanismo I-EXPLORATION +autorregulador I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +yodo I-EXPLORATION +que I-EXPLORATION +llevaría I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +consiguiente I-EXPLORATION +aumento I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +síntesis I-EXPLORATION +de I-EXPLORATION +hormona I-EXPLORATION +tiroidea. I-EXPLORATION +Tipo I-EXPLORATION +II: I-EXPLORATION +se I-EXPLORATION +produce I-EXPLORATION +sobre I-EXPLORATION +glándulas I-EXPLORATION +aparentemente I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +bocio I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +anticuerpos I-EXPLORATION +antiroideos I-EXPLORATION +y I-EXPLORATION +antirreceptor I-EXPLORATION +de I-EXPLORATION +TSH I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +mecanismo I-EXPLORATION +sería I-EXPLORATION +una I-EXPLORATION +citotoxicidad I-EXPLORATION +inducida I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +amiodarona I-EXPLORATION +o I-EXPLORATION +el I-EXPLORATION +yodo. I-EXPLORATION +La I-EXPLORATION +manifestación I-EXPLORATION +clínica I-EXPLORATION +más I-EXPLORATION +frecuente I-EXPLORATION +en I-EXPLORATION +estos I-EXPLORATION +casos I-EXPLORATION +suele I-EXPLORATION +ser I-EXPLORATION +un I-EXPLORATION +empeoramiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +cardiaca I-EXPLORATION +subyacente, I-EXPLORATION +aunque I-EXPLORATION +pueden I-EXPLORATION +existir I-EXPLORATION +los I-EXPLORATION +síntomas I-EXPLORATION +clásicos I-EXPLORATION +de I-EXPLORATION +hipertiroidismo. I-EXPLORATION +En I-EXPLORATION +ocasiones I-EXPLORATION +el I-EXPLORATION +curso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +es I-EXPLORATION +autolimitado, I-EXPLORATION +resolviéndose I-EXPLORATION +la I-EXPLORATION +situación I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +retirada I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +amiodarona I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +tratamiento I-EXPLORATION +adicional, I-EXPLORATION +aunque I-EXPLORATION +generalmente I-EXPLORATION +tras I-EXPLORATION +largos I-EXPLORATION +periodos I-EXPLORATION +de I-EXPLORATION +tiempo. I-EXPLORATION +La I-EXPLORATION +resolución I-EXPLORATION +del I-EXPLORATION +cuadro I-EXPLORATION +es I-EXPLORATION +más I-EXPLORATION +precoz I-EXPLORATION +cuando I-EXPLORATION +no I-EXPLORATION +existe I-EXPLORATION +patología I-EXPLORATION +subyacente. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +incluye I-TREATMENT +tionamidas I-TREATMENT +que I-TREATMENT +pueden I-TREATMENT +asociarse I-TREATMENT +con I-TREATMENT +perclorato I-TREATMENT +potásico I-TREATMENT +para I-TREATMENT +conseguir I-TREATMENT +una I-TREATMENT +rápida I-TREATMENT +descarga I-TREATMENT +del I-TREATMENT +yodo I-TREATMENT +intratiroideo I-TREATMENT +aumentando I-TREATMENT +su I-TREATMENT +eficacia, I-TREATMENT +corticoides, I-TREATMENT +plasmaféresis I-TREATMENT +en I-TREATMENT +casos I-TREATMENT +de I-TREATMENT +crisis I-TREATMENT +tireotóxicas I-TREATMENT +que I-TREATMENT +ponen I-TREATMENT +en I-TREATMENT +peligro I-TREATMENT +la I-TREATMENT +vida I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +litio I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +quirúrgico. I-TREATMENT +Bartalena I-TREATMENT +ha I-TREATMENT +propuesto I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +específico I-TREATMENT +según I-TREATMENT +el I-TREATMENT +tipo. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +tipo I-TREATMENT +I, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +que I-TREATMENT +existe I-TREATMENT +una I-TREATMENT +síntesis I-TREATMENT +de I-TREATMENT +hormona I-TREATMENT +tiroidea I-TREATMENT +aumentada, I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +elección I-TREATMENT +serían I-TREATMENT +los I-TREATMENT +antitiroideos I-TREATMENT +junto I-TREATMENT +a I-TREATMENT +perclorato I-TREATMENT +potásico, I-TREATMENT +mientras I-TREATMENT +que I-TREATMENT +los I-TREATMENT +corticoides I-TREATMENT +tendrían I-TREATMENT +un I-TREATMENT +papel I-TREATMENT +limitado. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tipo I-TREATMENT +II, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +que I-TREATMENT +el I-TREATMENT +mecanismo I-TREATMENT +fundamental I-TREATMENT +es I-TREATMENT +una I-TREATMENT +destrucción I-TREATMENT +tisular, I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +elección I-TREATMENT +serían I-TREATMENT +los I-TREATMENT +corticoides I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +altas, I-TREATMENT +por I-TREATMENT +su I-TREATMENT +efecto I-TREATMENT +antiinflamatorio I-TREATMENT +y I-TREATMENT +estabilizador I-TREATMENT +de I-TREATMENT +membranas. I-TREATMENT +La I-TREATMENT +cirugía I-TREATMENT +está I-TREATMENT +indicada I-TREATMENT +en I-TREATMENT +casos I-TREATMENT +graves I-TREATMENT +con I-TREATMENT +arritmias I-TREATMENT +potencialmente I-TREATMENT +letales I-TREATMENT +para I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +los I-TREATMENT +que I-TREATMENT +se I-TREATMENT +requiera I-TREATMENT +una I-TREATMENT +solución I-TREATMENT +rápida, I-TREATMENT +cuando I-TREATMENT +no I-TREATMENT +se I-TREATMENT +pueda I-TREATMENT +retirar I-TREATMENT +la I-TREATMENT +amiodarona I-TREATMENT +y I-TREATMENT +cuando I-TREATMENT +se I-TREATMENT +haya I-TREATMENT +demostrado I-TREATMENT +una I-TREATMENT +resistencia I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +médico. I-TREATMENT +Debe I-TREATMENT +practicarse I-TREATMENT +una I-TREATMENT +tiroidectomía I-TREATMENT +total I-TREATMENT +o I-TREATMENT +casi I-TREATMENT +total I-TREATMENT +sobre I-TREATMENT +todo I-TREATMENT +en I-TREATMENT +aquellos I-TREATMENT +pacientes I-TREATMENT +que I-TREATMENT +vayan I-TREATMENT +a I-TREATMENT +seguir I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amiodarona. I-TREATMENT + I-TREATMENT +CORRESPONDENCIA: I-TREATMENT +Carmen I-TREATMENT +G. I-TREATMENT +Suárez I-TREATMENT +Álvarez I-TREATMENT +Unidad I-TREATMENT +Hospitalización I-TREATMENT +a I-TREATMENT +Domicilio I-TREATMENT +Fundación I-TREATMENT +Jiménez I-TREATMENT +Díaz I-TREATMENT +Avda. I-TREATMENT +Reyes I-TREATMENT +Católicos, I-TREATMENT +2 I-TREATMENT +28040 I-TREATMENT +Madrid I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +persona I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +nacido B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +aldea I-PAST_MEDICAL_HISTORY +asturiana I-PAST_MEDICAL_HISTORY +cuya I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +vive I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +campo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ganadería. I-PAST_MEDICAL_HISTORY +Sus B-FAMILY_HISTORY +padres, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +estudios, I-FAMILY_HISTORY +fallecen I-FAMILY_HISTORY +él I-FAMILY_HISTORY +por I-FAMILY_HISTORY +patología I-FAMILY_HISTORY +tumoral, I-FAMILY_HISTORY +y I-FAMILY_HISTORY +ella I-FAMILY_HISTORY +por I-FAMILY_HISTORY +cardiopatía I-FAMILY_HISTORY +y I-FAMILY_HISTORY +diabetes. I-FAMILY_HISTORY +Es B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +hermanos. I-PAST_MEDICAL_HISTORY +Escolarizado I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +comienza I-PAST_MEDICAL_HISTORY +luego I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +trabajar I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +peón I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +posteriormente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +minería. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +reconoce I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +persona I-PAST_MEDICAL_HISTORY +alegre, I-PAST_MEDICAL_HISTORY +amigo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fiestas, I-PAST_MEDICAL_HISTORY +trabajador, I-PAST_MEDICAL_HISTORY +activo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +colaborador. I-PAST_MEDICAL_HISTORY +Dos B-FAMILY_HISTORY +de I-FAMILY_HISTORY +sus I-FAMILY_HISTORY +hermanas I-FAMILY_HISTORY +emigran I-FAMILY_HISTORY +a I-FAMILY_HISTORY +Europa I-FAMILY_HISTORY +por I-FAMILY_HISTORY +motivos I-FAMILY_HISTORY +laborales. I-FAMILY_HISTORY +Una I-FAMILY_HISTORY +de I-FAMILY_HISTORY +ellas, I-FAMILY_HISTORY +la I-FAMILY_HISTORY +mayor, I-FAMILY_HISTORY +se I-FAMILY_HISTORY +suicida I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +48 I-FAMILY_HISTORY +años. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Poco B-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esquizofrenia I-PAST_MEDICAL_HISTORY +paranoide I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1982, I-PAST_MEDICAL_HISTORY +contrajo I-PAST_MEDICAL_HISTORY +matrimonio I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +mujer I-PAST_MEDICAL_HISTORY +pidió I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +separación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +pocos I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY +Recibe I-PAST_MEDICAL_HISTORY +atención I-PAST_MEDICAL_HISTORY +ambulatoria I-PAST_MEDICAL_HISTORY +haciendo I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cumplimiento I-PAST_MEDICAL_HISTORY +irregular I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +farmacológico I-PAST_MEDICAL_HISTORY +evitando I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +tomas I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +engaño, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1984 I-PAST_MEDICAL_HISTORY +abandona I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tratamiento. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Cuatro I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +tarde I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +detenido I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +acusado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +doble I-PAST_MEDICAL_HISTORY +intento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +homicidio I-PAST_MEDICAL_HISTORY +contra I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +matrimonio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vecinos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +mantuvo I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +excelente I-PAST_MEDICAL_HISTORY +relación. I-PAST_MEDICAL_HISTORY +Según I-PAST_MEDICAL_HISTORY +él, I-PAST_MEDICAL_HISTORY +esas I-PAST_MEDICAL_HISTORY +personas I-PAST_MEDICAL_HISTORY +"ponían I-PAST_MEDICAL_HISTORY +cirios" I-PAST_MEDICAL_HISTORY +(hacían I-PAST_MEDICAL_HISTORY +ofrendas) I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +cosas I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +fueran I-PAST_MEDICAL_HISTORY +mal. I-PAST_MEDICAL_HISTORY +Es I-PAST_MEDICAL_HISTORY +encarcelado, I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +UHP I-PAST_MEDICAL_HISTORY +(unidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hospitalización I-PAST_MEDICAL_HISTORY +psiquiátrica) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +posteriormente I-PAST_MEDICAL_HISTORY +trasladado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hospital I-PAST_MEDICAL_HISTORY +psiquiátrico I-PAST_MEDICAL_HISTORY +penitenciario. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +1996 I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +retornado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Asturias, I-PAST_MEDICAL_HISTORY +permaneciendo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +diferentes I-PAST_MEDICAL_HISTORY +unidades I-PAST_MEDICAL_HISTORY +cerradas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +Servicios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Salud I-PAST_MEDICAL_HISTORY +Mental I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +mayo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2000 I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ingresa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +Casita. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +caracteriza I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tener I-PAST_MEDICAL_HISTORY +conciencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +psiquiátrica I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +somática, I-PAST_MEDICAL_HISTORY +ya I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +padece I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +insulino-dependiente, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +manifiesta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +claro I-PAST_MEDICAL_HISTORY +rechazo I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +toma I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +condición I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +permanecer I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +hogar I-PAST_MEDICAL_HISTORY +tutelado. I-PAST_MEDICAL_HISTORY +Posee I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +alto I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conservación I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +actividades I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +diaria I-PAST_MEDICAL_HISTORY +(AVDs) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +goza I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +capacidad I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +comunicación I-PAST_MEDICAL_HISTORY +verbal. I-PAST_MEDICAL_HISTORY +Ha I-PAST_MEDICAL_HISTORY +perdido I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +contacto I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +entorno I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +consecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +casi I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +lleva I-PAST_MEDICAL_HISTORY +institucionalizado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +problemas I-PAST_MEDICAL_HISTORY +económicos, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +soporte I-PAST_MEDICAL_HISTORY +familiar I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +suficiente I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +permanecer I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +casa. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +su I-EXPLORATION +ingreso, I-EXPLORATION +se I-EXPLORATION +hace I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +de I-EXPLORATION +enfermería I-EXPLORATION +usando I-EXPLORATION +el I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +salud I-EXPLORATION +mental4, I-EXPLORATION +procediendo I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +patrones I-EXPLORATION +alterados I-EXPLORATION +según I-EXPLORATION +Gordon5, I-EXPLORATION +y I-EXPLORATION +utilizando I-EXPLORATION +diagnósticos I-EXPLORATION +NANDA I-EXPLORATION +2001-20026. I-EXPLORATION +Se I-EXPLORATION +aplican I-EXPLORATION +también I-EXPLORATION +dos I-EXPLORATION +escalas I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cuestionario I-EXPLORATION +cuyos I-EXPLORATION +resultados I-EXPLORATION +están I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +posteriormente I-EXPLORATION +se I-EXPLORATION +evalúa I-EXPLORATION +por I-EXPLORATION +objetivos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +patrones I-EXPLORATION +de I-EXPLORATION +salud, I-EXPLORATION +hay I-EXPLORATION +cuatro I-EXPLORATION +claramente I-EXPLORATION +disfuncionales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +2 I-EXPLORATION +se I-EXPLORATION +comentan I-EXPLORATION +dichos I-EXPLORATION +patrones I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +los I-EXPLORATION +diagnósticos I-EXPLORATION +seleccionados I-EXPLORATION +para I-EXPLORATION +cada I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +ellos. I-EXPLORATION +Una B-TREATMENT +vez I-TREATMENT +examinados I-TREATMENT +los I-TREATMENT +patrones I-TREATMENT +y I-TREATMENT +seleccionados I-TREATMENT +los I-TREATMENT +diagnósticos, I-TREATMENT +se I-TREATMENT +establecen I-TREATMENT +diferentes I-TREATMENT +grupos I-TREATMENT +de I-TREATMENT +objetivos I-TREATMENT +a I-TREATMENT +partir I-TREATMENT +de I-TREATMENT +los I-TREATMENT +cuales I-TREATMENT +se I-TREATMENT +diseñaran I-TREATMENT +actividades I-TREATMENT +para I-TREATMENT +la I-TREATMENT +consecución I-TREATMENT +de I-TREATMENT +los I-TREATMENT +mismos. I-TREATMENT + I-TREATMENT +Manejo I-TREATMENT +inefectivo I-TREATMENT +del I-TREATMENT +régimen I-TREATMENT +terapéutico. I-TREATMENT +Respecto I-TREATMENT +al I-TREATMENT +primer I-TREATMENT +diagnóstico, I-TREATMENT +se I-TREATMENT +establecen I-TREATMENT +tres I-TREATMENT +grupos I-TREATMENT +de I-TREATMENT +objetivos: I-TREATMENT +objetivos I-TREATMENT +iniciales; I-TREATMENT +objetivos I-TREATMENT +a I-TREATMENT +los I-TREATMENT +seis I-TREATMENT +meses I-TREATMENT +y I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años. I-TREATMENT +Los I-TREATMENT +objetivos I-TREATMENT +iniciales I-TREATMENT +son I-TREATMENT +aquellos I-TREATMENT +que I-TREATMENT +se I-TREATMENT +deben I-TREATMENT +cumplir I-TREATMENT +desde I-TREATMENT +un I-TREATMENT +primer I-TREATMENT +momento. I-TREATMENT +Tienen I-TREATMENT +que I-TREATMENT +ver I-TREATMENT +con I-TREATMENT +cuestiones I-TREATMENT +básicas I-TREATMENT +del I-TREATMENT +funcionamiento I-TREATMENT +del I-TREATMENT +dispositivo I-TREATMENT +que I-TREATMENT +el I-TREATMENT +sujeto I-TREATMENT +debe I-TREATMENT +asumir I-TREATMENT +para I-TREATMENT +poder I-TREATMENT +permanecer I-TREATMENT +en I-TREATMENT +el I-TREATMENT +hogar I-TREATMENT +tutelado. I-TREATMENT +Son I-TREATMENT +los I-TREATMENT +siguientes: I-TREATMENT +1) I-TREATMENT +que I-TREATMENT +tome I-TREATMENT +su I-TREATMENT +medicación I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +día; I-TREATMENT +2) I-TREATMENT +que I-TREATMENT +acuda I-TREATMENT +acompañado I-TREATMENT +a I-TREATMENT +las I-TREATMENT +citas I-TREATMENT +en I-TREATMENT +el I-TREATMENT +centro I-TREATMENT +de I-TREATMENT +atención I-TREATMENT +primaria I-TREATMENT +(CAP); I-TREATMENT +3) I-TREATMENT +someterse I-TREATMENT +a I-TREATMENT +los I-TREATMENT +controles I-TREATMENT +analíticos I-TREATMENT +pertinentes, I-TREATMENT +y I-TREATMENT +4) I-TREATMENT +aceptar I-TREATMENT +la I-TREATMENT +dieta I-TREATMENT +antiglucemiante. I-TREATMENT + I-TREATMENT +El I-TREATMENT +segundo I-TREATMENT +grupo I-TREATMENT +de I-TREATMENT +objetivos, I-TREATMENT +es I-TREATMENT +decir, I-TREATMENT +los I-TREATMENT +que I-TREATMENT +se I-TREATMENT +deben I-TREATMENT +alcanzar I-TREATMENT +a I-TREATMENT +los I-TREATMENT +seis I-TREATMENT +meses, I-TREATMENT +son: I-TREATMENT +1) I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +tenga I-TREATMENT +una I-TREATMENT +noción I-TREATMENT +básica I-TREATMENT +de I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +son I-TREATMENT +los I-TREATMENT +fármacos, I-TREATMENT +pudiendo I-TREATMENT +enumerar I-TREATMENT +tres I-TREATMENT +beneficios I-TREATMENT +y I-TREATMENT +tres I-TREATMENT +efectos I-TREATMENT +secundarios; I-TREATMENT +2) I-TREATMENT +que I-TREATMENT +pueda I-TREATMENT +autoadministrase I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +bajo I-TREATMENT +supervisión; I-TREATMENT +3) I-TREATMENT +será I-TREATMENT +capaz I-TREATMENT +de I-TREATMENT +acudir I-TREATMENT +a I-TREATMENT +la I-TREATMENT +farmacia I-TREATMENT +sin I-TREATMENT +acompañamiento; I-TREATMENT +4) I-TREATMENT +podrá I-TREATMENT +reconocer I-TREATMENT +y I-TREATMENT +nombrar I-TREATMENT +al I-TREATMENT +menos I-TREATMENT +doce I-TREATMENT +alimentos I-TREATMENT +habituales I-TREATMENT +contraindicados I-TREATMENT +y I-TREATMENT +5) I-TREATMENT +conocerá I-TREATMENT +los I-TREATMENT +riesgos I-TREATMENT +de I-TREATMENT +ser I-TREATMENT +gran I-TREATMENT +fumador I-TREATMENT +describiendo I-TREATMENT +tres I-TREATMENT +enfermedades I-TREATMENT +graves I-TREATMENT +y I-TREATMENT +tres I-TREATMENT +beneficios I-TREATMENT +de I-TREATMENT +no I-TREATMENT +fumar. I-TREATMENT + I-TREATMENT +Los I-TREATMENT +objetivos I-TREATMENT +a I-TREATMENT +conseguir I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años, I-TREATMENT +son I-TREATMENT +el I-TREATMENT +tercer I-TREATMENT +grupo I-TREATMENT +de I-TREATMENT +los I-TREATMENT +que I-TREATMENT +corresponden I-TREATMENT +al I-TREATMENT +primer I-TREATMENT +diagnóstico I-TREATMENT +y I-TREATMENT +contemplan: I-TREATMENT +1) I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +autoadministre I-TREATMENT +su I-TREATMENT +medicación I-TREATMENT +preparándola I-TREATMENT +él I-TREATMENT +mismo I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +triturar, I-TREATMENT +incluso I-TREATMENT +estando I-TREATMENT +fuera; I-TREATMENT +2) I-TREATMENT +irá I-TREATMENT +solo I-TREATMENT +al I-TREATMENT +CAP I-TREATMENT +y I-TREATMENT +usará I-TREATMENT +su I-TREATMENT +tarjeta I-TREATMENT +de I-TREATMENT +crónicos I-TREATMENT +para I-TREATMENT +obtener I-TREATMENT +las I-TREATMENT +recetas; I-TREATMENT +3) I-TREATMENT +sellará I-TREATMENT +sus I-TREATMENT +recetas I-TREATMENT +en I-TREATMENT +la I-TREATMENT +inspección I-TREATMENT +médica I-TREATMENT +sin I-TREATMENT +acompañamiento; I-TREATMENT +4) I-TREATMENT +si I-TREATMENT +come I-TREATMENT +fuera I-TREATMENT +podrá I-TREATMENT +elegir I-TREATMENT +platos I-TREATMENT +adecuados I-TREATMENT +sin I-TREATMENT +apoyo; I-TREATMENT +5) I-TREATMENT +habrá I-TREATMENT +reducido I-TREATMENT +la I-TREATMENT +dosis/día I-TREATMENT +de I-TREATMENT +cigarrillos I-TREATMENT +a I-TREATMENT +10 I-TREATMENT +como I-TREATMENT +máximo. I-TREATMENT + I-TREATMENT +Después I-TREATMENT +se I-TREATMENT +da I-TREATMENT +paso I-TREATMENT +a I-TREATMENT +la I-TREATMENT +programación I-TREATMENT +de I-TREATMENT +actividades I-TREATMENT +dirigidas I-TREATMENT +al I-TREATMENT +logro I-TREATMENT +de I-TREATMENT +cada I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +tres I-TREATMENT +grupos I-TREATMENT +de I-TREATMENT +objetivos. I-TREATMENT +Para I-TREATMENT +los I-TREATMENT +objetivos I-TREATMENT +iniciales, I-TREATMENT +se I-TREATMENT +trabajó I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +entrevista I-TREATMENT +paciente-tutor I-TREATMENT +en I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +del I-TREATMENT +ingreso. I-TREATMENT +Se I-TREATMENT +informa I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +de I-TREATMENT +las I-TREATMENT +normas I-TREATMENT +a I-TREATMENT +seguir, I-TREATMENT +de I-TREATMENT +la I-TREATMENT +importancia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +medicación I-TREATMENT +y I-TREATMENT +controles I-TREATMENT +que I-TREATMENT +debe I-TREATMENT +asumir, I-TREATMENT +mostrándole I-TREATMENT +las I-TREATMENT +ventajas I-TREATMENT +y I-TREATMENT +los I-TREATMENT +lugares I-TREATMENT +en I-TREATMENT +que I-TREATMENT +se I-TREATMENT +va I-TREATMENT +a I-TREATMENT +realizar. I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +acompaña I-TREATMENT +al I-TREATMENT +CAP I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +presenta I-TREATMENT +a I-TREATMENT +los I-TREATMENT +profesionales I-TREATMENT +que I-TREATMENT +le I-TREATMENT +van I-TREATMENT +a I-TREATMENT +atender. I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +pide I-TREATMENT +el I-TREATMENT +consentimiento I-TREATMENT +expreso I-TREATMENT +y I-TREATMENT +la I-TREATMENT +aceptación I-TREATMENT +voluntaria I-TREATMENT +de I-TREATMENT +la I-TREATMENT +normativa I-TREATMENT +de I-TREATMENT +funcionamiento I-TREATMENT +de I-TREATMENT +La I-TREATMENT +Casita. I-TREATMENT + I-TREATMENT +De I-TREATMENT +entre I-TREATMENT +las I-TREATMENT +actividades I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +para I-TREATMENT +la I-TREATMENT +consecución I-TREATMENT +de I-TREATMENT +los I-TREATMENT +objetivos I-TREATMENT +a I-TREATMENT +los I-TREATMENT +seis I-TREATMENT +meses I-TREATMENT +y I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años, I-TREATMENT +se I-TREATMENT +destaca I-TREATMENT +la I-TREATMENT +inclusión I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +un I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +automedicación I-TREATMENT +que I-TREATMENT +se I-TREATMENT +desarrolla I-TREATMENT +con I-TREATMENT +formato I-TREATMENT +de I-TREATMENT +taller I-TREATMENT +y I-TREATMENT +que I-TREATMENT +integra I-TREATMENT +también I-TREATMENT +actividades I-TREATMENT +individuales I-TREATMENT +como I-TREATMENT +elaboración I-TREATMENT +de I-TREATMENT +fichas I-TREATMENT +de I-TREATMENT +los I-TREATMENT +fármacos I-TREATMENT +que I-TREATMENT +está I-TREATMENT +tomando, I-TREATMENT +posters I-TREATMENT +y I-TREATMENT +puestas I-TREATMENT +en I-TREATMENT +común I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +tema. I-TREATMENT +Se I-TREATMENT +refuerza I-TREATMENT +continuamente I-TREATMENT +su I-TREATMENT +colaboración I-TREATMENT +y I-TREATMENT +aceptación I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +anima I-TREATMENT +a I-TREATMENT +que I-TREATMENT +vaya I-TREATMENT +preparando I-TREATMENT +la I-TREATMENT +medicación. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +entrevista I-TREATMENT +semanal I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tutor I-TREATMENT +se I-TREATMENT +tratan I-TREATMENT +los I-TREATMENT +problemas I-TREATMENT +surgidos I-TREATMENT +al I-TREATMENT +respecto. I-TREATMENT +Se I-TREATMENT +acompaña I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +a I-TREATMENT +la I-TREATMENT +farmacia, I-TREATMENT +a I-TREATMENT +la I-TREATMENT +inspección I-TREATMENT +y I-TREATMENT +al I-TREATMENT +CAP I-TREATMENT +para I-TREATMENT +que I-TREATMENT +aprenda I-TREATMENT +el I-TREATMENT +proceso. I-TREATMENT +Se I-TREATMENT +refuerza I-TREATMENT +la I-TREATMENT +abstinencia I-TREATMENT +del I-TREATMENT +tabaco, I-TREATMENT +se I-TREATMENT +restringe I-TREATMENT +su I-TREATMENT +uso I-TREATMENT +a I-TREATMENT +determinados I-TREATMENT +espacios I-TREATMENT +de I-TREATMENT +la I-TREATMENT +casa I-TREATMENT +y I-TREATMENT +se I-TREATMENT +colocan I-TREATMENT +señales I-TREATMENT +de I-TREATMENT +advertencia. I-TREATMENT +Se I-TREATMENT +hacen I-TREATMENT +además I-TREATMENT +sesiones I-TREATMENT +para I-TREATMENT +debatir I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +hábito I-TREATMENT +tabáquico. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +evaluación, I-EVOLUTION +decir I-EVOLUTION +que I-EVOLUTION +tanto I-EVOLUTION +los I-EVOLUTION +objetivos I-EVOLUTION +inmediatos I-EVOLUTION +como I-EVOLUTION +los I-EVOLUTION +que I-EVOLUTION +van I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +conseguido. I-EVOLUTION +No I-EVOLUTION +ocurre I-EVOLUTION +los I-EVOLUTION +mismo I-EVOLUTION +con I-EVOLUTION +los I-EVOLUTION +programados I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +años, I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +los I-EVOLUTION +objetivos I-EVOLUTION +1, I-EVOLUTION +4 I-EVOLUTION +y I-EVOLUTION +5 I-EVOLUTION +referentes I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +autoadministración I-EVOLUTION +farmacológica, I-EVOLUTION +la I-EVOLUTION +dieta I-EVOLUTION +antiglucemiante I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +tabaco I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +lograron. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +sigue I-EVOLUTION +fumando I-EVOLUTION +>40 I-EVOLUTION +cigarrillos/día, I-EVOLUTION +y I-EVOLUTION +si I-EVOLUTION +no I-EVOLUTION +está I-EVOLUTION +bajo I-EVOLUTION +supervisión I-EVOLUTION +no I-EVOLUTION +toma I-EVOLUTION +su I-EVOLUTION +medicación I-EVOLUTION +ni I-EVOLUTION +tampoco I-EVOLUTION +respeta I-EVOLUTION +la I-EVOLUTION +dieta. I-EVOLUTION + I-EVOLUTION +Trastornos B-TREATMENT +de I-TREATMENT +los I-TREATMENT +procesos I-TREATMENT +del I-TREATMENT +pensamiento I-TREATMENT +y I-TREATMENT +Trastorno I-TREATMENT +de I-TREATMENT +la I-TREATMENT +percepción I-TREATMENT +sensorial I-TREATMENT +auditiva. I-TREATMENT +Continuando I-TREATMENT +con I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +siguientes I-TREATMENT +diagnósticos, I-TREATMENT +se I-TREATMENT +presentaron I-TREATMENT +dos I-TREATMENT +grupos I-TREATMENT +de I-TREATMENT +objetivos: I-TREATMENT +unos I-TREATMENT +permanentes I-TREATMENT +y I-TREATMENT +otros I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años. I-TREATMENT + I-TREATMENT +Los I-TREATMENT +permanentes I-TREATMENT +fueron: I-TREATMENT +1) I-TREATMENT +conocer I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +psicopatológicos I-TREATMENT +que I-TREATMENT +presenta I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +cuanto I-TREATMENT +a I-TREATMENT +alteraciones I-TREATMENT +del I-TREATMENT +pensamiento I-TREATMENT +y I-TREATMENT +en I-TREATMENT +lo I-TREATMENT +cognitivo-perceptivo, I-TREATMENT +y I-TREATMENT +2) I-TREATMENT +evitar I-TREATMENT +episodios I-TREATMENT +de I-TREATMENT +héteroagresividad I-TREATMENT +y I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +crisis. I-TREATMENT +El I-TREATMENT +objetivo I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años, I-TREATMENT +indica I-TREATMENT +que I-TREATMENT +el I-TREATMENT +sujeto I-TREATMENT +habrá I-TREATMENT +eliminado I-TREATMENT +las I-TREATMENT +expresiones I-TREATMENT +verbales I-TREATMENT +agresivas I-TREATMENT +y I-TREATMENT +con I-TREATMENT +contenido I-TREATMENT +de I-TREATMENT +muerte I-TREATMENT +hacia I-TREATMENT +otras I-TREATMENT +personas. I-TREATMENT + I-TREATMENT +Siguiendo I-TREATMENT +con I-TREATMENT +el I-TREATMENT +proceso, I-TREATMENT +se I-TREATMENT +realizan I-TREATMENT +las I-TREATMENT +actividades I-TREATMENT +acordadas I-TREATMENT +que I-TREATMENT +incluyen I-TREATMENT +en I-TREATMENT +primer I-TREATMENT +lugar I-TREATMENT +el I-TREATMENT +registro I-TREATMENT +de I-TREATMENT +los I-TREATMENT +datos I-TREATMENT +recogidos I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +ideación I-TREATMENT +delirante I-TREATMENT +y I-TREATMENT +conducta I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +Se I-TREATMENT +procura I-TREATMENT +generar I-TREATMENT +y I-TREATMENT +mantener I-TREATMENT +un I-TREATMENT +espacio I-TREATMENT +común I-TREATMENT +para I-TREATMENT +la I-TREATMENT +convivencia I-TREATMENT +y I-TREATMENT +la I-TREATMENT +tolerancia, I-TREATMENT +fomentando I-TREATMENT +el I-TREATMENT +respeto I-TREATMENT +a I-TREATMENT +las I-TREATMENT +personas. I-TREATMENT +En I-TREATMENT +las I-TREATMENT +entrevistas I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +mantiene I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tutor, I-TREATMENT +se I-TREATMENT +analizan I-TREATMENT +las I-TREATMENT +conductas I-TREATMENT +inapropiadas, I-TREATMENT +presentando I-TREATMENT +alternativas I-TREATMENT +que I-TREATMENT +cuando I-TREATMENT +se I-TREATMENT +reproducen I-TREATMENT +son I-TREATMENT +reforzadas I-TREATMENT +mediante I-TREATMENT +elogios. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +solicita I-TREATMENT +presencia I-TREATMENT +del I-TREATMENT +clínico, I-TREATMENT +a I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +las I-TREATMENT +consultas, I-TREATMENT +para I-TREATMENT +las I-TREATMENT +entrevistas I-TREATMENT +cuando I-TREATMENT +el I-TREATMENT +tutor I-TREATMENT +lo I-TREATMENT +valora. I-TREATMENT + I-TREATMENT +Los B-EVOLUTION +tres I-EVOLUTION +objetivos I-EVOLUTION +que I-EVOLUTION +acabamos I-EVOLUTION +de I-EVOLUTION +exponer, I-EVOLUTION +dos I-EVOLUTION +permanentes I-EVOLUTION +y I-EVOLUTION +uno I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +años, I-EVOLUTION +fueron I-EVOLUTION +conseguidos I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +plazos I-EVOLUTION +previstos. I-EVOLUTION + I-EVOLUTION +Deterioro B-TREATMENT +de I-TREATMENT +la I-TREATMENT +interacción I-TREATMENT +social. I-TREATMENT +Para I-TREATMENT +trabajar I-TREATMENT +la I-TREATMENT +problemática I-TREATMENT +que I-TREATMENT +presenta I-TREATMENT +el I-TREATMENT +cuarto I-TREATMENT +diagnóstico I-TREATMENT +se I-TREATMENT +establecen I-TREATMENT +cuatro I-TREATMENT +objetivos I-TREATMENT +a I-TREATMENT +los I-TREATMENT +seis I-TREATMENT +meses I-TREATMENT +y I-TREATMENT +dos I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años. I-TREATMENT +Los I-TREATMENT +cuatro I-TREATMENT +primeros I-TREATMENT +son: I-TREATMENT +1) I-TREATMENT +visitar I-TREATMENT +e I-TREATMENT +informar I-TREATMENT +a I-TREATMENT +los I-TREATMENT +vecinos I-TREATMENT +de I-TREATMENT +su I-TREATMENT +pueblo; I-TREATMENT +2) I-TREATMENT +entrevistarse I-TREATMENT +con I-TREATMENT +las I-TREATMENT +personas I-TREATMENT +agredidas; I-TREATMENT +3) I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +haga I-TREATMENT +visitas I-TREATMENT +programadas I-TREATMENT +a I-TREATMENT +su I-TREATMENT +casa I-TREATMENT +siendo I-TREATMENT +acompañado I-TREATMENT +por I-TREATMENT +personal I-TREATMENT +enfermero I-TREATMENT +y I-TREATMENT +4) I-TREATMENT +se I-TREATMENT +informará I-TREATMENT +a I-TREATMENT +las I-TREATMENT +fuerzas I-TREATMENT +del I-TREATMENT +orden I-TREATMENT +público I-TREATMENT +de I-TREATMENT +dicha I-TREATMENT +actividad. I-TREATMENT + I-TREATMENT +Los I-TREATMENT +dos I-TREATMENT +objetivos I-TREATMENT +siguientes, I-TREATMENT +a I-TREATMENT +conseguir I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años, I-TREATMENT +son: I-TREATMENT +1) I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +desarrollará I-TREATMENT +una I-TREATMENT +actividad I-TREATMENT +normal I-TREATMENT +durante I-TREATMENT +las I-TREATMENT +visitas, I-TREATMENT +relacionándose I-TREATMENT +con I-TREATMENT +parientes I-TREATMENT +y I-TREATMENT +vecinos I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mediada I-TREATMENT +de I-TREATMENT +lo I-TREATMENT +posible I-TREATMENT +y I-TREATMENT +2) I-TREATMENT +su I-TREATMENT +presencia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +no I-TREATMENT +será I-TREATMENT +causa I-TREATMENT +de I-TREATMENT +temor I-TREATMENT +o I-TREATMENT +alarma I-TREATMENT +social. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +lograr I-TREATMENT +estos I-TREATMENT +objetivos I-TREATMENT +se I-TREATMENT +fueron I-TREATMENT +realizando I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +largo I-TREATMENT +de I-TREATMENT +los I-TREATMENT +meses I-TREATMENT +numerosas I-TREATMENT +entrevistas I-TREATMENT +con I-TREATMENT +vecinos I-TREATMENT +del I-TREATMENT +pueblo I-TREATMENT +y I-TREATMENT +familiares, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +persona I-TREATMENT +agredida I-TREATMENT +(la I-TREATMENT +otra I-TREATMENT +falleció) I-TREATMENT +y I-TREATMENT +con I-TREATMENT +el I-TREATMENT +cura I-TREATMENT +amenazado I-TREATMENT +por I-TREATMENT +nuestro I-TREATMENT +paciente. I-TREATMENT +En I-TREATMENT +estos I-TREATMENT +encuentros I-TREATMENT +se I-TREATMENT +informó I-TREATMENT +de I-TREATMENT +las I-TREATMENT +características I-TREATMENT +del I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +visitas I-TREATMENT +y I-TREATMENT +se I-TREATMENT +procuró I-TREATMENT +reforzar I-TREATMENT +la I-TREATMENT +idea I-TREATMENT +de I-TREATMENT +que I-TREATMENT +dichas I-TREATMENT +visitas I-TREATMENT +no I-TREATMENT +alterarían I-TREATMENT +en I-TREATMENT +absoluto I-TREATMENT +el I-TREATMENT +orden I-TREATMENT +público I-TREATMENT +ni I-TREATMENT +supondrían I-TREATMENT +riesgo I-TREATMENT +para I-TREATMENT +nadie. I-TREATMENT +Además I-TREATMENT +se I-TREATMENT +dejó I-TREATMENT +perfectamente I-TREATMENT +claro I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +siempre I-TREATMENT +estaría I-TREATMENT +acompañado I-TREATMENT +de I-TREATMENT +personal I-TREATMENT +sanitario. I-TREATMENT +La I-TREATMENT +Guardia I-TREATMENT +Civil I-TREATMENT +también I-TREATMENT +fue I-TREATMENT +puntualmente I-TREATMENT +informada. I-TREATMENT + I-TREATMENT +Dichas B-EVOLUTION +actividades I-EVOLUTION +condujeron I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +consecución I-EVOLUTION +satisfactoria I-EVOLUTION +en I-EVOLUTION +tiempo I-EVOLUTION +y I-EVOLUTION +forma I-EVOLUTION +de I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +objetivos I-EVOLUTION +propuestos. I-EVOLUTION + I-EVOLUTION +Afrontamiento B-TREATMENT +familiar I-TREATMENT +comprometido. I-TREATMENT +El I-TREATMENT +quinto I-TREATMENT +y I-TREATMENT +último I-TREATMENT +de I-TREATMENT +los I-TREATMENT +diagnósticos I-TREATMENT +exige I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +el I-TREATMENT +planteamiento I-TREATMENT +de I-TREATMENT +tres I-TREATMENT +grupos I-TREATMENT +de I-TREATMENT +objetivos. I-TREATMENT +Un I-TREATMENT +primer I-TREATMENT +objetivo I-TREATMENT +permanente, I-TREATMENT +el I-TREATMENT +segundo I-TREATMENT +grupo I-TREATMENT +compuesto I-TREATMENT +por I-TREATMENT +tres I-TREATMENT +objetivos I-TREATMENT +a I-TREATMENT +cumplir I-TREATMENT +a I-TREATMENT +los I-TREATMENT +seis I-TREATMENT +meses I-TREATMENT +y I-TREATMENT +dos I-TREATMENT +más I-TREATMENT +que I-TREATMENT +deberían I-TREATMENT +lograrse I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años. I-TREATMENT + I-TREATMENT +El I-TREATMENT +objetivo I-TREATMENT +permanente, I-TREATMENT +es I-TREATMENT +que I-TREATMENT +su I-TREATMENT +familia I-TREATMENT +reciba I-TREATMENT +información I-TREATMENT +del I-TREATMENT +proyecto I-TREATMENT +rehabilitador I-TREATMENT +y I-TREATMENT +evolución I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +sostenida, I-TREATMENT +a I-TREATMENT +través I-TREATMENT +del I-TREATMENT +contacto I-TREATMENT +y I-TREATMENT +entrevistas I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tutor. I-TREATMENT +En I-TREATMENT +los I-TREATMENT +objetivos I-TREATMENT +a I-TREATMENT +los I-TREATMENT +seis I-TREATMENT +meses, I-TREATMENT +se I-TREATMENT +incluyen: I-TREATMENT +1) I-TREATMENT +un I-TREATMENT +mayor I-TREATMENT +protagonismo I-TREATMENT +de I-TREATMENT +esta I-TREATMENT +familia I-TREATMENT +en I-TREATMENT +el I-TREATMENT +proceso I-TREATMENT +terapéutico; I-TREATMENT +2) I-TREATMENT +visitas I-TREATMENT +programadas I-TREATMENT +semanales I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +llevarlo I-TREATMENT +a I-TREATMENT +comer I-TREATMENT +fuera, I-TREATMENT +y I-TREATMENT +3) I-TREATMENT +hacerse I-TREATMENT +cargo I-TREATMENT +del I-TREATMENT +lavado I-TREATMENT +de I-TREATMENT +su I-TREATMENT +ropa I-TREATMENT +a I-TREATMENT +cambio I-TREATMENT +de I-TREATMENT +una I-TREATMENT +contraprestación I-TREATMENT +económica I-TREATMENT +pactada. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +años I-TREATMENT +se I-TREATMENT +establecen I-TREATMENT +como I-TREATMENT +objetivos, I-TREATMENT +por I-TREATMENT +una I-TREATMENT +parte: I-TREATMENT +1) I-TREATMENT +que I-TREATMENT +su I-TREATMENT +hermano I-TREATMENT +sea I-TREATMENT +capaz I-TREATMENT +de I-TREATMENT +verbalizar I-TREATMENT +elogios I-TREATMENT +hacia I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +por I-TREATMENT +su I-TREATMENT +progresos I-TREATMENT +y I-TREATMENT +en I-TREATMENT +su I-TREATMENT +presencia I-TREATMENT +y I-TREATMENT +por I-TREATMENT +otro I-TREATMENT +lado: I-TREATMENT +2) I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +respete I-TREATMENT +la I-TREATMENT +opinión I-TREATMENT +de I-TREATMENT +sus I-TREATMENT +familiares I-TREATMENT +omitiendo I-TREATMENT +expresiones I-TREATMENT +desautorizantes I-TREATMENT +o I-TREATMENT +insultantes. I-TREATMENT + I-TREATMENT +El I-TREATMENT +diseño I-TREATMENT +de I-TREATMENT +actividades I-TREATMENT +para I-TREATMENT +estos I-TREATMENT +objetivos I-TREATMENT +incluyó I-TREATMENT +en I-TREATMENT +un I-TREATMENT +primer I-TREATMENT +momento I-TREATMENT +una I-TREATMENT +serie I-TREATMENT +de I-TREATMENT +entrevistas I-TREATMENT +programadas I-TREATMENT +entre I-TREATMENT +familiares, I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +tutor I-TREATMENT +a I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +aclarar I-TREATMENT +todos I-TREATMENT +los I-TREATMENT +aspectos I-TREATMENT +concernientes I-TREATMENT +al I-TREATMENT +proyecto I-TREATMENT +terapéutico I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +normas I-TREATMENT +de I-TREATMENT +funcionamiento, I-TREATMENT +actividades I-TREATMENT +dentro I-TREATMENT +y I-TREATMENT +fuera I-TREATMENT +del I-TREATMENT +dispositivo I-TREATMENT +y I-TREATMENT +colaboración I-TREATMENT +necesaria I-TREATMENT +de I-TREATMENT +la I-TREATMENT +familia. I-TREATMENT +A I-TREATMENT +lo I-TREATMENT +largo I-TREATMENT +del I-TREATMENT +tiempo I-TREATMENT +se I-TREATMENT +les I-TREATMENT +fue I-TREATMENT +informando I-TREATMENT +de I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +de I-TREATMENT +la I-TREATMENT +autonomía I-TREATMENT +que I-TREATMENT +conseguía I-TREATMENT +y I-TREATMENT +de I-TREATMENT +todos I-TREATMENT +los I-TREATMENT +avances I-TREATMENT +y I-TREATMENT +obstáculos. I-TREATMENT +Se I-TREATMENT +anima I-TREATMENT +en I-TREATMENT +las I-TREATMENT +entrevistas I-TREATMENT +a I-TREATMENT +verbalizar I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +piensan I-TREATMENT +unos I-TREATMENT +de I-TREATMENT +otros I-TREATMENT +con I-TREATMENT +corrección I-TREATMENT +y I-TREATMENT +respeto, I-TREATMENT +se I-TREATMENT +enseña I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +a I-TREATMENT +que I-TREATMENT +respete I-TREATMENT +las I-TREATMENT +opiniones I-TREATMENT +y I-TREATMENT +los I-TREATMENT +turnos I-TREATMENT +de I-TREATMENT +intervención I-TREATMENT +de I-TREATMENT +los I-TREATMENT +demás I-TREATMENT +y I-TREATMENT +se I-TREATMENT +consensuan I-TREATMENT +acuerdos I-TREATMENT +para I-TREATMENT +el I-TREATMENT +funcionamiento I-TREATMENT +diario, I-TREATMENT +visitas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +familia, I-TREATMENT +salidas I-TREATMENT +a I-TREATMENT +comer I-TREATMENT +fuera, I-TREATMENT +día I-TREATMENT +de I-TREATMENT +recogida I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ropa I-TREATMENT +sucia, I-TREATMENT +etc. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evaluación I-EVOLUTION +evidencia I-EVOLUTION +que I-EVOLUTION +tanto I-EVOLUTION +el I-EVOLUTION +objetivo I-EVOLUTION +permanente I-EVOLUTION +como I-EVOLUTION +los I-EVOLUTION +referidos I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +se I-EVOLUTION +consiguieron I-EVOLUTION +correctamente, I-EVOLUTION +no I-EVOLUTION +así I-EVOLUTION +los I-EVOLUTION +objetivos I-EVOLUTION +propuestos I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +años. I-EVOLUTION +El I-EVOLUTION +hermano I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +a I-EVOLUTION +penas I-EVOLUTION +si I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +capaz I-EVOLUTION +de I-EVOLUTION +elogiar I-EVOLUTION +los I-EVOLUTION +evidentes I-EVOLUTION +avances I-EVOLUTION +del I-EVOLUTION +paciente, I-EVOLUTION +ni I-EVOLUTION +éste I-EVOLUTION +último I-EVOLUTION +ha I-EVOLUTION +podido I-EVOLUTION +eliminar I-EVOLUTION +determinadas I-EVOLUTION +expresiones I-EVOLUTION +inapropiadas I-EVOLUTION +hacia I-EVOLUTION +su I-EVOLUTION +familia, I-EVOLUTION +en I-EVOLUTION +especial I-EVOLUTION +hacia I-EVOLUTION +su I-EVOLUTION +hermano, I-EVOLUTION +aunque I-EVOLUTION +si I-EVOLUTION +disminuyeron I-EVOLUTION +en I-EVOLUTION +tono I-EVOLUTION +y I-EVOLUTION +frecuencia. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipercolesterolemia, I-PAST_MEDICAL_HISTORY +obesidad, I-PAST_MEDICAL_HISTORY +rigidez I-PAST_MEDICAL_HISTORY +articular, I-PAST_MEDICAL_HISTORY +microadenoma I-PAST_MEDICAL_HISTORY +hipofisiario I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +migrañoso, I-PAST_MEDICAL_HISTORY +quien I-PAST_MEDICAL_HISTORY +ejerce I-PAST_MEDICAL_HISTORY +funciones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pinche I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +Hospital I-PAST_MEDICAL_HISTORY +Universitario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Ceuta I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +diez I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Inicia B-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +contracturas I-PRESENT_ILLNESS +musculares I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lumbalgias I-PRESENT_ILLNESS +severas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +mayoría I-PRESENT_ILLNESS +ocasionadas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +rol I-PRESENT_ILLNESS +dentro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cocina, I-PRESENT_ILLNESS +solicitando I-PRESENT_ILLNESS +constantes I-PRESENT_ILLNESS +bajas I-PRESENT_ILLNESS +laborales, I-PRESENT_ILLNESS +evoluciona I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +parestesias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +incontinencia I-PRESENT_ILLNESS +urinaria, I-PRESENT_ILLNESS +es B-DERIVED_FROM/TO +referida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +especializado I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +realizar I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +artrodesis I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +columna I-DERIVED_FROM/TO +lumbo-sacra I-DERIVED_FROM/TO +L4-L5-S1 I-DERIVED_FROM/TO +precisando I-DERIVED_FROM/TO +incapacidad I-DERIVED_FROM/TO +temporal I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +año, I-DERIVED_FROM/TO +posteriormente B-EVOLUTION +presenta I-EVOLUTION +síntomas I-EVOLUTION +sugestivos I-EVOLUTION +de I-EVOLUTION +compresión I-EVOLUTION +radicular I-EVOLUTION +y I-EVOLUTION +estenosis I-EVOLUTION +de I-EVOLUTION +canal I-EVOLUTION +medular, I-EVOLUTION +por B-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +nuevamente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +referida I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +quirúrgico, I-DERIVED_FROM/TO +realizándose I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +resección I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hernias I-DERIVED_FROM/TO +discales I-DERIVED_FROM/TO +C5-C6 I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +C6-C7, I-DERIVED_FROM/TO +necesitando I-DERIVED_FROM/TO +nuevamente I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +incapacidad I-DERIVED_FROM/TO +temporal I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +año I-DERIVED_FROM/TO +más. I-DERIVED_FROM/TO +Al B-EVOLUTION +reincorporarse I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +puesto I-EVOLUTION +de I-EVOLUTION +trabajo, I-EVOLUTION +se I-EVOLUTION +realiza I-EVOLUTION +una I-EVOLUTION +valoración I-EVOLUTION +médica I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Prevención I-EVOLUTION +de I-EVOLUTION +Riesgos I-EVOLUTION +Laborales I-EVOLUTION +del I-EVOLUTION +Hospital, I-EVOLUTION +donde I-EVOLUTION +posterior I-EVOLUTION +al I-EVOLUTION +estudio I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +protocolos I-EVOLUTION +de I-EVOLUTION +manipulación I-EVOLUTION +manual I-EVOLUTION +de I-EVOLUTION +cargas I-EVOLUTION +y I-EVOLUTION +movimientos I-EVOLUTION +repetitivos, I-EVOLUTION +se I-EVOLUTION +valora I-EVOLUTION +como I-EVOLUTION +No I-EVOLUTION +Apta I-EVOLUTION +para I-EVOLUTION +realizar I-EVOLUTION +las I-EVOLUTION +funciones I-EVOLUTION +de I-EVOLUTION +pinche I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cocina. I-EVOLUTION +Se I-EVOLUTION +propone I-EVOLUTION +una I-EVOLUTION +adaptación I-EVOLUTION +del I-EVOLUTION +puesto I-EVOLUTION +de I-EVOLUTION +trabajo, I-EVOLUTION +de I-EVOLUTION +imposible I-EVOLUTION +cumplimiento I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +mando I-EVOLUTION +intermedio. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +caso I-EVOLUTION +es I-EVOLUTION +estudiado I-EVOLUTION +por I-EVOLUTION +Gerencia I-EVOLUTION +para I-EVOLUTION +solicitar I-EVOLUTION +su I-EVOLUTION +reubicación I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +puesto I-EVOLUTION +acorde I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +patologías I-EVOLUTION +que I-EVOLUTION +presenta, I-EVOLUTION +donde I-EVOLUTION +pudiera I-EVOLUTION +desempeñar I-EVOLUTION +funciones I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +perjudicaran I-EVOLUTION +su I-EVOLUTION +salud; I-EVOLUTION +en I-EVOLUTION +vista I-EVOLUTION +de I-EVOLUTION +no I-EVOLUTION +tener I-EVOLUTION +un I-EVOLUTION +puesto I-EVOLUTION +con I-EVOLUTION +esas I-EVOLUTION +características I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +empresa, I-EVOLUTION +la I-EVOLUTION +trabajadora I-EVOLUTION +denuncia I-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +inspectoría I-EVOLUTION +del I-EVOLUTION +trabajo I-EVOLUTION +su I-EVOLUTION +situación I-EVOLUTION +y I-EVOLUTION +solicita I-EVOLUTION +una I-EVOLUTION +minusvalía I-EVOLUTION +al I-EVOLUTION +Instituto I-EVOLUTION +de I-EVOLUTION +Mayores I-EVOLUTION +y I-EVOLUTION +Servicios I-EVOLUTION +Sociales, I-EVOLUTION +donde I-EVOLUTION +el I-EVOLUTION +equipo I-EVOLUTION +de I-EVOLUTION +valoración I-EVOLUTION +y I-EVOLUTION +orientación I-EVOLUTION +otorga I-EVOLUTION +un I-EVOLUTION +grado I-EVOLUTION +de I-EVOLUTION +discapacidad I-EVOLUTION +del I-EVOLUTION +65% I-EVOLUTION +según I-EVOLUTION +los I-EVOLUTION +baremos I-EVOLUTION +vigentes I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +fecha I-EVOLUTION +y I-EVOLUTION +además I-EVOLUTION +la I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +Inspección I-EVOLUTION +de I-EVOLUTION +Trabajo I-EVOLUTION +requiere I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +empresa I-EVOLUTION +realizar I-EVOLUTION +una I-EVOLUTION +adaptación I-EVOLUTION +del I-EVOLUTION +puesto I-EVOLUTION +de I-EVOLUTION +trabajo I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +debe I-EVOLUTION +garantizar I-EVOLUTION +la I-EVOLUTION +reinserción I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +trabajadores I-EVOLUTION +con I-EVOLUTION +minusvalías I-EVOLUTION +por I-EVOLUTION +condiciones I-EVOLUTION +médicas. I-EVOLUTION +Se I-EVOLUTION +replantea I-EVOLUTION +la I-EVOLUTION +adaptación I-EVOLUTION +del I-EVOLUTION +puesto I-EVOLUTION +de I-EVOLUTION +trabajo I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +valoración I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +riesgos I-EVOLUTION +por I-EVOLUTION +parte I-EVOLUTION +del I-EVOLUTION +Técnico I-EVOLUTION +de I-EVOLUTION +Prevención I-EVOLUTION +en I-EVOLUTION +conjunto I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +Gobernanta, I-EVOLUTION +haciéndolo I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +minuciosa I-EVOLUTION +y I-EVOLUTION +específica, I-EVOLUTION +se I-EVOLUTION +logra I-EVOLUTION +un I-EVOLUTION +acuerdo I-EVOLUTION +para I-EVOLUTION +su I-EVOLUTION +reintegro I-EVOLUTION +a I-EVOLUTION +dicha I-EVOLUTION +área. I-EVOLUTION +Sin I-EVOLUTION +embargo I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +reincorporación, I-EVOLUTION +la I-EVOLUTION +trabajadora I-EVOLUTION +sufre I-EVOLUTION +múltiples I-EVOLUTION +episodios I-EVOLUTION +conflictivospor I-EVOLUTION +parte I-EVOLUTION +de I-EVOLUTION +compañeros, I-EVOLUTION +quienes I-EVOLUTION +se I-EVOLUTION +niegan I-EVOLUTION +a I-EVOLUTION +asumir I-EVOLUTION +gran I-EVOLUTION +parte I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +actividades I-EVOLUTION +diarias I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +adaptación I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +realizado. I-EVOLUTION +Pasado I-EVOLUTION +un I-EVOLUTION +tiempo, I-EVOLUTION +su I-EVOLUTION +jefe I-EVOLUTION +inmediato I-EVOLUTION +ha I-EVOLUTION +logrado I-EVOLUTION +establecer I-EVOLUTION +un I-EVOLUTION +plan I-EVOLUTION +de I-EVOLUTION +trabajo I-EVOLUTION +adecuado I-EVOLUTION +para I-EVOLUTION +distribuir I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +homogénea I-EVOLUTION +las I-EVOLUTION +actividades I-EVOLUTION +diarias I-EVOLUTION +de I-EVOLUTION +cocina I-EVOLUTION +y I-EVOLUTION +mejorar I-EVOLUTION +las I-EVOLUTION +relaciones I-EVOLUTION +interpersonales. I-EVOLUTION +Actualmente I-EVOLUTION +desempeña I-EVOLUTION +las I-EVOLUTION +funciones I-EVOLUTION +de I-EVOLUTION +pinche I-EVOLUTION +de I-EVOLUTION +cocina, I-EVOLUTION +con I-EVOLUTION +las I-EVOLUTION +restricciones I-EVOLUTION +impuestas I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Prevención I-EVOLUTION +de I-EVOLUTION +Riesgos I-EVOLUTION +Laborales, I-EVOLUTION +además I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +reconocimientos I-EVOLUTION +médicos I-EVOLUTION +anuales I-EVOLUTION +valorando I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +patología. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +reconocimiento I-PRESENT_ILLNESS +medico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +abril I-PRESENT_ILLNESS +2015. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +- B-PAST_MEDICAL_HISTORY +Antecedentes I-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +bocio I-PAST_MEDICAL_HISTORY +coloide I-PAST_MEDICAL_HISTORY +(tiroidectomía I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2010), I-PAST_MEDICAL_HISTORY +intervención I-PAST_MEDICAL_HISTORY +quirúrgica I-PAST_MEDICAL_HISTORY +debida I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tráfico I-PAST_MEDICAL_HISTORY +(1995). I-PAST_MEDICAL_HISTORY +Menopausia I-PAST_MEDICAL_HISTORY +precoz, I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +hipocrómica, I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tráfico I-PAST_MEDICAL_HISTORY +(2009), I-PAST_MEDICAL_HISTORY +rinitis I-PAST_MEDICAL_HISTORY +vasomotora I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +extrínseca I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +polen I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +asma, I-PAST_MEDICAL_HISTORY +gonalgia, I-PAST_MEDICAL_HISTORY +hipocalcemia, I-PAST_MEDICAL_HISTORY +adenoma I-PAST_MEDICAL_HISTORY +tubular I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colon I-PAST_MEDICAL_HISTORY +(2014), I-PAST_MEDICAL_HISTORY +obesidad. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Hace I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +aparecen I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +pigmentada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +dorsal I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +diagnosticadas I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +notalgia I-PAST_MEDICAL_HISTORY +parestésica. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +relaciona I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +aparición I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ninguna I-PAST_MEDICAL_HISTORY +situación I-PAST_MEDICAL_HISTORY +especial, I-PAST_MEDICAL_HISTORY +no B-FAMILY_HISTORY +refiere I-FAMILY_HISTORY +otros I-FAMILY_HISTORY +casos I-FAMILY_HISTORY +en I-FAMILY_HISTORY +familiares. I-FAMILY_HISTORY + I-FAMILY_HISTORY +- B-EXPLORATION +Exploración I-EXPLORATION +física: I-EXPLORATION +mácula I-EXPLORATION +hiperpigmentada I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +supraescapular; I-EXPLORATION +contracturas I-EXPLORATION +musculares I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +trapecios I-EXPLORATION +y I-EXPLORATION +zona I-EXPLORATION +supraescapular I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Síntomas: I-EXPLORATION +refiere I-EXPLORATION +mucho I-EXPLORATION +prurito I-EXPLORATION +y I-EXPLORATION +"pinchazos", I-EXPLORATION +mejora I-EXPLORATION +cuando I-EXPLORATION +está I-EXPLORATION +más I-EXPLORATION +relajada I-EXPLORATION +y I-EXPLORATION +tras I-EXPLORATION +tratamiento I-EXPLORATION +rehabilitador I-EXPLORATION +con I-EXPLORATION +fisioterapia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +contracturas I-EXPLORATION +musculares. I-EXPLORATION +Los I-EXPLORATION +síntomas I-EXPLORATION +empeoran I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +rascado. I-EXPLORATION + I-EXPLORATION +- B-TREATMENT +Tratamiento: I-TREATMENT +no I-TREATMENT +ha I-TREATMENT +requerido I-TREATMENT +tratamiento I-TREATMENT +específico I-TREATMENT +salvo I-TREATMENT +hidratación I-TREATMENT +y I-TREATMENT +evitar I-TREATMENT +irritación I-TREATMENT +la I-TREATMENT +zona. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +reconocimiento I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +abril I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2015. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +- B-PAST_MEDICAL_HISTORY +Antecedentes I-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +gramíneas, I-PAST_MEDICAL_HISTORY +condromalacia I-PAST_MEDICAL_HISTORY +bilateral, I-PAST_MEDICAL_HISTORY +lumbalgia I-PAST_MEDICAL_HISTORY +(RMN I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2015: I-PAST_MEDICAL_HISTORY +prolapso I-PAST_MEDICAL_HISTORY +discal), I-PAST_MEDICAL_HISTORY +contracturas I-PAST_MEDICAL_HISTORY +cervicodorsales, I-PAST_MEDICAL_HISTORY +urticaria I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2011que I-PAST_MEDICAL_HISTORY +duró I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +causa I-PAST_MEDICAL_HISTORY +probada I-PAST_MEDICAL_HISTORY +(tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Xazal I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +remisión). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Hace I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +apareció I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +lesión I-PAST_MEDICAL_HISTORY +pigmentada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +dorsal, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +eccema I-PAST_MEDICAL_HISTORY +inespecífico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +corticoides I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +unos I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +(por I-PAST_MEDICAL_HISTORY +dermatólogo) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +notalgia I-PAST_MEDICAL_HISTORY +parestestica. I-PAST_MEDICAL_HISTORY +Habitualmente B-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +contracturas I-PRESENT_ILLNESS +cervicodorsales I-PRESENT_ILLNESS +tensionales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +estrés. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +mejoró I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +relajantes I-PRESENT_ILLNESS +muscularespor I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lumbalgia I-PRESENT_ILLNESS +aguda. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +relaciona I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ninguna I-PRESENT_ILLNESS +situación I-PRESENT_ILLNESS +especial, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +casos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +familiares. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +- I-PRESENT_ILLNESS +Exploración B-EXPLORATION +física: I-EXPLORATION +mácula I-EXPLORATION +hiperpigmentada I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +dorsal I-EXPLORATION +media I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +derecha, I-EXPLORATION +contracturas I-EXPLORATION +musculares I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +trapecios I-EXPLORATION +y I-EXPLORATION +músculos I-EXPLORATION +paravertebrales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +cervicodorsal. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Síntomas: I-EXPLORATION +prurito. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Tratamiento: B-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +refiere I-TREATMENT +que I-TREATMENT +los I-TREATMENT +dermatólogos I-TREATMENT +que I-TREATMENT +lo I-TREATMENT +habían I-TREATMENT +visto I-TREATMENT +inicialmente I-TREATMENT +lo I-TREATMENT +diagnosticaban I-TREATMENT +más I-TREATMENT +como I-TREATMENT +un I-TREATMENT +eczema I-TREATMENT +inespecífico I-TREATMENT +y I-TREATMENT +lo I-TREATMENT +trataron I-TREATMENT +con I-TREATMENT +corticoides I-TREATMENT +tópicos, I-TREATMENT +que I-TREATMENT +remitían I-TREATMENT +parcialmente I-TREATMENT +la I-TREATMENT +sintomatología, I-TREATMENT +con I-TREATMENT +recaídas I-TREATMENT +continuadas I-TREATMENT +tras I-TREATMENT +cese I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT +Los I-TREATMENT +síntomas I-TREATMENT +mejoran I-TREATMENT +con I-TREATMENT +crema I-TREATMENT +hidratante I-TREATMENT +tipo I-TREATMENT +urea; I-TREATMENT +el I-TREATMENT +rascado I-TREATMENT +empeora I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +y I-TREATMENT +provoca I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT + I-TREATMENT + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Urgencias I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +pelvis. I-DERIVED_FROM/TO +Refería B-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +suprarrenal I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sospecha I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipoaldosteronismo, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +(EPOC) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +broncodilatadores. I-PAST_MEDICAL_HISTORY +Tras B-TREATMENT +múltiples I-TREATMENT +resecciones I-TREATMENT +transuretrales I-TREATMENT +por I-TREATMENT +adenocarcinoma I-TREATMENT +vesical, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +practicó I-TREATMENT +una I-TREATMENT +prostatocistectomía I-TREATMENT +más I-TREATMENT +nefrectomía I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +derivación I-TREATMENT +tipo I-TREATMENT +Bricker I-TREATMENT +por I-TREATMENT +adenocarcinoma I-TREATMENT +de I-TREATMENT +próstata, I-TREATMENT +carcinoma I-TREATMENT +vesical I-TREATMENT +infiltrante I-TREATMENT +y I-TREATMENT +anulación I-TREATMENT +pielonefrótica I-TREATMENT +izquierda. I-TREATMENT +Posteriormente B-EVOLUTION +al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +semanas I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +drenaje I-EVOLUTION +mediante I-EVOLUTION +punción I-EVOLUTION +percutánea I-EVOLUTION +de I-EVOLUTION +absceso I-EVOLUTION +pelviano I-EVOLUTION +post-quirúrgico. I-EVOLUTION + I-EVOLUTION +Aproximadamente I-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +elevaciones I-EVOLUTION +importantes I-EVOLUTION +del I-EVOLUTION +PSA I-EVOLUTION +de I-EVOLUTION +858, I-EVOLUTION +59 I-EVOLUTION +ng.ml-1, I-EVOLUTION +se I-EVOLUTION +instauró I-EVOLUTION +bloqueo I-EVOLUTION +hormonal I-EVOLUTION +con I-EVOLUTION +antiandrógenos, I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +fueron I-EVOLUTION +efectivos. I-EVOLUTION +Clínicamente B-EXPLORATION +presentaba I-EXPLORATION +astenia, I-EXPLORATION +anorexia, I-EXPLORATION +objetivándose I-EXPLORATION +una I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +de I-EXPLORATION +1.404 I-EXPLORATION +U. I-EXPLORATION +L-1, I-EXPLORATION +descenso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hematocrito I-EXPLORATION +(28,1%) I-EXPLORATION +y I-EXPLORATION +hemoglobina I-EXPLORATION +(9, I-EXPLORATION +3 I-EXPLORATION +g.dl-1), I-EXPLORATION +se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +eritropoyetina I-TREATMENT +más I-TREATMENT +hierro. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +(TAC) I-EXPLORATION +abdomino-pélvica, I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +afectación I-EXPLORATION +linfoadenopática I-EXPLORATION +retroperitoneal I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +metastásico, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +metástasis I-EXPLORATION +óseas I-EXPLORATION +osteoblásticas I-EXPLORATION +que I-EXPLORATION +afectaban I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +columna I-EXPLORATION +lumbosacra I-EXPLORATION +y I-EXPLORATION +estructuras I-EXPLORATION +pélvicas. I-EXPLORATION +Se I-EXPLORATION +efectuó I-EXPLORATION +nuevo I-EXPLORATION +control I-EXPLORATION +al I-EXPLORATION +cabo I-EXPLORATION +de I-EXPLORATION +tres I-EXPLORATION +meses I-EXPLORATION +con I-EXPLORATION +hallazgos I-EXPLORATION +similares, I-EXPLORATION +llamaba I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +la I-EXPLORATION +importante I-EXPLORATION +esclerosis I-EXPLORATION +existente I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +dorsales I-EXPLORATION +y I-EXPLORATION +primeros I-EXPLORATION +lumbares I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +costillas, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +blásticas. I-EXPLORATION + I-EXPLORATION +El B-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Dolor I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +existencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +pelvis, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +lumbar, I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +caderas, I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +inguinal I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +extremidad I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuerza. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +continuo, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +EVA I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8/10, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +conciliar I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sueño, I-PRESENT_ILLNESS +aumentaba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +movilización I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +asociaba I-PRESENT_ILLNESS +parestesias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +extremidades. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +ligera I-EXPLORATION +paresia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +grado I-EXPLORATION +leve I-EXPLORATION +(4/5) I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +de I-EXPLORATION +balance I-EXPLORATION +muscular. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +hallándose I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +diseminación I-EXPLORATION +metastásica I-EXPLORATION +en I-EXPLORATION +calota, I-EXPLORATION +escápula I-EXPLORATION +derecha, I-EXPLORATION +ambos I-EXPLORATION +hombros, I-EXPLORATION +húmero, I-EXPLORATION +parrilla I-EXPLORATION +costal, I-EXPLORATION +pelvis, I-EXPLORATION +ambos I-EXPLORATION +fémures I-EXPLORATION +y I-EXPLORATION +tibias. I-EXPLORATION + B-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amitriptilina I-TREATMENT +25 I-TREATMENT +mg.24 I-TREATMENT +h-1, I-TREATMENT +sulfato I-TREATMENT +de I-TREATMENT +morfina I-TREATMENT +de I-TREATMENT +liberación I-TREATMENT +controlada I-TREATMENT +15 I-TREATMENT +mg.12 I-TREATMENT +h-1, I-TREATMENT +acetil I-TREATMENT +salicilato I-TREATMENT +de I-TREATMENT +lisisna I-TREATMENT +1800 I-TREATMENT +mg.8 I-TREATMENT +h-1, I-TREATMENT +omeprazol I-TREATMENT +20 I-TREATMENT +mg.24 I-TREATMENT +h-1, I-TREATMENT +lactulosa I-TREATMENT +10 I-TREATMENT +g.8 I-TREATMENT +h-1 I-TREATMENT +y I-TREATMENT +metamizol I-TREATMENT +de I-TREATMENT +analgésico I-TREATMENT +de I-TREATMENT +rescate. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +visita I-TREATMENT +sucesiva I-TREATMENT +se I-TREATMENT +apreció I-TREATMENT +un I-TREATMENT +mal I-TREATMENT +control I-TREATMENT +del I-TREATMENT +dolor I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +analgésico. I-TREATMENT +Se I-TREATMENT +aumentó I-TREATMENT +el I-TREATMENT +sulfato I-TREATMENT +de I-TREATMENT +morfina I-TREATMENT +30 I-TREATMENT +mg.8 I-TREATMENT +h-1, I-TREATMENT +iniciándose I-TREATMENT +pauta I-TREATMENT +con I-TREATMENT +dexametasona I-TREATMENT +y I-TREATMENT +se I-TREATMENT +remitió I-TREATMENT +al I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Medicina I-TREATMENT +Nuclear I-TREATMENT +para I-TREATMENT +valorar I-TREATMENT +tratamiento I-TREATMENT +paliativo I-TREATMENT +con I-TREATMENT +Sm-153 I-TREATMENT +Lexidronam I-TREATMENT +(Quadramet®). I-TREATMENT +El B-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +anemia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +previa I-EXPLORATION +al I-EXPLORATION +tratamiento. I-EXPLORATION +Se B-TREATMENT +administró I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +paliativa I-TREATMENT +de I-TREATMENT +80 I-TREATMENT +mCi I-TREATMENT +de I-TREATMENT +Sm-153. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +semana, I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +lumbar I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +pelvis I-EVOLUTION +habían I-EVOLUTION +desaparecido I-EVOLUTION +en I-EVOLUTION +48 I-EVOLUTION +horas, I-EVOLUTION +persistiendo I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +fémur I-EVOLUTION +derecho. I-EVOLUTION +El I-EVOLUTION +EVA I-EVOLUTION +era I-EVOLUTION +de I-EVOLUTION +5/10 I-EVOLUTION +y I-EVOLUTION +había I-EVOLUTION +mejorado I-EVOLUTION +la I-EVOLUTION +deambulación. I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +mantener I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +tratamiento I-TREATMENT +analgésico I-TREATMENT +excepto I-TREATMENT +la I-TREATMENT +dexametasona I-TREATMENT +que I-TREATMENT +se I-TREATMENT +retiró. I-TREATMENT +Transcurridas B-EVOLUTION +4 I-EVOLUTION +semanas I-EVOLUTION +del I-EVOLUTION +Sm-153, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +asintomático I-EVOLUTION +con I-EVOLUTION +EVA I-EVOLUTION +de I-EVOLUTION +1/10, I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +analítica I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +se I-EVOLUTION +apreciaba I-EVOLUTION +leucopenia I-EVOLUTION +(3.000/mm3) I-EVOLUTION +y I-EVOLUTION +plaquetopenia I-EVOLUTION +(121.000/mm3), I-EVOLUTION +sin I-EVOLUTION +repercusiones I-EVOLUTION +clínicas. I-EVOLUTION +Los I-EVOLUTION +opiáceos I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +AINE I-EVOLUTION +fueron I-EVOLUTION +retirados I-EVOLUTION +progresivamente, I-EVOLUTION +permaneciendo I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +con I-EVOLUTION +amitriptilina I-EVOLUTION +25 I-EVOLUTION +mg.24 I-EVOLUTION +h-1 I-EVOLUTION +y I-EVOLUTION +metamizol I-EVOLUTION +a I-EVOLUTION +demanda. I-EVOLUTION +La I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +8 I-EVOLUTION +semanas I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +analítica I-EVOLUTION +se I-EVOLUTION +normalizó. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colecistectomía, I-PAST_MEDICAL_HISTORY +hallux I-PAST_MEDICAL_HISTORY +valgus, I-PAST_MEDICAL_HISTORY +úlcera I-PAST_MEDICAL_HISTORY +gástrica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +neuralgia I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +quinto I-PAST_MEDICAL_HISTORY +par I-PAST_MEDICAL_HISTORY +izquierdo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Presentaba B-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +territorio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +trigémino I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +mantenido I-PRESENT_ILLNESS +controlado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +gabapentina. I-PRESENT_ILLNESS +Desde I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +severa, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +farmacológico. I-PRESENT_ILLNESS +La B-DERIVED_FROM/TO +falta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +control I-DERIVED_FROM/TO +motivó I-DERIVED_FROM/TO +ingreso I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +carácter I-DERIVED_FROM/TO +urgente I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Neurología, I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +solicitaron I-DERIVED_FROM/TO +colaboración I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Dolor. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +fronto-parietal I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +paladar, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +descargas I-PRESENT_ILLNESS +eléctricas I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +frecuentes I-PRESENT_ILLNESS +(en I-PRESENT_ILLNESS +torno I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +diarias), I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +EVA I-PRESENT_ILLNESS +9-10. I-PRESENT_ILLNESS +En B-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +estaba I-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +metamizol I-TREATMENT +(8 I-TREATMENT +gr/24 I-TREATMENT +horas) I-TREATMENT +y I-TREATMENT +tramadol I-TREATMENT +(300 I-TREATMENT +mgr/24 I-TREATMENT +horas) I-TREATMENT +intravenoso I-TREATMENT +en I-TREATMENT +perfusión I-TREATMENT +continua, I-TREATMENT +gabapentina I-TREATMENT +(1.200 I-TREATMENT +mgr/8 I-TREATMENT +horas) I-TREATMENT +y I-TREATMENT +topiramato I-TREATMENT +(25 I-TREATMENT +mgr/12 I-TREATMENT +horas I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral), I-TREATMENT +buprenorfina I-TREATMENT +transdérmica I-TREATMENT +(35 I-TREATMENT +µgr/hora) I-TREATMENT +y I-TREATMENT +petidina I-TREATMENT +intravenosa I-TREATMENT +de I-TREATMENT +rescate I-TREATMENT +(100 I-TREATMENT +mgr/8 I-TREATMENT +horas). I-TREATMENT + I-TREATMENT +Se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +bloqueo I-TREATMENT +nervioso I-TREATMENT +de I-TREATMENT +1ª I-TREATMENT +y I-TREATMENT +2ª I-TREATMENT +ramas I-TREATMENT +izquierdas I-TREATMENT +del I-TREATMENT +quinto I-TREATMENT +par I-TREATMENT +con I-TREATMENT +bupivacaína I-TREATMENT +0, I-TREATMENT +5%, I-TREATMENT +con B-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +logró I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +analgesia I-EVOLUTION +superficial I-EVOLUTION +(EVA I-EVOLUTION +4), I-EVOLUTION +aunque I-EVOLUTION +persistía I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +paladar. I-EVOLUTION +Se B-TREATMENT +ajustó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +farmacológico I-TREATMENT +asociando I-TREATMENT +oxcarbacepina I-TREATMENT +300 I-TREATMENT +mgr/12 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +topiramato I-TREATMENT +y I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +progresiva I-TREATMENT +la I-TREATMENT +buprenorfina. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días, I-EVOLUTION +dada I-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente, I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta, I-EVOLUTION +presentando I-EVOLUTION +entonces I-EVOLUTION +EVA I-EVOLUTION +0 I-EVOLUTION +(incluso I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +paladar). I-EVOLUTION +La I-EVOLUTION +cifra I-EVOLUTION +de I-EVOLUTION +sodio I-EVOLUTION +al I-EVOLUTION +abandonar I-EVOLUTION +el I-EVOLUTION +hospital I-EVOLUTION +estaba I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +límites I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad, I-EVOLUTION +según I-EVOLUTION +una I-EVOLUTION +analítica I-EVOLUTION +realizada I-EVOLUTION +durante I-EVOLUTION +su I-EVOLUTION +ingreso. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +dolor I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +controlado I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +revisión I-EVOLUTION +efectuada I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refirió I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +crisis I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +ese I-EVOLUTION +tiempo. I-EVOLUTION +En B-EXPLORATION +esa I-EXPLORATION +misma I-EXPLORATION +visita I-EXPLORATION +se I-EXPLORATION +comprueba I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +análisis I-EXPLORATION +realizado I-EXPLORATION +unos I-EXPLORATION +días I-EXPLORATION +antes I-EXPLORATION +aparece I-EXPLORATION +una I-EXPLORATION +cifra I-EXPLORATION +de I-EXPLORATION +sodio I-EXPLORATION +de I-EXPLORATION +125 I-EXPLORATION +mgr/dl. I-EXPLORATION +Hacía B-TREATMENT +más I-TREATMENT +de I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +había I-TREATMENT +comenzado I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +un I-TREATMENT +antihipertensivo I-TREATMENT +que I-TREATMENT +combina I-TREATMENT +un I-TREATMENT +inhibidor I-TREATMENT +de I-TREATMENT +los I-TREATMENT +receptores I-TREATMENT +de I-TREATMENT +angiotensina I-TREATMENT +II I-TREATMENT +y I-TREATMENT +un I-TREATMENT +diurético I-TREATMENT +tiazídico I-TREATMENT +(hidroclorotiazida). I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +presentaba I-TREATMENT +síntomas I-TREATMENT +atribuibles I-TREATMENT +a I-TREATMENT +dicha I-TREATMENT +hiponatremia. I-TREATMENT + I-TREATMENT +Debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +la I-TREATMENT +contribución I-TREATMENT +tanto I-TREATMENT +de I-TREATMENT +hidroclorotiazida I-TREATMENT +como I-TREATMENT +oxcarbacepina I-TREATMENT +en I-TREATMENT +la I-TREATMENT +hiponatremia, I-TREATMENT +se I-TREATMENT +retiró, I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +con I-TREATMENT +su I-TREATMENT +médico I-TREATMENT +de I-TREATMENT +cabecera, I-TREATMENT +la I-TREATMENT +hidroclorotiazida. I-TREATMENT +En B-EXPLORATION +un I-EXPLORATION +ionograma I-EXPLORATION +solicitado I-EXPLORATION +15 I-EXPLORATION +días I-EXPLORATION +después, I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +del I-EXPLORATION +sodio I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +143 I-EXPLORATION +mgr/dl, I-EXPLORATION +con I-EXPLORATION +normalidad I-EXPLORATION +del I-EXPLORATION +potasio I-EXPLORATION +y I-EXPLORATION +cloro. I-EXPLORATION + I-EXPLORATION +Dos B-EVOLUTION +meses I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +ingresada I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencias I-EVOLUTION +con I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +intensa I-EVOLUTION +astenia I-EVOLUTION +y I-EVOLUTION +debilidad I-EVOLUTION +muscular I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +cifra I-EVOLUTION +de I-EVOLUTION +sodio I-EVOLUTION +de I-EVOLUTION +120 I-EVOLUTION +mgr/dl. I-EVOLUTION +Nuevamente B-TREATMENT +había I-TREATMENT +comenzado, I-TREATMENT +hacía I-TREATMENT +un I-TREATMENT +mes, I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +hidroclorotiazida I-TREATMENT +debido I-TREATMENT +al I-TREATMENT +mal I-TREATMENT +control I-TREATMENT +de I-TREATMENT +su I-TREATMENT +presión I-TREATMENT +arterial. I-TREATMENT + I-TREATMENT +Ante B-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +evolución, I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +meses, I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +doloroso I-EVOLUTION +se B-TREATMENT +decidió I-TREATMENT +retirar I-TREATMENT +la I-TREATMENT +oxcarbacepina I-TREATMENT +y I-TREATMENT +dejar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +únicamente I-TREATMENT +con I-TREATMENT +gabapentina I-TREATMENT +para I-TREATMENT +control I-TREATMENT +de I-TREATMENT +su I-TREATMENT +dolor I-TREATMENT +neuropático. I-TREATMENT +En B-EVOLUTION +esta I-EVOLUTION +ocasión I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +la I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +hidroclorotiazida. I-EVOLUTION +Los I-EVOLUTION +síntomas I-EVOLUTION +atribuibles I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +hiponatremia I-EVOLUTION +mejoraron I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +inmediata I-EVOLUTION +al I-EVOLUTION +retirar I-EVOLUTION +oxcarbacepina. I-EVOLUTION +En B-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +analítica I-EXPLORATION +solicitada I-EXPLORATION +8 I-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +el I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +sodio I-EXPLORATION +fue I-EXPLORATION +140 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas I-PAST_MEDICAL_HISTORY +conocidas, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +fumadora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +embarazos I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estapedectomía I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +oído I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +otoesclerosis. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Traumatología I-PRESENT_ILLNESS +derivada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +Centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Salud I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Mayo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +2002 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +omalgia I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +atraumática I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Previamente I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +valorada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tratada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +servicios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Neurología, I-PRESENT_ILLNESS +Reumatología I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Rehabilitación I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +mejoría. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +dolor I-EXPLORATION +inespecífico I-EXPLORATION +en I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +del I-EXPLORATION +brazo I-EXPLORATION +izquierdo, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +ocasiones I-EXPLORATION +se I-EXPLORATION +exacerbaba I-EXPLORATION +sin I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +esfuerzos I-EXPLORATION +ni I-EXPLORATION +cambios I-EXPLORATION +posturales. I-EXPLORATION +No I-EXPLORATION +habia I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +atrapamiento I-EXPLORATION +subacromial I-EXPLORATION +ni I-EXPLORATION +atrofias I-EXPLORATION +musculares I-EXPLORATION +clínicamente I-EXPLORATION +evidentes. I-EXPLORATION +La I-EXPLORATION +movilidad I-EXPLORATION +era I-EXPLORATION +completa. I-EXPLORATION +Los I-EXPLORATION +reflejos I-EXPLORATION +eran I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +simétricos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +RM I-EXPLORATION +cervical I-EXPLORATION +que I-EXPLORATION +aportaba I-EXPLORATION +(Abril I-EXPLORATION +2002) I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +evidentes. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +hombro I-EXPLORATION +(Mayo I-EXPLORATION +2002) I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +rotura I-EXPLORATION +parcial I-EXPLORATION +del I-EXPLORATION +tendón I-EXPLORATION +supraespinoso I-EXPLORATION +y I-EXPLORATION +bursitis I-EXPLORATION +subacromial I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +mediante I-TREATMENT +infiltraciones I-TREATMENT +locales I-TREATMENT +con I-TREATMENT +corticoides I-TREATMENT +y I-TREATMENT +rehabilitación I-TREATMENT +sin I-TREATMENT +mejoría. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +seguía I-EVOLUTION +presentando I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +sintomatología I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +neurofisiológico I-EXPLORATION +(Junio I-EXPLORATION +2003) I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +dependientes I-EXPLORATION +de I-EXPLORATION +C5-C6 I-EXPLORATION +izquierdos, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +hombro I-EXPLORATION +(Agosto I-EXPLORATION +2003) I-EXPLORATION +que I-EXPLORATION +evidencia I-EXPLORATION +nuevamente I-EXPLORATION +una I-EXPLORATION +rotura I-EXPLORATION +parcial I-EXPLORATION +del I-EXPLORATION +tendón I-EXPLORATION +supraespinoso. I-EXPLORATION +Ante I-EXPLORATION +esta I-EXPLORATION +situación I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +exploración I-EXPLORATION +artroscópica I-EXPLORATION +(Diciembre I-EXPLORATION +2003) I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +bursitis I-EXPLORATION +subacromial I-EXPLORATION +con I-EXPLORATION +manguito I-EXPLORATION +íntegro, I-EXPLORATION +realizándose B-TREATMENT +una I-TREATMENT +acromioplastia I-TREATMENT +artroscópica. I-TREATMENT +Tras B-EXPLORATION +dicha I-EXPLORATION +intervención I-EXPLORATION +y I-EXPLORATION +nueva I-EXPLORATION +rehabilitación I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +muestra I-EXPLORATION +mejoría I-EXPLORATION +clínica. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +serie I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +que I-EXPLORATION +consistieron I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +torácico I-EXPLORATION +(Diciembre I-EXPLORATION +2004), I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +hombro I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +RM I-EXPLORATION +del I-EXPLORATION +plexo I-EXPLORATION +braquial I-EXPLORATION +(Enero I-EXPLORATION +2005) I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +schwannoma I-EXPLORATION +del I-EXPLORATION +plexo I-EXPLORATION +braquial. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +RM I-EXPLORATION +del I-EXPLORATION +plexo I-EXPLORATION +braquial I-EXPLORATION +(Junio I-EXPLORATION +2005) I-EXPLORATION +mostrando I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +lesión I-EXPLORATION +y I-EXPLORATION +nuevo I-EXPLORATION +estudio I-EXPLORATION +neurofisiológico I-EXPLORATION +(Julio I-EXPLORATION +2005) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +evidenciaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +plexo I-EXPLORATION +braquial. I-EXPLORATION +En B-TREATMENT +este I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +plantea I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +una I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +para I-TREATMENT +su I-TREATMENT +resección. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +incluía I-TREATMENT +pregabalina I-TREATMENT +(300 I-TREATMENT +mg/12 I-TREATMENT +horas), I-TREATMENT +fentanilo I-TREATMENT +transdermico I-TREATMENT +(50 I-TREATMENT +μg/72 I-TREATMENT +horas) I-TREATMENT +y I-TREATMENT +ketorolaco I-TREATMENT +(10 I-TREATMENT +mg/8 I-TREATMENT +horas). I-TREATMENT + I-TREATMENT +La I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +se I-TREATMENT +lleva I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +en I-TREATMENT +Agosto I-TREATMENT +2005 I-TREATMENT +procediéndose I-TREATMENT +a I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +del I-TREATMENT +tumor I-TREATMENT +mediante I-TREATMENT +osteotomía I-TREATMENT +de I-TREATMENT +clavícula I-TREATMENT +con I-TREATMENT +posterior I-TREATMENT +reconstrucción I-TREATMENT +con I-TREATMENT +placa. I-TREATMENT +La B-EVOLUTION +anestesia I-EVOLUTION +y I-EVOLUTION +cirugía I-EVOLUTION +transcurren I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +lo I-EXPLORATION +describe I-EXPLORATION +como I-EXPLORATION +schwannoma I-EXPLORATION +(neurilenoma) I-EXPLORATION +antiguo. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +posteriores I-EVOLUTION +consultas I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +de I-EVOLUTION +miembro I-EVOLUTION +superior I-EVOLUTION +izquierdo I-EVOLUTION +se I-EVOLUTION +había I-EVOLUTION +resuelto. I-EVOLUTION +Sólo I-EVOLUTION +quedó I-EVOLUTION +una I-EVOLUTION +ligera I-EVOLUTION +hipoestesia I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +del I-EVOLUTION +territorio I-EVOLUTION +del I-EVOLUTION +nervio I-EVOLUTION +circunflejo, I-EVOLUTION +sin I-EVOLUTION +evidenciarse I-EVOLUTION +alteraciones I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +fuerza I-EVOLUTION +o I-EVOLUTION +los I-EVOLUTION +reflejos, I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +última I-EVOLUTION +revisión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +había I-EVOLUTION +normalizado. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +caucásica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +(contusión I-PRESENT_ILLNESS +pulmonar I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +clavícula I-PRESENT_ILLNESS +izquierda) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pélvico I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +consecuencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tráfico. I-PRESENT_ILLNESS +Debido B-TREATMENT +a I-TREATMENT +que I-TREATMENT +desarrolló I-TREATMENT +insuficiencia I-TREATMENT +respiratoria I-TREATMENT +hipoxémica I-TREATMENT +fue I-TREATMENT +ingresada I-TREATMENT +en I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Reanimación I-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasiva. I-TREATMENT +A B-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +complicó I-EVOLUTION +con I-EVOLUTION +síndrome I-EVOLUTION +del I-EVOLUTION +distrés I-EVOLUTION +respiratorio I-EVOLUTION +del I-EVOLUTION +adulto, I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +final I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +respiratorio I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +y B-TREATMENT +fue I-TREATMENT +posible I-TREATMENT +extubar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +a I-TREATMENT +las I-TREATMENT +72 I-TREATMENT +h. I-TREATMENT +La I-TREATMENT +sedoanalgesia I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +midazolam I-TREATMENT +y I-TREATMENT +fentanilo I-TREATMENT +en I-TREATMENT +perfusión I-TREATMENT +continua I-TREATMENT +endovenosa. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +la I-EVOLUTION +extubación I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refería I-EVOLUTION +dolor I-EVOLUTION +intenso I-EVOLUTION +y I-EVOLUTION +lancinante I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +del I-EVOLUTION +hombro I-EVOLUTION +izquierdo I-EVOLUTION +con I-EVOLUTION +impotencia I-EVOLUTION +funcional. I-EVOLUTION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +analgésico I-TREATMENT +con I-TREATMENT +paracetamol I-TREATMENT +1g/6 I-TREATMENT +h I-TREATMENT +e I-TREATMENT +infusión I-TREATMENT +continua I-TREATMENT +endovenosa I-TREATMENT +de I-TREATMENT +remifentanilo, I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética, I-EXPLORATION +hallándose I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +plexo I-EXPLORATION +braquial I-EXPLORATION +izquierdo I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +supra I-EXPLORATION +e I-EXPLORATION +infraclavicular. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +prescrito I-TREATMENT +fue I-TREATMENT +ineficaz I-TREATMENT +y I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +remifentanilo I-TREATMENT +fue I-TREATMENT +elevándose I-TREATMENT +hasta I-TREATMENT +llegar I-TREATMENT +a I-TREATMENT +un I-TREATMENT +máximo I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +mcg/kg/min; I-TREATMENT +en I-TREATMENT +esta I-TREATMENT +situación I-TREATMENT +este I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +mostró I-TREATMENT +ineficaz I-TREATMENT +porque I-TREATMENT +la I-TREATMENT +intensidad I-TREATMENT +del I-TREATMENT +dolor I-TREATMENT +no I-TREATMENT +mejoró I-TREATMENT +(VAS I-TREATMENT +8) I-TREATMENT +y I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +presentaba I-TREATMENT +excesiva I-TREATMENT +sedación I-TREATMENT +que I-TREATMENT +se I-TREATMENT +manifestaba I-TREATMENT +con I-TREATMENT +desaturaciones I-TREATMENT +frecuentes I-TREATMENT +en I-TREATMENT +la I-TREATMENT +monitorización I-TREATMENT +con I-TREATMENT +pulsioximetría I-TREATMENT +continua. I-TREATMENT + I-TREATMENT +En I-TREATMENT +vista I-TREATMENT +de I-TREATMENT +las I-TREATMENT +imágenes I-TREATMENT +radiológicas, I-TREATMENT +la I-TREATMENT +alternativa I-TREATMENT +analgésica I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +epidural I-TREATMENT +cervical I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +C5-C6 I-TREATMENT +para I-TREATMENT +analgesia I-TREATMENT +controlada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +(PCA) I-TREATMENT +con I-TREATMENT +una I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +375 I-TREATMENT +% I-TREATMENT +ropivacaína I-TREATMENT +a I-TREATMENT +2 I-TREATMENT +mL/h I-TREATMENT +con I-TREATMENT +bolos I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +mL I-TREATMENT +(tiempo I-TREATMENT +de I-TREATMENT +cierre I-TREATMENT +60 I-TREATMENT +min), I-TREATMENT +tras I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +dosis I-TREATMENT +test I-TREATMENT +y I-TREATMENT +de I-TREATMENT +carga I-TREATMENT +con I-TREATMENT +5 I-TREATMENT +mL I-TREATMENT +de I-TREATMENT +ropivacaína I-TREATMENT +0, I-TREATMENT +375 I-TREATMENT +% I-TREATMENT +se B-EVOLUTION +logró I-EVOLUTION +en I-EVOLUTION +diez I-EVOLUTION +minutos I-EVOLUTION +un I-EVOLUTION +adecuado I-EVOLUTION +control I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +(VAS I-EVOLUTION +2) I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +respiratorias I-EVOLUTION +ni I-EVOLUTION +hemodinámicas I-EVOLUTION +asociadas. I-EVOLUTION +A B-TREATMENT +la I-TREATMENT +vez I-TREATMENT +se I-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +específico I-TREATMENT +para I-TREATMENT +el I-TREATMENT +dolor I-TREATMENT +neuropático. I-TREATMENT + I-TREATMENT +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +trasladada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +referencia I-DERIVED_FROM/TO +12 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +después I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +ingreso I-DERIVED_FROM/TO +hospitalario, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +adecuado I-DERIVED_FROM/TO +control I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +gabapentina I-DERIVED_FROM/TO +600 I-DERIVED_FROM/TO +mg/8 I-DERIVED_FROM/TO +h I-DERIVED_FROM/TO +vo, I-DERIVED_FROM/TO +amitriptilina I-DERIVED_FROM/TO +25 I-DERIVED_FROM/TO +mg/d I-DERIVED_FROM/TO +vo, I-DERIVED_FROM/TO +clonacepam I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +mg/d, I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +tramadol I-DERIVED_FROM/TO +75 I-DERIVED_FROM/TO +mg/12 I-DERIVED_FROM/TO +h I-DERIVED_FROM/TO +vo. I-DERIVED_FROM/TO +El B-TREATMENT +catéter I-TREATMENT +fue I-TREATMENT +entonces I-TREATMENT +retirado I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diestra, I-PRESENT_ILLNESS +viuda, I-PRESENT_ILLNESS +ocupación: I-PRESENT_ILLNESS +hogar. I-PRESENT_ILLNESS +Padecimiento I-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +toque I-PRESENT_ILLNESS +eléctrico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +descargas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +frontal, I-PRESENT_ILLNESS +temporal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +periorbitaria I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +segundos I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +minuto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +períodos I-PRESENT_ILLNESS +libres I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +descargas I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +sensitivas, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +producía I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hablar I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +comer. I-PRESENT_ILLNESS +Cuatro B-TREATMENT +años I-TREATMENT +previos I-TREATMENT +a I-TREATMENT +su I-TREATMENT +llegada I-TREATMENT +a I-TREATMENT +nuestra I-TREATMENT +clínica I-TREATMENT +del I-TREATMENT +dolor I-TREATMENT +se I-TREATMENT +le I-TREATMENT +había I-TREATMENT +realizado I-TREATMENT +una I-TREATMENT +compresión I-TREATMENT +con I-TREATMENT +balón I-TREATMENT +en I-TREATMENT +ganglio I-TREATMENT +de I-TREATMENT +Gasser I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +había I-TREATMENT +sido I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +carbamacepina I-TREATMENT +por I-TREATMENT +otros I-TREATMENT +médicos, I-TREATMENT +con I-TREATMENT +éxito I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +año, I-TREATMENT +posterior I-TREATMENT +al I-TREATMENT +cual I-TREATMENT +reinicio I-TREATMENT +cuadro I-TREATMENT +de I-TREATMENT +mismas I-TREATMENT +característica. I-TREATMENT +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +contaba I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trauma I-PAST_MEDICAL_HISTORY +craneal, I-PAST_MEDICAL_HISTORY +cambios I-PAST_MEDICAL_HISTORY +visuales, I-PAST_MEDICAL_HISTORY +tinnitus, I-PAST_MEDICAL_HISTORY +vértigo I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +auditiva. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +perdido I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +kg I-PAST_MEDICAL_HISTORY +debido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +disminución I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ingesta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alimentos I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +dolor. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedades I-PAST_MEDICAL_HISTORY +crónico-degenerativas. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +inicial I-EXPLORATION +era I-EXPLORATION +esencialmente I-EXPLORATION +normal. I-EXPLORATION +Contaba I-EXPLORATION +con I-EXPLORATION +exámenes I-EXPLORATION +generales I-EXPLORATION +normales, I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +bloqueo I-TREATMENT +de I-TREATMENT +ganglio I-TREATMENT +de I-TREATMENT +Gasser I-TREATMENT +con I-TREATMENT +fenol I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicio I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +carbamacepina I-TREATMENT +200 I-TREATMENT +mg I-TREATMENT +c-12 I-TREATMENT +hrs I-TREATMENT +y I-TREATMENT +gabapentina I-TREATMENT +300 I-TREATMENT +mg I-TREATMENT +c-12 I-TREATMENT +hrs, I-TREATMENT +presentó I-TREATMENT +mejoría I-TREATMENT +24 I-TREATMENT +hrs I-TREATMENT +y I-TREATMENT +reinició I-TREATMENT +sintomatología. I-TREATMENT +Evolucionó B-EVOLUTION +sin I-EVOLUTION +control I-EVOLUTION +y I-EVOLUTION +al I-EVOLUTION +reexplorar I-EVOLUTION +se I-EVOLUTION +encontró I-EVOLUTION +punto I-EVOLUTION +doloroso I-EVOLUTION +bajo I-EVOLUTION +mastoides I-EVOLUTION +del I-EVOLUTION +lado I-EVOLUTION +izquierdo I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +exacerbado I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +flexión I-EVOLUTION +de I-EVOLUTION +cuello. I-EVOLUTION +Se B-TREATMENT +realizó I-TREATMENT +bloqueo I-TREATMENT +de I-TREATMENT +plexo I-TREATMENT +cervical I-TREATMENT +superficial I-TREATMENT +con I-TREATMENT +lidocaína I-TREATMENT +al I-TREATMENT +2% I-TREATMENT +simple I-TREATMENT +y I-TREATMENT +C2 I-TREATMENT +izquierdo I-TREATMENT +con I-TREATMENT +lidocaína I-TREATMENT +al I-TREATMENT +1% I-TREATMENT +simple I-TREATMENT +y I-TREATMENT +alcohol I-TREATMENT +puro I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +inmediata, I-TREATMENT +desapareciendo I-TREATMENT +el I-TREATMENT +dolor. I-TREATMENT +La B-EXPLORATION +RMN I-EXPLORATION +mostró I-EXPLORATION +estenosis I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +cervical. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomática I-EVOLUTION +7 I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +al I-EVOLUTION +procedimiento, I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +éste I-EVOLUTION +reporte I-EVOLUTION +sin I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +realizar I-EVOLUTION +nuevo I-EVOLUTION +bloqueo. I-EVOLUTION +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +enviada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +columna I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +completar I-DERIVED_FROM/TO +tratamiento. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Paciente B-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +diestra, B-PAST_MEDICAL_HISTORY +soltera, I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +ortopedista. I-PAST_MEDICAL_HISTORY +Padecimiento B-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +punzante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +temporal I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +mismo I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +periorbitario I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +intermitente, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +sensitivas. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +limitaba I-PRESENT_ILLNESS +sueño I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +bajado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +causa I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +mismo. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +apófisis I-EXPLORATION +espinosas I-EXPLORATION +de I-EXPLORATION +C2, I-EXPLORATION +C3 I-EXPLORATION +y I-EXPLORATION +punto I-EXPLORATION +doloroso I-EXPLORATION +occipital I-EXPLORATION +izquierdo. I-EXPLORATION +Las I-EXPLORATION +radiografías I-EXPLORATION +mostraban I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lordosis I-EXPLORATION +cervical. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +bloqueo I-TREATMENT +desinflamatorio I-TREATMENT +de I-TREATMENT +C2 I-TREATMENT +y I-TREATMENT +C3 I-TREATMENT +izquierdos I-TREATMENT +con I-TREATMENT +lidocaína I-TREATMENT +al I-TREATMENT +1% I-TREATMENT +simple I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +del I-TREATMENT +80% I-TREATMENT +en I-TREATMENT +sintomatología, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +gabapentina I-TREATMENT +300 I-TREATMENT +mg I-TREATMENT +c-12 I-TREATMENT +hrs. I-TREATMENT +Se I-TREATMENT +dio I-TREATMENT +manejo I-TREATMENT +para I-TREATMENT +patología I-TREATMENT +cervical I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +columna, I-TREATMENT +no I-TREATMENT +hubo I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +aplicar I-TREATMENT +nuevos I-TREATMENT +bloqueos I-TREATMENT +cervicales. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomática I-EVOLUTION +3 I-EVOLUTION +años I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hernia I-PRESENT_ILLNESS +discal, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Durogesic® I-PRESENT_ILLNESS +150 I-PRESENT_ILLNESS +μg/h I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +buena I-PRESENT_ILLNESS +eficacia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +seguridad. I-PRESENT_ILLNESS +Se B-TREATMENT +cambia I-TREATMENT +por I-TREATMENT +un I-TREATMENT +genérico, I-TREATMENT +notándose B-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +doloroso I-EVOLUTION +y I-EVOLUTION +síntomas I-EVOLUTION +neurológicos I-EVOLUTION +de I-EVOLUTION +inestabilidad. I-EVOLUTION +Se B-TREATMENT +vuelve I-TREATMENT +a I-TREATMENT +cambiar I-TREATMENT +a I-TREATMENT +Durogesic®, I-TREATMENT +y B-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +se I-EVOLUTION +estabiliza I-EVOLUTION +la I-EVOLUTION +analgesia I-EVOLUTION +y I-EVOLUTION +desaparece I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +neurológica. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +neuralgia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +trigémino, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Durogesic® I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +μg/h I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +buena I-PRESENT_ILLNESS +eficacia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +seguridad. I-PRESENT_ILLNESS +En B-TREATMENT +neurología I-TREATMENT +se I-TREATMENT +cambia I-TREATMENT +por I-TREATMENT +fentanilo I-TREATMENT +genérico, I-TREATMENT +notándose B-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +doloroso. I-EVOLUTION +Se B-TREATMENT +vuelve I-TREATMENT +a I-TREATMENT +cambiar I-TREATMENT +a I-TREATMENT +Durogesic®, I-TREATMENT +y I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +se I-TREATMENT +estabiliza I-TREATMENT +la I-TREATMENT +analgesia. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +62 B-TREATMENT +kg, I-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Durogesic® I-TREATMENT +100 I-TREATMENT +μg/h. I-TREATMENT +Se I-TREATMENT +cambia I-TREATMENT +la I-TREATMENT +prescripción I-TREATMENT +a I-TREATMENT +fentanilo I-TREATMENT +genérico I-TREATMENT +100 I-TREATMENT +μg. I-TREATMENT +Pérdida B-EVOLUTION +de I-EVOLUTION +eficacia I-EVOLUTION +analgésica. I-EVOLUTION +Se B-TREATMENT +restaura I-TREATMENT +Durogesic® I-TREATMENT +100 I-TREATMENT +μg/h. I-TREATMENT +Mejoría B-EVOLUTION +clínica. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estenosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +canal I-PRESENT_ILLNESS +medular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hernia I-PRESENT_ILLNESS +discal, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Durogesic® I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +μg/h I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +buena I-PRESENT_ILLNESS +eficacia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +seguridad. I-PRESENT_ILLNESS +Se B-TREATMENT +cambia I-TREATMENT +por I-TREATMENT +fentanilo I-TREATMENT +genérico, I-TREATMENT +notándose I-TREATMENT +un I-TREATMENT +empeoramiento I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +doloroso. I-TREATMENT +Se I-TREATMENT +vuelve I-TREATMENT +a I-TREATMENT +cambiar I-TREATMENT +a I-TREATMENT +Durogesic®, I-TREATMENT +y I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +se I-TREATMENT +estabiliza I-TREATMENT +la I-TREATMENT +analgesia. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +osteoartrosis I-PAST_MEDICAL_HISTORY +primaria, I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +invalidante, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +prótesis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cadera I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Durogesic® I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +μg/h. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +modo. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +actualidad I-PAST_MEDICAL_HISTORY +continúa I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Durogesic® I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +μg/h. I-PAST_MEDICAL_HISTORY +Hace I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +brote I-PAST_MEDICAL_HISTORY +psicótico, I-PAST_MEDICAL_HISTORY +motivo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +psiquiátricamente. I-PAST_MEDICAL_HISTORY +Al B-TREATMENT +alta I-TREATMENT +del I-TREATMENT +hospital I-TREATMENT +se I-TREATMENT +le I-TREATMENT +prescribió I-TREATMENT +fentanilo I-TREATMENT +50 I-TREATMENT +μg/h I-TREATMENT +(genérico). I-TREATMENT +A B-EVOLUTION +raíz I-EVOLUTION +de I-EVOLUTION +dicho I-EVOLUTION +cambio I-EVOLUTION +se I-EVOLUTION +volvieran I-EVOLUTION +a I-EVOLUTION +agravar I-EVOLUTION +sus I-EVOLUTION +algias I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +abstinencia I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +caracterizaba I-EVOLUTION +por I-EVOLUTION +inquietud, I-EVOLUTION +irritabilidad I-EVOLUTION +y B-TREATMENT +un I-TREATMENT +cuadro I-TREATMENT +confusional I-TREATMENT +que I-TREATMENT +desapareció I-TREATMENT +al I-TREATMENT +volver I-TREATMENT +a I-TREATMENT +prescribirse I-TREATMENT +nuevamente I-TREATMENT +Durogesic® I-TREATMENT +50 I-TREATMENT +μg/h. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cáncer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vejiga I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +metástasis, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Durogesic® I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +μg/h I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +buena I-PRESENT_ILLNESS +eficacia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +seguridad. I-PRESENT_ILLNESS +En B-TREATMENT +oncología I-TREATMENT +se I-TREATMENT +cambia I-TREATMENT +por I-TREATMENT +fentanilo I-TREATMENT +genérico, I-TREATMENT +notándose I-TREATMENT +un I-TREATMENT +empeoramiento I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +doloroso. I-TREATMENT +Se B-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +cambiar I-EVOLUTION +a I-EVOLUTION +Durogesic®, I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +se I-EVOLUTION +estabiliza I-EVOLUTION +la I-EVOLUTION +analgesia. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +fantasma I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +muñón I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +extremidad I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +(EID) I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1/3 I-PRESENT_ILLNESS +medio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +refractario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +analgésico I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +oral, I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Dolor I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +colocación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +bomba I-DERIVED_FROM/TO +intratecal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ziconotide. I-DERIVED_FROM/TO +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presenta: I-PAST_MEDICAL_HISTORY +obesidad, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +ansioso-depresivo, I-PAST_MEDICAL_HISTORY +neumonía I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +atípica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +abril I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2007 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +ciprofloxacino, I-PAST_MEDICAL_HISTORY +castaña, I-PAST_MEDICAL_HISTORY +kiwi I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +látex. I-PAST_MEDICAL_HISTORY +Respecto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +traumatológica, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +sufre I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +espiroidea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tercio I-PAST_MEDICAL_HISTORY +distal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tibia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +maleolo I-PAST_MEDICAL_HISTORY +peroneo I-PAST_MEDICAL_HISTORY +derechos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +mayo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2000 I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +laboral, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +osteosíntesis I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +tornillos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +placa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +neutralización. I-PAST_MEDICAL_HISTORY +Tras I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +curso I-PAST_MEDICAL_HISTORY +postoperatorio I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +dada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alta. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +comienza I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +espontáneo, I-PAST_MEDICAL_HISTORY +punzante I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tobillo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cara I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +pierna I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +aumenta I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +palpación I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +cargar I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +miembro I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +intenta I-PAST_MEDICAL_HISTORY +caminar, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +añade I-PAST_MEDICAL_HISTORY +edema I-PAST_MEDICAL_HISTORY +severo I-PAST_MEDICAL_HISTORY +infracondíleo, I-PAST_MEDICAL_HISTORY +palidez, I-PAST_MEDICAL_HISTORY +frialdad I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hiperhidrosis I-PAST_MEDICAL_HISTORY +diagnosticándose I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Distrofia I-PAST_MEDICAL_HISTORY +Simpático I-PAST_MEDICAL_HISTORY +Refleja I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EID. I-PAST_MEDICAL_HISTORY +Es I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +técnicas I-PAST_MEDICAL_HISTORY +regionales I-PAST_MEDICAL_HISTORY +asociadas I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fracasaron, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +finalmente, I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +sufrir I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +intervenciones I-PAST_MEDICAL_HISTORY +(simpatectomía I-PAST_MEDICAL_HISTORY +lumbar, I-PAST_MEDICAL_HISTORY +absceso, I-PAST_MEDICAL_HISTORY +celulitis) I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +decide I-PAST_MEDICAL_HISTORY +amputación I-PAST_MEDICAL_HISTORY +infracondílea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EID. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +posteriori, I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +desfavorable, I-PAST_MEDICAL_HISTORY +realizándose I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +nueva I-PAST_MEDICAL_HISTORY +amputación I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1/3 I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +muslo I-PAST_MEDICAL_HISTORY +EID I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +marzo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2004. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Seguidamente I-PAST_MEDICAL_HISTORY +continúa I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +intenso I-PAST_MEDICAL_HISTORY +continuo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tobillo, I-PAST_MEDICAL_HISTORY +pie I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +rodilla I-PAST_MEDICAL_HISTORY +amputados I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +decide I-PAST_MEDICAL_HISTORY +implantación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +catéter I-PAST_MEDICAL_HISTORY +epidural I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +ambulatorio I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +analgesia I-PAST_MEDICAL_HISTORY +epidural I-PAST_MEDICAL_HISTORY +controlada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +(PCEA) I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +13 I-PAST_MEDICAL_HISTORY +abril I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2004, I-PAST_MEDICAL_HISTORY +asociado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +bajada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +importante I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +farmacológico I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +venía I-PAST_MEDICAL_HISTORY +tomando I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anterioridad I-PAST_MEDICAL_HISTORY +(antidepresivos I-PAST_MEDICAL_HISTORY +tricíclicos, I-PAST_MEDICAL_HISTORY +benzodiacepinas, I-PAST_MEDICAL_HISTORY +mórficos, I-PAST_MEDICAL_HISTORY +AINEs, I-PAST_MEDICAL_HISTORY +etc.). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +favorable I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2005 I-PAST_MEDICAL_HISTORY +sufre I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tráfico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +arrancamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +catéter I-PAST_MEDICAL_HISTORY +epidural, I-PAST_MEDICAL_HISTORY +contractura I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +muscular I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +vertiginoso I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +empeoramiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +depresivo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +doloroso. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +intentó I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +adaptación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +prótesis I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +poder I-PAST_MEDICAL_HISTORY +caminar I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +sesiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rehabilitación, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +éxito I-PAST_MEDICAL_HISTORY +debido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +secuela I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +crónico I-PAST_MEDICAL_HISTORY +consistente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +flexo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cadera I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EID I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +impidió I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +adaptación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +prótesis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +consecuencia, I-PAST_MEDICAL_HISTORY +caminar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +normalidad. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-TREATMENT +enero I-TREATMENT +de I-TREATMENT +2008 I-TREATMENT +acude I-TREATMENT +a I-TREATMENT +nuestra I-TREATMENT +Unidad I-TREATMENT +del I-TREATMENT +Dolor I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +le I-TREATMENT +propone I-TREATMENT +la I-TREATMENT +implantación I-TREATMENT +de I-TREATMENT +bomba I-TREATMENT +de I-TREATMENT +infusión I-TREATMENT +continua I-TREATMENT +de I-TREATMENT +Ziconotide I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +intratecal, I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +acepta I-TREATMENT +tras I-TREATMENT +ser I-TREATMENT +informada I-TREATMENT +del I-TREATMENT +procedimiento, I-TREATMENT +posibles I-TREATMENT +resultados, I-TREATMENT +complicaciones I-TREATMENT +y I-TREATMENT +efectos I-TREATMENT +adversos. I-TREATMENT +Se I-TREATMENT +entrega I-TREATMENT +consentimiento I-TREATMENT +informado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cita I-TREATMENT +para I-TREATMENT +el I-TREATMENT +20/2/2008 I-TREATMENT +para I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +bomba. I-TREATMENT + I-TREATMENT +Colocación I-TREATMENT +de I-TREATMENT +bomba I-TREATMENT +intratecal I-TREATMENT +de I-TREATMENT +ziconotide I-TREATMENT +y I-TREATMENT +evolución I-TREATMENT +posterior I-TREATMENT + I-TREATMENT +Con I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +decúbito I-TREATMENT +lateral I-TREATMENT +se I-TREATMENT +hace I-TREATMENT +incisión I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +abdomen I-TREATMENT +para I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +bomba I-TREATMENT +de I-TREATMENT +infusión I-TREATMENT +subcutánea. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +localiza I-TREATMENT +espacio I-TREATMENT +intradural I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +L4-L5 I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +introduce I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +infusión I-TREATMENT +continua. I-TREATMENT +Dicho I-TREATMENT +catéter I-TREATMENT +se I-TREATMENT +tuneliza I-TREATMENT +vía I-TREATMENT +subcutánea I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +unión I-TREATMENT +con I-TREATMENT +la I-TREATMENT +bomba I-TREATMENT +de I-TREATMENT +infusión. I-TREATMENT +Cierre I-TREATMENT +de I-TREATMENT +incisiones I-TREATMENT +con I-TREATMENT +sutura. I-TREATMENT +Programación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +bomba I-TREATMENT +de I-TREATMENT +ziconotide. I-TREATMENT +La I-TREATMENT +dosis I-TREATMENT +inicial I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +2 I-TREATMENT +microg/día I-TREATMENT +de I-TREATMENT +ziconotide I-TREATMENT +que I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +largo I-TREATMENT +de I-TREATMENT +13 I-TREATMENT +meses I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +a I-TREATMENT +7, I-TREATMENT +8 I-TREATMENT +microg/día. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +estado I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +cuando I-EVOLUTION +acudió I-EVOLUTION +por I-EVOLUTION +primera I-EVOLUTION +vez I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +era I-EVOLUTION +muy I-EVOLUTION +desfavorable: I-EVOLUTION +EVA I-EVOLUTION +8/10, I-EVOLUTION +imposibilidad I-EVOLUTION +de I-EVOLUTION +sueño I-EVOLUTION +reparador I-EVOLUTION +por I-EVOLUTION +despertares I-EVOLUTION +frecuentes I-EVOLUTION +por I-EVOLUTION +dolor, I-EVOLUTION +estreñimiento I-EVOLUTION +moderado I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +opiodes, I-EVOLUTION +falta I-EVOLUTION +de I-EVOLUTION +apetito, I-EVOLUTION +incapacidad I-EVOLUTION +de I-EVOLUTION +realizar I-EVOLUTION +actividad I-EVOLUTION +normal I-EVOLUTION +por I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +estado I-EVOLUTION +depresivo I-EVOLUTION +grave. I-EVOLUTION +Los I-EVOLUTION +requerimientos I-EVOLUTION +analgésicos I-EVOLUTION +eran I-EVOLUTION +altos I-EVOLUTION +con I-EVOLUTION +dosis I-EVOLUTION +muy I-EVOLUTION +elevada I-EVOLUTION +de I-EVOLUTION +opioides I-EVOLUTION +y I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +rescates I-EVOLUTION +frecuentes I-EVOLUTION +(cada I-EVOLUTION +2 I-EVOLUTION +horas). I-EVOLUTION +Durante I-EVOLUTION +la I-EVOLUTION +subida I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +bomba I-EVOLUTION +de I-EVOLUTION +ziconotide I-EVOLUTION +se I-EVOLUTION +consiguió I-EVOLUTION +disminuir I-EVOLUTION +su I-EVOLUTION +tratamiento I-EVOLUTION +antiálgico I-EVOLUTION +y I-EVOLUTION +mejorar I-EVOLUTION +notablemente I-EVOLUTION +su I-EVOLUTION +dolor I-EVOLUTION +pasando I-EVOLUTION +de I-EVOLUTION +8/10 I-EVOLUTION +a I-EVOLUTION +4/10 I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +escala I-EVOLUTION +EVA, I-EVOLUTION +además I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +mayor I-EVOLUTION +descanso I-EVOLUTION +nocturno I-EVOLUTION +(durmiendo I-EVOLUTION +más I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +horas I-EVOLUTION +sin I-EVOLUTION +despertar I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +dolor), I-EVOLUTION +recuperar I-EVOLUTION +apetito, I-EVOLUTION +eliminar I-EVOLUTION +estreñimiento, I-EVOLUTION +volver I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +vida I-EVOLUTION +cotidiana I-EVOLUTION +y I-EVOLUTION +elevar I-EVOLUTION +su I-EVOLUTION +estado I-EVOLUTION +de I-EVOLUTION +ánimo. I-EVOLUTION +En I-EVOLUTION +este I-EVOLUTION +tiempo I-EVOLUTION +de I-EVOLUTION +adaptación I-EVOLUTION +dosis/efecto, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +tuvo I-EVOLUTION +periodos I-EVOLUTION +limitados I-EVOLUTION +de I-EVOLUTION +mareo, I-EVOLUTION +sensación I-EVOLUTION +de I-EVOLUTION +embotamiento I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cabeza, I-EVOLUTION +acúfenos I-EVOLUTION +y I-EVOLUTION +cefalea I-EVOLUTION +que I-EVOLUTION +remitieron I-EVOLUTION +con I-EVOLUTION +tratamiento I-EVOLUTION +sintomático I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +paso I-EVOLUTION +del I-EVOLUTION +tiempo. I-EVOLUTION + I-EVOLUTION +Actualmente, I-EVOLUTION +continúa I-EVOLUTION +en I-EVOLUTION +seguimiento I-EVOLUTION +en I-EVOLUTION +nuestra I-EVOLUTION +unidad I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +recaída I-EVOLUTION +del I-EVOLUTION +dolor. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rabdomiosarcoma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +muslo I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +metástasis I-PAST_MEDICAL_HISTORY +ganglionar I-PAST_MEDICAL_HISTORY +inguinal I-PAST_MEDICAL_HISTORY +ipsilateral, I-PAST_MEDICAL_HISTORY +fue B-PRESENT_ILLNESS +programada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +electiva I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +resección I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +recidiva I-PRESENT_ILLNESS +tumoral I-PRESENT_ILLNESS +local I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tejidos I-PRESENT_ILLNESS +blandos, I-PRESENT_ILLNESS +vaciamiento I-PRESENT_ILLNESS +ganglionar I-PRESENT_ILLNESS +inguinal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +colocación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +catéteres I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +braquiterapia. I-PRESENT_ILLNESS +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +quimioterapia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +previos, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +medicamentos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +intervención I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +tumor I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +anestésicas. I-PAST_MEDICAL_HISTORY +Sus B-EXPLORATION +exámenes I-EXPLORATION +prequirúrgicos I-EXPLORATION +mostraban I-EXPLORATION +hemoglobina I-EXPLORATION +10, I-EXPLORATION +9 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +31, I-EXPLORATION +7%, I-EXPLORATION +conteo I-EXPLORATION +plaquetario I-EXPLORATION +213.000/µl, I-EXPLORATION +TPT I-EXPLORATION +24, I-EXPLORATION +5 I-EXPLORATION +segundos, I-EXPLORATION +TP I-EXPLORATION +11, I-EXPLORATION +3 I-EXPLORATION +segundos I-EXPLORATION +e I-EXPLORATION +INR I-EXPLORATION +1, I-EXPLORATION +06. I-EXPLORATION +Se I-EXPLORATION +reservó I-EXPLORATION +1 I-EXPLORATION +unidad I-EXPLORATION +de I-EXPLORATION +glóbulos I-EXPLORATION +rojos I-EXPLORATION +empaquetados I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +evaluación I-EXPLORATION +preanestésica. I-EXPLORATION +Se B-TREATMENT +discutió I-TREATMENT +con I-TREATMENT +su I-TREATMENT +madre I-TREATMENT +en I-TREATMENT +la I-TREATMENT +evaluación I-TREATMENT +preanestésica I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +ofrecer I-TREATMENT +una I-TREATMENT +técnica I-TREATMENT +regional I-TREATMENT +continua I-TREATMENT +para I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +del I-TREATMENT +perioperatorio, I-TREATMENT +destacando I-TREATMENT +su I-TREATMENT +papel I-TREATMENT +en I-TREATMENT +el I-TREATMENT +control I-TREATMENT +analgésico I-TREATMENT +post-quirúrgico. I-TREATMENT +El I-TREATMENT +consentimiento I-TREATMENT +informado I-TREATMENT +fue I-TREATMENT +diligenciado. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +tenía I-TREATMENT +una I-TREATMENT +vena I-TREATMENT +periférica I-TREATMENT +canalizada I-TREATMENT +a I-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +al I-TREATMENT +quirófano I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +inducción I-TREATMENT +anestésica I-TREATMENT +convencional I-TREATMENT +con I-TREATMENT +fentanil I-TREATMENT +2 I-TREATMENT +µg/kg, I-TREATMENT +lidocaína I-TREATMENT +1 I-TREATMENT +mg/kg, I-TREATMENT +propofol I-TREATMENT +2 I-TREATMENT +mg/kg, I-TREATMENT +dexametasona I-TREATMENT +0, I-TREATMENT +15 I-TREATMENT +mg/kg I-TREATMENT +y I-TREATMENT +cisatracurio I-TREATMENT +2 I-TREATMENT +mg/kg, I-TREATMENT +intubación I-TREATMENT +orotraqueal I-TREATMENT +con I-TREATMENT +tubo I-TREATMENT +5.0 I-TREATMENT +sin I-TREATMENT +balón, I-TREATMENT +mantenimiento I-TREATMENT +anestésico I-TREATMENT +balanceado I-TREATMENT +con I-TREATMENT +remifentanilo I-TREATMENT +en I-TREATMENT +infusión I-TREATMENT +titulada I-TREATMENT +y I-TREATMENT +sevoflurano I-TREATMENT +a I-TREATMENT +0, I-TREATMENT +8 I-TREATMENT +MAC, I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +con I-TREATMENT +volumen I-TREATMENT +corriente I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +ml/kg, I-TREATMENT +frecuencia I-TREATMENT +respiratoria I-TREATMENT +22 I-TREATMENT +por I-TREATMENT +minuto, I-TREATMENT +PEEP I-TREATMENT +5 I-TREATMENT +cmH2O I-TREATMENT +y I-TREATMENT +FiO2 I-TREATMENT +70%. I-TREATMENT +Después I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +posicionó I-TREATMENT +en I-TREATMENT +decúbito I-TREATMENT +lateral I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +flexión I-TREATMENT +de I-TREATMENT +las I-TREATMENT +caderas. I-TREATMENT +En I-TREATMENT +esta I-TREATMENT +posición I-TREATMENT +realizamos I-TREATMENT +un I-TREATMENT +escaneo I-TREATMENT +previo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +caudal I-TREATMENT +utilizando I-TREATMENT +un I-TREATMENT +equipo I-TREATMENT +SonoSite I-TREATMENT +M-Turbo® I-TREATMENT +con I-TREATMENT +transductor I-TREATMENT +lineal I-TREATMENT +L25x I-TREATMENT +de I-TREATMENT +13-6 I-TREATMENT +MHz, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +identificaron I-TREATMENT +los I-TREATMENT +distintas I-TREATMENT +estructuras I-TREATMENT +a I-TREATMENT +ese I-TREATMENT +nivel I-TREATMENT +incluida I-TREATMENT +la I-TREATMENT +membrana I-TREATMENT +sacro-coxígea I-TREATMENT +y I-TREATMENT +los I-TREATMENT +cuernos I-TREATMENT +sacros. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +antisepsia I-TREATMENT +con I-TREATMENT +clorhexidina I-TREATMENT +al I-TREATMENT +4% I-TREATMENT +en I-TREATMENT +zona I-TREATMENT +lumbosacra I-TREATMENT +y I-TREATMENT +perineal I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cubrió I-TREATMENT +con I-TREATMENT +campos I-TREATMENT +estériles. I-TREATMENT +Con I-TREATMENT +técnica I-TREATMENT +aséptica I-TREATMENT +nuevamente I-TREATMENT +se I-TREATMENT +escanearon I-TREATMENT +las I-TREATMENT +estructuras I-TREATMENT +y I-TREATMENT +con I-TREATMENT +el I-TREATMENT +transductor I-TREATMENT +en I-TREATMENT +el I-TREATMENT +eje I-TREATMENT +longitudinal I-TREATMENT +al I-TREATMENT +sacro I-TREATMENT +y I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +abordar I-TREATMENT +el I-TREATMENT +espacio I-TREATMENT +caudal I-TREATMENT +en I-TREATMENT +plano I-TREATMENT +con I-TREATMENT +una I-TREATMENT +aguja I-TREATMENT +20G I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +cm I-TREATMENT +para I-TREATMENT +técnica I-TREATMENT +continua I-TREATMENT +(Set I-TREATMENT +StimuLong I-TREATMENT +Sono I-TREATMENT +catheter I-TREATMENT +PAJUNK®). I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +allí I-TREATMENT +y I-TREATMENT +bajo I-TREATMENT +visión I-TREATMENT +ultrasonográfica I-TREATMENT +directa I-TREATMENT +se I-TREATMENT +pasó I-TREATMENT +el I-TREATMENT +catéter I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +aguja, I-TREATMENT +avanzándolo I-TREATMENT +hasta I-TREATMENT +una I-TREATMENT +distancia I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +cm, I-TREATMENT +quedando I-TREATMENT +3 I-TREATMENT +cm I-TREATMENT +en I-TREATMENT +el I-TREATMENT +espacio I-TREATMENT +caudal, I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +la I-TREATMENT +aguja I-TREATMENT +y I-TREATMENT +se I-TREATMENT +instaló I-TREATMENT +el I-TREATMENT +filtro I-TREATMENT +del I-TREATMENT +equipo. I-TREATMENT +Visualizando I-TREATMENT +la I-TREATMENT +punta I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +en I-TREATMENT +el I-TREATMENT +espacio I-TREATMENT +caudal I-TREATMENT +y I-TREATMENT +con I-TREATMENT +el I-TREATMENT +modo I-TREATMENT +Doppler I-TREATMENT +color I-TREATMENT +activado I-TREATMENT +en I-TREATMENT +el I-TREATMENT +quipo I-TREATMENT +se I-TREATMENT +inyectó I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +bolo I-TREATMENT +de I-TREATMENT +16 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +mezcla I-TREATMENT +anestésica I-TREATMENT +(bupivacaína I-TREATMENT +0, I-TREATMENT +5% I-TREATMENT +con I-TREATMENT +epinefrina I-TREATMENT +1: I-TREATMENT +200.000, I-TREATMENT +8 I-TREATMENT +ml I-TREATMENT ++ I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +0, I-TREATMENT +9% I-TREATMENT +estéril I-TREATMENT +8 I-TREATMENT +ml) I-TREATMENT +visualizando I-TREATMENT +la I-TREATMENT +estela I-TREATMENT +de I-TREATMENT +color I-TREATMENT +(efecto I-TREATMENT +Doppler) I-TREATMENT +confirmando I-TREATMENT +flujo I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +espacio I-TREATMENT +epidural. I-TREATMENT +Finalmente I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +externa I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +fue I-TREATMENT +dirigida I-TREATMENT +hacia I-TREATMENT +cefálico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cubrió I-TREATMENT +con I-TREATMENT +apósitos I-TREATMENT +estériles I-TREATMENT +3M™ I-TREATMENT +Tegaderm™. I-TREATMENT + I-TREATMENT +Después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +del I-TREATMENT +catéter, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +reposicionó I-TREATMENT +en I-TREATMENT +decúbito I-TREATMENT +supino I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +llevada I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +conglomerado I-TREATMENT +tumoral I-TREATMENT +sobre I-TREATMENT +vasos I-TREATMENT +inguinales I-TREATMENT +los I-TREATMENT +cuales I-TREATMENT +se I-TREATMENT +liberaron, I-TREATMENT +se I-TREATMENT +envió I-TREATMENT +un I-TREATMENT +espécimen I-TREATMENT +inicial I-TREATMENT +reseccionado I-TREATMENT +para I-TREATMENT +biopsia I-TREATMENT +por I-TREATMENT +congelación, I-TREATMENT +que I-TREATMENT +resultó I-TREATMENT +positiva I-TREATMENT +en I-TREATMENT +los I-TREATMENT +márgenes I-TREATMENT +y I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +ampliar I-TREATMENT +dicha I-TREATMENT +resección I-TREATMENT +con I-TREATMENT +nuevo I-TREATMENT +resultado I-TREATMENT +negativo. I-TREATMENT +Se I-TREATMENT +resecó I-TREATMENT +vasto I-TREATMENT +medial I-TREATMENT +y I-TREATMENT +crural I-TREATMENT +completamente I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +afectada. I-TREATMENT +Se I-TREATMENT +dejaron I-TREATMENT +8 I-TREATMENT +catéteres I-TREATMENT +para I-TREATMENT +braquiterapia. I-TREATMENT +La I-TREATMENT +pérdida I-TREATMENT +sanguínea I-TREATMENT +fue I-TREATMENT +aproximadamente I-TREATMENT +de I-TREATMENT +50 I-TREATMENT +ml I-TREATMENT +y I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +transfundida. I-TREATMENT +La I-TREATMENT +duración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +15 I-TREATMENT +minutos I-TREATMENT +y I-TREATMENT +los I-TREATMENT +requerimientos I-TREATMENT +anestésicos I-TREATMENT +durante I-TREATMENT +su I-TREATMENT +realización I-TREATMENT +fueron I-TREATMENT +mínimos. I-TREATMENT +Al I-TREATMENT +finalizar I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +aplicaron I-TREATMENT +2 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +morfina I-TREATMENT +intravenosos, I-TREATMENT +se I-TREATMENT +extubó I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +llevada I-TREATMENT +a I-TREATMENT +recuperación I-TREATMENT +para I-TREATMENT +vigilancia I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +la I-TREATMENT +infusión I-TREATMENT +por I-TREATMENT +el I-TREATMENT +catéter I-TREATMENT +caudal I-TREATMENT +a I-TREATMENT +3 I-TREATMENT +ml/h I-TREATMENT +de I-TREATMENT +una I-TREATMENT +mezcla I-TREATMENT +de I-TREATMENT +fentanilo I-TREATMENT +3 I-TREATMENT +µg/ml I-TREATMENT +y I-TREATMENT +bupivacaína I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +1% I-TREATMENT +sin I-TREATMENT +epinefrina. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +estable I-EVOLUTION +en I-EVOLUTION +recuperación I-EVOLUTION +durante I-EVOLUTION +3 I-EVOLUTION +horas I-EVOLUTION +más I-EVOLUTION +sin I-EVOLUTION +requerir I-EVOLUTION +suplementos I-EVOLUTION +analgésicos I-EVOLUTION +y I-EVOLUTION +luego I-EVOLUTION +fue I-EVOLUTION +trasladada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +habitación I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +general I-EVOLUTION +pediátrica. I-EVOLUTION +Los B-TREATMENT +medicamentos I-TREATMENT +analgésicos I-TREATMENT +que I-TREATMENT +recibió I-TREATMENT +adicionalmente I-TREATMENT +durante I-TREATMENT +su I-TREATMENT +hospitalización I-TREATMENT +fueron I-TREATMENT +acetaminofeno I-TREATMENT +240 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +horas I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +diclofenaco I-TREATMENT +15 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +vía I-TREATMENT +intravenosa I-TREATMENT +por I-TREATMENT +horario, I-TREATMENT +con I-TREATMENT +rescates I-TREATMENT +de I-TREATMENT +hidromorfona I-TREATMENT +a I-TREATMENT +necesidad. I-TREATMENT +El B-EVOLUTION +seguimiento I-EVOLUTION +analgésico I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +se I-EVOLUTION +detalla I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +tabla I-EVOLUTION +I. I-EVOLUTION +No B-TREATMENT +fueron I-TREATMENT +requeridos I-TREATMENT +rescates I-TREATMENT +con I-TREATMENT +opioides. I-TREATMENT +El I-TREATMENT +catéter I-TREATMENT +fue I-TREATMENT +retirado I-TREATMENT +al I-TREATMENT +tercer I-TREATMENT +día I-TREATMENT +postoperatorio I-TREATMENT +después I-TREATMENT +de I-TREATMENT +70 I-TREATMENT +horas I-TREATMENT +de I-TREATMENT +colocado I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT +El B-EVOLUTION +mismo I-EVOLUTION +día I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +con I-EVOLUTION +adecuado I-EVOLUTION +control I-EVOLUTION +del I-EVOLUTION +dolor, I-EVOLUTION +medicación I-EVOLUTION +oral I-EVOLUTION +e I-EVOLUTION +instrucciones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +48 I-PAST_MEDICAL_HISTORY +kg, I-PAST_MEDICAL_HISTORY +talla I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +156 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ASA I-PAST_MEDICAL_HISTORY +III. I-PAST_MEDICAL_HISTORY +Exfumadora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +diarios, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ceguera I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +postraumática I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dificultad I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +marcha I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +apoyo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +estudiada. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cirugía I-PRESENT_ILLNESS +vascular I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +isquemia I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +grado I-PRESENT_ILLNESS +IV, I-PRESENT_ILLNESS +pendiente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +quirúrgico I-PRESENT_ILLNESS +mediante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +amputación I-PRESENT_ILLNESS +supracondílea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dicho I-PRESENT_ILLNESS +miembro. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-EXPLORATION +estudio I-EXPLORATION +preoperatorio I-EXPLORATION +mostró: I-EXPLORATION +anemia I-EXPLORATION +microcítica I-EXPLORATION +- I-EXPLORATION +hipocrómica, I-EXPLORATION +coagulación I-EXPLORATION +y I-EXPLORATION +bioquímica I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +trastorno I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +repolarización I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +electrocardiograma. I-EXPLORATION + I-EXPLORATION +Durante I-EXPLORATION +su I-EXPLORATION +estancia I-EXPLORATION +en I-EXPLORATION +dicho I-EXPLORATION +servicio I-EXPLORATION +mantuvo I-EXPLORATION +dolor I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +derecho, I-EXPLORATION +continuo I-EXPLORATION +y I-EXPLORATION +progresivamente I-EXPLORATION +intolerable, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +epidural I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +L3-L4 I-TREATMENT +para I-TREATMENT +la I-TREATMENT +conexión I-TREATMENT +de I-TREATMENT +una I-TREATMENT +bomba I-TREATMENT +de I-TREATMENT +infusión I-TREATMENT +PCA I-TREATMENT +(Analgesia I-TREATMENT +Controlada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +Paciente) I-TREATMENT +y I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +una I-TREATMENT +solución I-TREATMENT +compuesta I-TREATMENT +por I-TREATMENT +ropivacaína I-TREATMENT +0, I-TREATMENT +2 I-TREATMENT +% I-TREATMENT +más I-TREATMENT +cloruro I-TREATMENT +mórfico I-TREATMENT +0, I-TREATMENT +004 I-TREATMENT +% I-TREATMENT +a I-TREATMENT +una I-TREATMENT +velocidad I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +ml/h I-TREATMENT +y I-TREATMENT +bolos I-TREATMENT +de I-TREATMENT +rescate I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +ml. I-TREATMENT +La I-TREATMENT +punción I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +con I-TREATMENT +una I-TREATMENT +aguja I-TREATMENT +Tuohy I-TREATMENT +18 I-TREATMENT +G. I-TREATMENT +La I-TREATMENT +colocación I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +fue I-TREATMENT +técnicamente I-TREATMENT +sencilla I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT +No I-TREATMENT +hubo I-TREATMENT +aspiración I-TREATMENT +de I-TREATMENT +sangre I-TREATMENT +o I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +cefalorraquídeo I-TREATMENT +y I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +test I-TREATMENT +(4 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +bupivacaína I-TREATMENT +0, I-TREATMENT +25 I-TREATMENT +% I-TREATMENT +con I-TREATMENT +vasoconstrictor) I-TREATMENT +fue I-TREATMENT +negativa. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +había I-TREATMENT +recibido I-TREATMENT +tratamiento I-TREATMENT +anticoagulante I-TREATMENT +durante I-TREATMENT +las I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +previas I-TREATMENT +a I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +del I-TREATMENT +catéter. I-TREATMENT +Tras B-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +colocación I-EVOLUTION +del I-EVOLUTION +catéter I-EVOLUTION +epidural I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +preexistentes: I-EVOLUTION +mayor I-EVOLUTION +severidad I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +del I-EVOLUTION +miembro I-EVOLUTION +inferior I-EVOLUTION +derecho, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +bloqueo I-EVOLUTION +motor I-EVOLUTION +completo I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +miembros I-EVOLUTION +inferiores. I-EVOLUTION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +suspender I-TREATMENT +la I-TREATMENT +perfusión I-TREATMENT +a I-TREATMENT +través I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +epidural I-TREATMENT +y I-TREATMENT +se I-TREATMENT +reevaluó I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +pasadas I-TREATMENT +2, I-TREATMENT +4 I-TREATMENT +y I-TREATMENT +8 I-TREATMENT +horas. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +exploración I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +8 I-EXPLORATION +horas I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +monoplejía I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +monoparesia I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +incontinencia I-EXPLORATION +del I-EXPLORATION +esfínter I-EXPLORATION +anal I-EXPLORATION +(la I-EXPLORATION +paciente I-EXPLORATION +era I-EXPLORATION +portadora I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +sonda I-EXPLORATION +vesical). I-EXPLORATION +En I-EXPLORATION +todo I-EXPLORATION +momento, I-EXPLORATION +nuestra I-EXPLORATION +paciente I-EXPLORATION +negó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +lumbar. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +retirada I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +epidural I-TREATMENT +solicitándose B-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +con I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +lumbar I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +fracturas I-EXPLORATION +vertebrales I-EXPLORATION +L1, I-EXPLORATION +L2 I-EXPLORATION +y I-EXPLORATION +L4 I-EXPLORATION +y I-EXPLORATION +protrusión I-EXPLORATION +discal I-EXPLORATION +L3-L4 I-EXPLORATION +que I-EXPLORATION +condicionaba I-EXPLORATION +compromiso I-EXPLORATION +radicular I-EXPLORATION +(más I-EXPLORATION +marcado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +derecho) I-EXPLORATION +e I-EXPLORATION +importante I-EXPLORATION +estenosis I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +lumbar, I-EXPLORATION +agravada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +epidural I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +a I-EXPLORATION +dicho I-EXPLORATION +nivel. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +dexametasona I-TREATMENT +4 I-TREATMENT +mg/6 I-TREATMENT +h, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +su I-TREATMENT +traslado I-TREATMENT +al I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +neurocirugía I-TREATMENT +para I-TREATMENT +su I-TREATMENT +valoración. I-TREATMENT + I-TREATMENT +Durante B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +neurocirugía I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +electromiografía, I-EXPLORATION +objetivándose I-EXPLORATION +una I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +nervioso I-EXPLORATION +periférico I-EXPLORATION +que I-EXPLORATION +podría I-EXPLORATION +corresponderse I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +polineuropatía I-EXPLORATION +mixta. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +todos I-EXPLORATION +estos I-EXPLORATION +datos, I-EXPLORATION +se I-EXPLORATION +consideró I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +era I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +conjunción I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +patologías, I-EXPLORATION +desestimándose I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +quirúrgica I-EXPLORATION +dado I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +beneficiaría I-EXPLORATION +de I-EXPLORATION +dicho I-EXPLORATION +tratamiento. I-EXPLORATION + I-EXPLORATION +Finalmente, B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +trasladada I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +vascular I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +completar I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +quirúrgico. I-DERIVED_FROM/TO +La B-TREATMENT +amputación I-TREATMENT +supracondílea I-TREATMENT +del I-TREATMENT +miembro I-TREATMENT +inferior I-TREATMENT +derecho I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +con I-TREATMENT +mascarilla I-TREATMENT +laríngea I-TREATMENT +i-gel™ I-TREATMENT +(Intersurgical I-TREATMENT +Ltd., I-TREATMENT +Wokingham, I-TREATMENT +England) I-TREATMENT +número I-TREATMENT +4. I-TREATMENT +La I-TREATMENT +inducción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +anestesia I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +intravenosa I-TREATMENT +de I-TREATMENT +fentanilo I-TREATMENT +2 I-TREATMENT +µg/kg I-TREATMENT +y I-TREATMENT +propofol I-TREATMENT +2 I-TREATMENT +mg/kg. I-TREATMENT +El I-TREATMENT +mantenimiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +con I-TREATMENT +sevofluorano I-TREATMENT +2 I-TREATMENT +% I-TREATMENT +en I-TREATMENT +una I-TREATMENT +mezcla I-TREATMENT +de I-TREATMENT +oxígeno I-TREATMENT +- I-TREATMENT +aire I-TREATMENT +con I-TREATMENT +un I-TREATMENT +flujo I-TREATMENT +de I-TREATMENT +gas I-TREATMENT +fresco I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +l/min. I-TREATMENT +La I-TREATMENT +administración I-TREATMENT +adicional I-TREATMENT +de I-TREATMENT +fentanilo I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +según I-TREATMENT +parámetros I-TREATMENT +clínicos, I-TREATMENT +cifras I-TREATMENT +de I-TREATMENT +tensión I-TREATMENT +arterial I-TREATMENT +y I-TREATMENT +frecuencia I-TREATMENT +cardiaca. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +monitorización I-TREATMENT +estándar I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +constatándose I-TREATMENT +estabilidad I-TREATMENT +hemodinámica I-TREATMENT +durante I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +cirugía. I-TREATMENT +Al B-EVOLUTION +finalizar I-EVOLUTION +el I-EVOLUTION +procedimiento I-EVOLUTION +quirúrgico I-EVOLUTION +se I-EVOLUTION +retiró I-EVOLUTION +la I-EVOLUTION +mascarilla I-EVOLUTION +laríngea I-EVOLUTION +cuando I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +estuvo I-EVOLUTION +completamente I-EVOLUTION +despierta. I-EVOLUTION +Fue I-EVOLUTION +trasladada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Recuperación I-EVOLUTION +Postanestésica I-EVOLUTION +donde I-EVOLUTION +permaneció I-EVOLUTION +durante I-EVOLUTION +2 I-EVOLUTION +horas. I-EVOLUTION +Su I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +SDRC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +extremidad I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +esguince I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +ocurrido I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +llegada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad. I-PRESENT_ILLNESS +Colocación B-TREATMENT +en I-TREATMENT +quirófano, I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +de I-TREATMENT +un I-TREATMENT +electrodo I-TREATMENT +octopolar I-TREATMENT +(Octrode) I-TREATMENT +de I-TREATMENT +la I-TREATMENT +firma I-TREATMENT +ANS I-TREATMENT +(Advances I-TREATMENT +Neurological I-TREATMENT +Systems I-TREATMENT +Inc, I-TREATMENT +Plano. I-TREATMENT +USA) I-TREATMENT +entre I-TREATMENT +T8-T12 I-TREATMENT +y I-TREATMENT +conexión I-TREATMENT +a I-TREATMENT +un I-TREATMENT +generador I-TREATMENT +de I-TREATMENT +impulsos I-TREATMENT +eléctricos I-TREATMENT +externo. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +despierta I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +la I-TREATMENT +programación I-TREATMENT +del I-TREATMENT +sistema I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +localización I-TREATMENT +de I-TREATMENT +las I-TREATMENT +parestesias I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +afectada. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +revisó I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +observándose I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +respuesta, I-EVOLUTION +tanto I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +como I-EVOLUTION +del I-EVOLUTION +resto I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +acompañante, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +colocación, I-TREATMENT +en I-TREATMENT +quirófano I-TREATMENT +y I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general, I-TREATMENT +de I-TREATMENT +un I-TREATMENT +generador I-TREATMENT +de I-TREATMENT +impulsos I-TREATMENT +eléctricos I-TREATMENT +implantable I-TREATMENT +y I-TREATMENT +programable, I-TREATMENT +marca I-TREATMENT +Génesis. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +revisó I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +semana, I-EVOLUTION +15 I-EVOLUTION +y I-EVOLUTION +30 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +implantación I-EVOLUTION +del I-EVOLUTION +generador, I-EVOLUTION +observando I-EVOLUTION +que I-EVOLUTION +había I-EVOLUTION +iniciado I-EVOLUTION +los I-EVOLUTION +ejercicios I-EVOLUTION +de I-EVOLUTION +rehabilitación I-EVOLUTION +que I-EVOLUTION +antes I-EVOLUTION +no I-EVOLUTION +podía I-EVOLUTION +hacer I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +intenso I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +alodinia I-EVOLUTION +del I-EVOLUTION +tobillo I-EVOLUTION +y I-EVOLUTION +pie, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +también I-EVOLUTION +había I-EVOLUTION +vuelto I-EVOLUTION +al I-EVOLUTION +colegio I-EVOLUTION +primero I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +ayuda I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +muleta I-EVOLUTION +y I-EVOLUTION +después I-EVOLUTION +sin I-EVOLUTION +protección I-EVOLUTION +alguna I-EVOLUTION +haciendo I-EVOLUTION +una I-EVOLUTION +vida I-EVOLUTION +completamente I-EVOLUTION +normal I-EVOLUTION +para I-EVOLUTION +su I-EVOLUTION +edad. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +implantación I-EVOLUTION +del I-EVOLUTION +generador, I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +revisión I-EVOLUTION +realizada I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +encontramos I-EVOLUTION +que, I-EVOLUTION +tanto I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +como I-EVOLUTION +el I-EVOLUTION +edema I-EVOLUTION +articular I-EVOLUTION +estaban I-EVOLUTION +haciendo I-EVOLUTION +su I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +desde I-EVOLUTION +hacía I-EVOLUTION +una I-EVOLUTION +semana. I-EVOLUTION +Se B-EXPLORATION +comprobó I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +batería I-EXPLORATION +del I-EXPLORATION +generador I-EXPLORATION +implantable I-EXPLORATION +se I-EXPLORATION +estaba I-EXPLORATION +agotando, I-EXPLORATION +debido I-EXPLORATION +al I-EXPLORATION +funcionamiento I-EXPLORATION +continuo I-EXPLORATION +que I-EXPLORATION +había I-EXPLORATION +sido I-EXPLORATION +necesario I-EXPLORATION +hacer I-EXPLORATION +para I-EXPLORATION +mantener I-EXPLORATION +controlados I-EXPLORATION +los I-EXPLORATION +síntomas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente, I-EXPLORATION +ante B-TREATMENT +esta I-TREATMENT +situación I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +implantar I-TREATMENT +un I-TREATMENT +generador I-TREATMENT +recargable, I-TREATMENT +marca I-TREATMENT +EON I-TREATMENT +Mini, I-TREATMENT +que I-TREATMENT +le I-TREATMENT +permita I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +una I-TREATMENT +prolongación I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tiempo I-TREATMENT +de I-TREATMENT +recambio I-TREATMENT +del I-TREATMENT +generador. I-TREATMENT +Este I-TREATMENT +nuevo I-TREATMENT +generador I-TREATMENT +también I-TREATMENT +se I-TREATMENT +implantó I-TREATMENT +en I-TREATMENT +quirófano I-TREATMENT +y I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general. I-TREATMENT +La B-EVOLUTION +niña I-EVOLUTION +ha I-EVOLUTION +vuelto I-EVOLUTION +al I-EVOLUTION +colegio I-EVOLUTION +con I-EVOLUTION +control I-EVOLUTION +tanto I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +como I-EVOLUTION +del I-EVOLUTION +resto I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas, I-EVOLUTION +permaneciendo, I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +totalmente I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Niña B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +13 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +diagnosticó I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +SDRC I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +extremidad I-PAST_MEDICAL_HISTORY +inferior I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tobillo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Fue B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Dolor I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Traumatología I-DERIVED_FROM/TO +Pediátrica. I-DERIVED_FROM/TO +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +farmacológico I-TREATMENT +sin I-TREATMENT +resultado I-TREATMENT +analgésico I-TREATMENT +adecuado I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +(previa I-TREATMENT +información I-TREATMENT +y I-TREATMENT +obtención I-TREATMENT +del I-TREATMENT +consentimiento I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +los I-TREATMENT +padres) I-TREATMENT +la I-TREATMENT +implantación, I-TREATMENT +en I-TREATMENT +quirófano I-TREATMENT +y I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general, I-TREATMENT +de I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +epidural I-TREATMENT +lumbar I-TREATMENT +conectado I-TREATMENT +a I-TREATMENT +una I-TREATMENT +bomba I-TREATMENT +externa I-TREATMENT +para I-TREATMENT +administrar I-TREATMENT +una I-TREATMENT +infusión I-TREATMENT +continua I-TREATMENT +de I-TREATMENT +bupivacaína I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +semanas. I-TREATMENT +Se B-EVOLUTION +obtuvo I-EVOLUTION +un I-EVOLUTION +alivio I-EVOLUTION +completo I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +del I-EVOLUTION +resto I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas, I-EVOLUTION +pero I-EVOLUTION +este I-EVOLUTION +desapareció I-EVOLUTION +una I-EVOLUTION +vez I-EVOLUTION +retirada I-EVOLUTION +la I-EVOLUTION +infusión I-EVOLUTION +de I-EVOLUTION +bupivacaína I-EVOLUTION +volviendo I-EVOLUTION +a I-EVOLUTION +aparecer I-EVOLUTION +tanto I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +como I-EVOLUTION +el I-EVOLUTION +resto I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +acompañantes. I-EVOLUTION + I-EVOLUTION +Previa B-TREATMENT +información I-TREATMENT +y I-TREATMENT +consentimiento I-TREATMENT +paterno I-TREATMENT +se I-TREATMENT +implantó I-TREATMENT +en I-TREATMENT +quirófano, I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general, I-TREATMENT +un I-TREATMENT +electrodo I-TREATMENT +octopolar I-TREATMENT +en I-TREATMENT +cordones I-TREATMENT +medulares I-TREATMENT +posteriores I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +T12-T9 I-TREATMENT +y I-TREATMENT +se I-TREATMENT +conectó I-TREATMENT +a I-TREATMENT +un I-TREATMENT +generador I-TREATMENT +de I-TREATMENT +impulsos I-TREATMENT +eléctricos I-TREATMENT +externo. I-TREATMENT +Se B-EVOLUTION +programó I-EVOLUTION +una I-EVOLUTION +vez I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +estaba I-EVOLUTION +despierta I-EVOLUTION +consiguiéndose I-EVOLUTION +un I-EVOLUTION +buen I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +parestesias I-EVOLUTION +con I-EVOLUTION +alivio I-EVOLUTION +completo I-EVOLUTION +del I-EVOLUTION +dolor. I-EVOLUTION +Ello I-EVOLUTION +permitió I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +iniciara I-EVOLUTION +la I-EVOLUTION +rehabilitación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +afectada. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +se I-EVOLUTION +revisó I-EVOLUTION +observándose I-EVOLUTION +que I-EVOLUTION +continuaba I-EVOLUTION +el I-EVOLUTION +alivio I-EVOLUTION +sin I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +utilizase I-EVOLUTION +el I-EVOLUTION +generador I-EVOLUTION +de I-EVOLUTION +impulsos I-EVOLUTION +externo. I-EVOLUTION +Ante B-TREATMENT +esta I-TREATMENT +situación I-TREATMENT +se I-TREATMENT +desconectó I-TREATMENT +el I-TREATMENT +generador I-TREATMENT +externo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +rehabilitador I-TREATMENT +citando I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +cuatro I-TREATMENT +semanas I-TREATMENT +más I-TREATMENT +tarde. I-TREATMENT +Ante B-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +acompañantes, I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +(de I-EVOLUTION +acuerdo I-EVOLUTION +con I-EVOLUTION +los I-EVOLUTION +padres) I-EVOLUTION +explantar I-EVOLUTION +el I-EVOLUTION +electrodo I-EVOLUTION +medular. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +remisión I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +esguince I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tratado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Traumatología I-PRESENT_ILLNESS +Pediátrica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +remitido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +unidad I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuadro. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-TREATMENT +inició I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +farmacológico I-TREATMENT +(gabapentina I-TREATMENT +más I-TREATMENT +tramadol) I-TREATMENT +con I-TREATMENT +remisión I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +de I-TREATMENT +dolor I-TREATMENT +que I-TREATMENT +permitió I-TREATMENT +el I-TREATMENT +inicio I-TREATMENT +de I-TREATMENT +la I-TREATMENT +rehabilitación I-TREATMENT +del I-TREATMENT +pie. I-TREATMENT +Continúa B-EVOLUTION +en I-EVOLUTION +igual I-EVOLUTION +situación. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +inicia I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuadro. I-PRESENT_ILLNESS +Presenta I-PRESENT_ILLNESS +esguince I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +desarrollo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +SDRC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +Es B-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Dolor I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Reumatología I-DERIVED_FROM/TO +Pediátrica I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +cuatro I-DERIVED_FROM/TO +años I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +diagnóstico. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-TREATMENT +le I-TREATMENT +administra I-TREATMENT +tratamiento I-TREATMENT +farmacológico I-TREATMENT +más I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +parche I-TREATMENT +de I-TREATMENT +capsaicina I-TREATMENT +al I-TREATMENT +8 I-TREATMENT +% I-TREATMENT +sin I-TREATMENT +remisión I-TREATMENT +del I-TREATMENT +cuadro. I-TREATMENT +Colocación I-TREATMENT +en I-TREATMENT +quirófano, I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +y I-TREATMENT +previo I-TREATMENT +consentimiento I-TREATMENT +paterno, I-TREATMENT +de I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +epidural I-TREATMENT +lumbar I-TREATMENT +y I-TREATMENT +conexión I-TREATMENT +a I-TREATMENT +una I-TREATMENT +bomba I-TREATMENT +externa I-TREATMENT +para I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +una I-TREATMENT +infusión I-TREATMENT +continúa I-TREATMENT +de I-TREATMENT +bupivacaína I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +semanas. I-TREATMENT +Retirada I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +pasado I-TREATMENT +ese I-TREATMENT +tiempo. I-TREATMENT +Remisión B-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +diagnóstico. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +previo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +esguince I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +Fue B-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +4 I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +después I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +diagnóstico. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-TREATMENT +le I-TREATMENT +administra I-TREATMENT +tratamiento I-TREATMENT +farmacológico I-TREATMENT +más I-TREATMENT +aplicación I-TREATMENT +del I-TREATMENT +parche I-TREATMENT +de I-TREATMENT +capsaicina I-TREATMENT +al I-TREATMENT +8 I-TREATMENT +%. I-TREATMENT +Remisión B-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas I-PAST_MEDICAL_HISTORY +conocidas I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +sacro I-PRESENT_ILLNESS +incapacitante, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manera I-PRESENT_ILLNESS +continua I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cierta I-PRESENT_ILLNESS +irradiación I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +porción I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +apreciaba I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +sensitivas I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esfínteres. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Por I-PRESENT_ILLNESS +dicho I-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +hospitales. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +practicaron I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +lumbar I-EXPLORATION +que I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +relieve I-EXPLORATION +un I-EXPLORATION +hemangioma I-EXPLORATION +en I-EXPLORATION +L5, I-EXPLORATION +una I-EXPLORATION +RMN I-EXPLORATION +de I-EXPLORATION +pelvis I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +rotura I-EXPLORATION +muscular I-EXPLORATION +grado I-EXPLORATION +I I-EXPLORATION +del I-EXPLORATION +glúteo I-EXPLORATION +mayor I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +estructura I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +interpretó I-EXPLORATION +como I-EXPLORATION +quiste I-EXPLORATION +de I-EXPLORATION +Tarlov I-EXPLORATION +sacro. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +paracetamol, I-TREATMENT +nolotil, I-TREATMENT +tramadol I-TREATMENT +y I-TREATMENT +gabapentina I-TREATMENT +sin I-TREATMENT +mejoría. I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +realizaron I-TREATMENT +dos I-TREATMENT +bloqueos I-TREATMENT +facetarios I-TREATMENT +e I-TREATMENT +incluso I-TREATMENT +un I-TREATMENT +bloqueo I-TREATMENT +del I-TREATMENT +músculo I-TREATMENT +piriforme I-TREATMENT +izquierdo, I-TREATMENT +todo I-TREATMENT +ello I-TREATMENT +sin I-TREATMENT +resultados. I-TREATMENT +En B-EVOLUTION +este I-EVOLUTION +último I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +quedó I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +hipoestesia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +inferior I-EVOLUTION +izquierda I-EVOLUTION +residual. I-EVOLUTION +Fue B-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +ante I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +este I-DERIVED_FROM/TO +pudiera I-DERIVED_FROM/TO +ser I-DERIVED_FROM/TO +causado I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +hemangioma I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +L5. I-DERIVED_FROM/TO +La B-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +estaba I-EXPLORATION +consciente I-EXPLORATION +y I-EXPLORATION +orientada. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lenguaje. I-EXPLORATION +La I-EXPLORATION +función I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pares I-EXPLORATION +craneales I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Presentaba I-EXPLORATION +un I-EXPLORATION +dolor I-EXPLORATION +muy I-EXPLORATION +importante I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +sacra I-EXPLORATION +8/10 I-EXPLORATION +según I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +EVA, I-EXPLORATION +aproximadamente I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +S2 I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +fuerza I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +4/5, I-EXPLORATION +con I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +flexo-extensión I-EXPLORATION +distal. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +extremidades I-EXPLORATION +la I-EXPLORATION +fuerza I-EXPLORATION +era I-EXPLORATION +5/5. I-EXPLORATION +Se I-EXPLORATION +advirtió I-EXPLORATION +una I-EXPLORATION +hipoestesia I-EXPLORATION +en I-EXPLORATION +territorio I-EXPLORATION +de I-EXPLORATION +L5. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Babinsky. I-EXPLORATION +La I-EXPLORATION +deambulación I-EXPLORATION +era I-EXPLORATION +dificultosa. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +general I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +alteraciones I-EXPLORATION +destacables. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +RM I-EXPLORATION +(Philips I-EXPLORATION +Medical I-EXPLORATION +Systems) I-EXPLORATION +lumbosacra I-EXPLORATION +en I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +visualizaban I-EXPLORATION +hemangiomas I-EXPLORATION +vertebrales I-EXPLORATION +en I-EXPLORATION +L2 I-EXPLORATION +y I-EXPLORATION +L5, I-EXPLORATION +advirtiéndose I-EXPLORATION +claramente I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +central I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +en I-EXPLORATION +canal I-EXPLORATION +espinal I-EXPLORATION +sacro I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +transición I-EXPLORATION +S2-S3. I-EXPLORATION +Esta I-EXPLORATION +estructura I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +práctica I-EXPLORATION +totalidad I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +y I-EXPLORATION +remodelaba I-EXPLORATION +parcialmente I-EXPLORATION +el I-EXPLORATION +contorno I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +dichos I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +y I-EXPLORATION +elementos I-EXPLORATION +posteriores. I-EXPLORATION +Esta I-EXPLORATION +formación I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +íntimo I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +ambas I-EXPLORATION +raíces I-EXPLORATION +S3 I-EXPLORATION +y I-EXPLORATION +S4 I-EXPLORATION +sin I-EXPLORATION +englobarlas. I-EXPLORATION +Su I-EXPLORATION +morfología I-EXPLORATION +era I-EXPLORATION +ovalada I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +contornos I-EXPLORATION +nítidos I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tamaño I-EXPLORATION +máximo I-EXPLORATION +aproximado I-EXPLORATION +de I-EXPLORATION +22 I-EXPLORATION +X I-EXPLORATION +19 I-EXPLORATION +X I-EXPLORATION +14 I-EXPLORATION +mm. I-EXPLORATION +Según I-EXPLORATION +la I-EXPLORATION +clasificación I-EXPLORATION +de I-EXPLORATION +Nabors I-EXPLORATION +correspondía I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +meningocele I-EXPLORATION +intrasacro I-EXPLORATION +oculto. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +punción I-TREATMENT +(Needle I-TREATMENT +Ostycut I-TREATMENT +150 I-TREATMENT +mm I-TREATMENT +13G I-TREATMENT +Angiomed) I-TREATMENT +y I-TREATMENT +evacuación I-TREATMENT +del I-TREATMENT +quiste I-TREATMENT +sacro I-TREATMENT +guiado I-TREATMENT +por I-TREATMENT +TC I-TREATMENT +(GE I-TREATMENT +Medical I-TREATMENT +Systems I-TREATMENT +BrightSpeed) I-TREATMENT +obteniéndose I-TREATMENT +unos I-TREATMENT +2 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +un I-TREATMENT +líquido I-TREATMENT +hemático. I-TREATMENT +El B-EXPLORATION +examen I-EXPLORATION +citológico I-EXPLORATION +describió I-EXPLORATION +una I-EXPLORATION +celularidad I-EXPLORATION +benigna. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +mejoría I-EVOLUTION +notable I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +sacro I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +escala I-EVOLUTION +de I-EVOLUTION +EVA I-EVOLUTION +era I-EVOLUTION +de I-EVOLUTION +3/10 I-EVOLUTION +reiniciando I-EVOLUTION +la I-EVOLUTION +deambulación I-EVOLUTION +sin I-EVOLUTION +dificultad, I-EVOLUTION +no I-EVOLUTION +presentando I-EVOLUTION +debilidad I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +pierna I-EVOLUTION +izquierda I-EVOLUTION +ni I-EVOLUTION +hipoestesia. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que, B-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +unos I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +molestias I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +parestesias I-PAST_MEDICAL_HISTORY +(no I-PAST_MEDICAL_HISTORY +dolor) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +espalda I-PAST_MEDICAL_HISTORY +(región I-PAST_MEDICAL_HISTORY +dorsal I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +lado I-PAST_MEDICAL_HISTORY +izquierdo) I-PAST_MEDICAL_HISTORY +junto I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +sensibilidad I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +roce I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ropa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +esa I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +(hiperestesia I-PAST_MEDICAL_HISTORY +mecánica). I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetivaba I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +hiperestesia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +escapular I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +hiperestesia I-EXPLORATION +cutánea I-EXPLORATION +y I-EXPLORATION +dinámica, I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +circular I-EXPLORATION +delimitada I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +correspondía I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +hiperpigmentación. I-EXPLORATION +La I-EXPLORATION +RMN I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +cervical I-EXPLORATION +y I-EXPLORATION +dorsal I-EXPLORATION +mostraba I-EXPLORATION +protrusiones I-EXPLORATION +discales I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +C4, I-EXPLORATION +C5, I-EXPLORATION +C6 I-EXPLORATION +y I-EXPLORATION +D1, I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +radicular, I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +medular I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +neurofisiológico I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +no I-TREATMENT +iniciar I-TREATMENT +tratamiento, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +le I-TREATMENT +molestaban I-TREATMENT +dichos I-TREATMENT +síntomas I-TREATMENT +y I-TREATMENT +tampoco I-TREATMENT +era I-TREATMENT +partidario I-TREATMENT +de I-TREATMENT +ello. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +manchas I-PRESENT_ILLNESS +cutáneas I-PRESENT_ILLNESS +extensas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +espalda, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +picor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dichas I-PRESENT_ILLNESS +zonas, I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +todo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +épocas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +calor. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +ellas, I-EXPLORATION +siendo I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +crónico I-EXPLORATION +perivascular I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +melanófagos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +dermis I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +hiperpigmentación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +capa I-EXPLORATION +basal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +epidermis. I-EXPLORATION +Fue I-EXPLORATION +Rojo I-EXPLORATION +Congo I-EXPLORATION +negativo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +pudo I-EXPLORATION +practicar I-EXPLORATION +RMN I-EXPLORATION +por I-EXPLORATION +padecer I-EXPLORATION +claustrofobia. I-EXPLORATION +No B-TREATMENT +requirió I-TREATMENT +tratamiento. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +maculosa I-PRESENT_ILLNESS +adyacente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +columna, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +D5-D7, I-PRESENT_ILLNESS +levemente I-PRESENT_ILLNESS +pruriginosa, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +neurológica, I-EXPLORATION +como I-EXPLORATION +única I-EXPLORATION +alteración I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +hiperestesia I-EXPLORATION +al I-EXPLORATION +pinchazo I-EXPLORATION +justo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +RMN I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +dorsal I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Tampoco B-TREATMENT +requirió I-TREATMENT +tratamiento I-TREATMENT +farmacológico. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +zonas I-PRESENT_ILLNESS +paravertebrales I-PRESENT_ILLNESS +diferenciadas, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +D2 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +D7, I-PRESENT_ILLNESS +paravertebrales I-PRESENT_ILLNESS +ambas. I-PRESENT_ILLNESS +Aumentaba I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +solo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +época I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +calor. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +RMN I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +practicada. I-EXPLORATION +Se B-TREATMENT +intentó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +capsaicina I-TREATMENT +tópica, I-TREATMENT +pero I-TREATMENT +como I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +lo I-TREATMENT +toleraba I-TREATMENT +y I-TREATMENT +en I-TREATMENT +cambio I-TREATMENT +sí I-TREATMENT +el I-TREATMENT +prurito, I-TREATMENT +prefirió I-TREATMENT +no I-TREATMENT +probar I-TREATMENT +otros I-TREATMENT +tratamientos I-TREATMENT +farmacológicos. I-TREATMENT + I-TREATMENT + +En B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2001, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +produce I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +altercado I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +agente I-PAST_MEDICAL_HISTORY +policial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +joven I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +localidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Bilbao. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +consecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +altercado I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +joven I-PAST_MEDICAL_HISTORY +sufre I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +herida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +arma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fuego I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +nalga I-PAST_MEDICAL_HISTORY +izquierda. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +disparo I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +producido I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +arma I-PAST_MEDICAL_HISTORY +reglamentaria I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +agente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +munición I-PAST_MEDICAL_HISTORY +utilizada I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +proyectil I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +mm I-PAST_MEDICAL_HISTORY +Parabellum I-PAST_MEDICAL_HISTORY +Sako-Luger I-PAST_MEDICAL_HISTORY +KPO I-PAST_MEDICAL_HISTORY +[1]. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Las I-PAST_MEDICAL_HISTORY +declaraciones I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +agente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +lesionado I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +contradictorias. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +agente I-PAST_MEDICAL_HISTORY +relató I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +joven, I-PAST_MEDICAL_HISTORY +sentado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +asiento I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dentro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +turismo, I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +encaró I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +arma I-PAST_MEDICAL_HISTORY +hallándose I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +agente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +exterior I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +vehículo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +puerta I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +abierta. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +actitud I-PAST_MEDICAL_HISTORY +defensiva, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +agente I-PAST_MEDICAL_HISTORY +relata I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +disparó I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +lesionado I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +hallaba I-PAST_MEDICAL_HISTORY +dentro I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +vehículo I-PAST_MEDICAL_HISTORY +y, I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +disparo, I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +arrastró I-PAST_MEDICAL_HISTORY +fuera I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +turismo. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +disparo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +escenario I-PAST_MEDICAL_HISTORY +nº I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +correspondiente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +declaraciones I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +agente, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +esquematiza I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +imagen I-PAST_MEDICAL_HISTORY +nº I-PAST_MEDICAL_HISTORY +1. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +declaraciones I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +lesionado I-PAST_MEDICAL_HISTORY +indicó I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +hallándose I-PAST_MEDICAL_HISTORY +sentado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +asiento I-PAST_MEDICAL_HISTORY +trasero I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +vehículo, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +abrió I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +puerta I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +arrastrado I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +asfalto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +carretera I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +agente I-PAST_MEDICAL_HISTORY +policial, I-PAST_MEDICAL_HISTORY +cayendo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +él I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +decúbito I-PAST_MEDICAL_HISTORY +prono I-PAST_MEDICAL_HISTORY +sobre I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +manos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +quedando I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +pies I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +interior I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +turismo. I-PAST_MEDICAL_HISTORY +Una I-PAST_MEDICAL_HISTORY +vez I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +suelo, I-PAST_MEDICAL_HISTORY +escuchó I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sintió I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +disparo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +nalga I-PAST_MEDICAL_HISTORY +izquierda. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +disparo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +escenario I-PAST_MEDICAL_HISTORY +nº I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +correspondiente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +declaraciones I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +lesionado, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +recoge I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +imagen I-PAST_MEDICAL_HISTORY +nº I-PAST_MEDICAL_HISTORY +2. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +HALLAZGOS B-PRESENT_ILLNESS +EXPLORATORIOS I-PRESENT_ILLNESS +Y I-PRESENT_ILLNESS +PRUEBAS I-PRESENT_ILLNESS +COMPLEMENTARIAS: I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +lesionado I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +visto I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +vez I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +forense I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Bilbao I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +hechos, I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +estancia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +hospitalario I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +asistencia I-PRESENT_ILLNESS +urgente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +extracción I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +proyectil. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +en I-EXPLORATION +esta I-EXPLORATION +clínica I-EXPLORATION +médico I-EXPLORATION +forense I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +cicatriz I-EXPLORATION +oval I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +x I-EXPLORATION +1.5 I-EXPLORATION +cms I-EXPLORATION +en I-EXPLORATION +flanco I-EXPLORATION +posterior I-EXPLORATION +izquierdo I-EXPLORATION +(imagen I-EXPLORATION +3). I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +radiográficos I-EXPLORATION +realizados I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +asistencia I-EXPLORATION +en I-EXPLORATION +urgencias I-EXPLORATION +(radiografías I-EXPLORATION +simples I-EXPLORATION +AP I-EXPLORATION +y I-EXPLORATION +laterales I-EXPLORATION +de I-EXPLORATION +pelvis I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +pélvico) I-EXPLORATION +indicaban I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +varios I-EXPLORATION +fragmentos I-EXPLORATION +radiopacos I-EXPLORATION +irregulares I-EXPLORATION +de I-EXPLORATION +diversos I-EXPLORATION +tamaños I-EXPLORATION +localizados I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +glútea I-EXPLORATION +izquierda I-EXPLORATION +(imagen I-EXPLORATION +4). I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +lesiones I-EXPLORATION +óseas I-EXPLORATION +asociadas. I-EXPLORATION + I-EXPLORATION +Dos B-TREATMENT +años I-TREATMENT +después I-TREATMENT +de I-TREATMENT +los I-TREATMENT +hechos, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +extracción I-TREATMENT +quirúrgica I-TREATMENT +de I-TREATMENT +dos I-TREATMENT +fragmentos I-TREATMENT +de I-TREATMENT +proyectil I-TREATMENT +de I-TREATMENT +la I-TREATMENT +nalga I-TREATMENT +izquierda. I-TREATMENT +El I-TREATMENT +médico I-TREATMENT +forense I-TREATMENT +se I-TREATMENT +halla I-TREATMENT +presente I-TREATMENT +en I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +y I-TREATMENT +los I-TREATMENT +fragmentos I-TREATMENT +son I-TREATMENT +recogidos I-TREATMENT +y, I-TREATMENT +sin I-TREATMENT +manipulación I-TREATMENT +previa, I-TREATMENT +remitidos I-TREATMENT +para I-TREATMENT +estudio I-TREATMENT +balístico. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +practicaron I-EXPLORATION +diversas I-EXPLORATION +pruebas I-EXPLORATION +complementarias: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Estudio I-EXPLORATION +criminalístico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +prendas I-EXPLORATION +del I-EXPLORATION +lesionado: I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +camiseta I-EXPLORATION +del I-EXPLORATION +lesionado I-EXPLORATION +indicó I-EXPLORATION +que I-EXPLORATION +existía I-EXPLORATION +un I-EXPLORATION +orifico I-EXPLORATION +de I-EXPLORATION +disparo I-EXPLORATION +con I-EXPLORATION +dos I-EXPLORATION +grandes I-EXPLORATION +desgarros I-EXPLORATION +radiales, I-EXPLORATION +ahumamiento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +(imagen I-EXPLORATION +5) I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +residuos I-EXPLORATION +de I-EXPLORATION +plomo, I-EXPLORATION +bario I-EXPLORATION +y I-EXPLORATION +antimomio I-EXPLORATION +que I-EXPLORATION +indicaron I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +disparo I-EXPLORATION +pudo I-EXPLORATION +ser I-EXPLORATION +producido I-EXPLORATION +a I-EXPLORATION +cañón I-EXPLORATION +tocante I-EXPLORATION +o I-EXPLORATION +a I-EXPLORATION +muy I-EXPLORATION +corta I-EXPLORATION +distancia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +camiseta. I-EXPLORATION +El I-EXPLORATION +orificio I-EXPLORATION +se I-EXPLORATION +hallaba I-EXPLORATION +situado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +camiseta, I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +cuadrante I-EXPLORATION +inferior I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Estudio I-EXPLORATION +del I-EXPLORATION +arma I-EXPLORATION +reglamentaria I-EXPLORATION +utilizada: I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +arma I-EXPLORATION +no I-EXPLORATION +permite I-EXPLORATION +identificar I-EXPLORATION +ninguna I-EXPLORATION +anomalía I-EXPLORATION +en I-EXPLORATION +esta I-EXPLORATION +que I-EXPLORATION +pudiese I-EXPLORATION +haber I-EXPLORATION +producido I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +proyectil I-EXPLORATION +[2]. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +fragmentos I-EXPLORATION +de I-EXPLORATION +proyectil I-EXPLORATION +extraídos I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +del I-EXPLORATION +lesionado: I-EXPLORATION +se I-EXPLORATION +identifican I-EXPLORATION +ambos I-EXPLORATION +fragmentos, I-EXPLORATION +deformados I-EXPLORATION +y I-EXPLORATION +correspondientes I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +extremos I-EXPLORATION +del I-EXPLORATION +culote I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +punta I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +proyectil I-EXPLORATION +camisado I-EXPLORATION +tipo I-EXPLORATION +9 I-EXPLORATION +mm. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +fragmentos I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +residuos I-EXPLORATION +químicos I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +biológicos I-EXPLORATION +y I-EXPLORATION +algún I-EXPLORATION +desinfectante, I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +silicio. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +superficie, I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +surcos I-EXPLORATION +irregulares I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +del I-EXPLORATION +labrado I-EXPLORATION +del I-EXPLORATION +ánima I-EXPLORATION +del I-EXPLORATION +arma. I-EXPLORATION +La I-EXPLORATION +conclusión I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +indica I-EXPLORATION +que I-EXPLORATION +ha I-EXPLORATION +existido I-EXPLORATION +fragmentación I-EXPLORATION +y I-EXPLORATION +rebote I-EXPLORATION +del I-EXPLORATION +proyectil I-EXPLORATION +camisado I-EXPLORATION +9 I-EXPLORATION +mm I-EXPLORATION +contra I-EXPLORATION +una I-EXPLORATION +superficie I-EXPLORATION +irregular. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +escena I-EXPLORATION +descrita I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +atestado I-EXPLORATION +policial: I-EXPLORATION +según I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +del I-EXPLORATION +atestado I-EXPLORATION +policial, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lugar I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hechos I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +impactos I-EXPLORATION +de I-EXPLORATION +proyectil I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +vehículo I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +entorno. I-EXPLORATION +Se I-EXPLORATION +encuentra I-EXPLORATION +un I-EXPLORATION +casquillo I-EXPLORATION +de I-EXPLORATION +proyectil I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +asfalto I-EXPLORATION +que I-EXPLORATION +coincide I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +supuestamente I-EXPLORATION +disparado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +agente. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +criminalísticos I-EXPLORATION +practicados I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +derivados I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +del I-EXPLORATION +atestado, I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +heridas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +imagen, I-EXPLORATION +permitieron I-EXPLORATION +establecer I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +disparo I-EXPLORATION +practicado I-EXPLORATION +había I-EXPLORATION +presentado I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +características I-EXPLORATION +generales: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Disparo I-EXPLORATION +a I-EXPLORATION +cañón I-EXPLORATION +tocante I-EXPLORATION +o I-EXPLORATION +muy I-EXPLORATION +próximo I-EXPLORATION +al I-EXPLORATION +contacto I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +camiseta. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Penetración I-EXPLORATION +de I-EXPLORATION +fragmentos I-EXPLORATION +como I-EXPLORATION +orificio I-EXPLORATION +único I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuerpo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +víctima I-EXPLORATION +con I-EXPLORATION +trayectoria I-EXPLORATION +descrita I-EXPLORATION +en I-EXPLORATION +imágenes I-EXPLORATION +6 I-EXPLORATION +y I-EXPLORATION +7. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Ausencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +óseas I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +fracturas I-EXPLORATION +o I-EXPLORATION +fisuras I-EXPLORATION +evidenciables I-EXPLORATION +con I-EXPLORATION +estudios I-EXPLORATION +radiográficos. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Proyectil I-EXPLORATION +9 I-EXPLORATION +mm I-EXPLORATION +Pb I-EXPLORATION +KPO I-EXPLORATION +Sako. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Análisis I-EXPLORATION +balístico I-EXPLORATION +con I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +rebote I-EXPLORATION +(ricochet) I-EXPLORATION +sobre I-EXPLORATION +una I-EXPLORATION +superficie I-EXPLORATION +irregular. I-EXPLORATION +Se I-EXPLORATION +descarta I-EXPLORATION +una I-EXPLORATION +superficie I-EXPLORATION +metálica I-EXPLORATION +o I-EXPLORATION +pulida I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +irregularidad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +surcos. I-EXPLORATION +La I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +silicio I-EXPLORATION +sobre I-EXPLORATION +los I-EXPLORATION +restos I-EXPLORATION +recogidos I-EXPLORATION +no I-EXPLORATION +permite I-EXPLORATION +confirmar I-EXPLORATION +impactos I-EXPLORATION +sobre I-EXPLORATION +asfalto. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Ausencia I-EXPLORATION +de I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +anomalías I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +arma I-EXPLORATION +que I-EXPLORATION +pudieran I-EXPLORATION +sugerir I-EXPLORATION +alteraciones I-EXPLORATION +del I-EXPLORATION +proyectil I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +boca I-EXPLORATION +del I-EXPLORATION +cañón I-EXPLORATION +que I-EXPLORATION +simulasen I-EXPLORATION +un I-EXPLORATION +rebote I-EXPLORATION +y I-EXPLORATION +fragmentación I-EXPLORATION +del I-EXPLORATION +proyectil I-EXPLORATION +[2]. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Ausencia I-EXPLORATION +de I-EXPLORATION +elementos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +indumentaria I-EXPLORATION +del I-EXPLORATION +lesionado I-EXPLORATION +que I-EXPLORATION +pudieran I-EXPLORATION +haber I-EXPLORATION +actuado I-EXPLORATION +como I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +impacto I-EXPLORATION +intermedio, I-EXPLORATION +y I-EXPLORATION +fuente I-EXPLORATION +de I-EXPLORATION +fragmentación I-EXPLORATION +y I-EXPLORATION +rebote, I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +arma I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +del I-EXPLORATION +lesionado. I-EXPLORATION + I-EXPLORATION + +El B-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +traemos I-PRESENT_ILLNESS +hoy I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +colación, I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +arpoximada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuarenta I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +Fuerzas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Seguridad I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Estado, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +agónico, I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +heridas I-PRESENT_ILLNESS +localizadas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +parietal I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +respectivamente. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +parietal I-EXPLORATION +derecha I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +herida I-EXPLORATION +contusa, I-EXPLORATION +irregular, I-EXPLORATION +estrellada, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +cavidad I-EXPLORATION +anfractuosa I-EXPLORATION +debida I-EXPLORATION +al I-EXPLORATION +despegue I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tegumentos, I-EXPLORATION +con I-EXPLORATION +algunos I-EXPLORATION +depósitos I-EXPLORATION +negruzcos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +parietofrontal I-EXPLORATION +izquierda I-EXPLORATION +hay I-EXPLORATION +otra I-EXPLORATION +herida I-EXPLORATION +ovalada, I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +centímetro I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +aproximado I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +ligeramente I-EXPLORATION +evertidos. I-EXPLORATION +Otras I-EXPLORATION +lesiones I-EXPLORATION +asociadas I-EXPLORATION +son I-EXPLORATION +hematoma I-EXPLORATION +en I-EXPLORATION +gafas I-EXPLORATION +y I-EXPLORATION +epistaxis. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +autopsia, I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +fractura I-EXPLORATION +radial I-EXPLORATION +del I-EXPLORATION +parietal I-EXPLORATION +derecho, I-EXPLORATION +que I-EXPLORATION +converge I-EXPLORATION +sobre I-EXPLORATION +un I-EXPLORATION +orificio I-EXPLORATION +redondeado I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +cortantes I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +externa I-EXPLORATION +del I-EXPLORATION +hueso. I-EXPLORATION +La I-EXPLORATION +tabla I-EXPLORATION +interna I-EXPLORATION +biselada I-EXPLORATION +a I-EXPLORATION +modo I-EXPLORATION +de I-EXPLORATION +cono I-EXPLORATION +truncado I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +del I-EXPLORATION +cráneo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +hemicráneo I-EXPLORATION +izquierdo I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +otro I-EXPLORATION +orificio I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +parietofrontal I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +externa I-EXPLORATION +biselada I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +más I-EXPLORATION +ancha I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +exterior. I-EXPLORATION +La I-EXPLORATION +tabla I-EXPLORATION +interna I-EXPLORATION +presentaba I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +del I-EXPLORATION +orificio I-EXPLORATION +cortantes. I-EXPLORATION + I-EXPLORATION +COMENTARIO: B-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +España, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tasa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +suicidios I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +decenio I-PRESENT_ILLNESS +comprendido I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +1990 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +1999 I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4, I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cien I-PRESENT_ILLNESS +mil I-PRESENT_ILLNESS +habitantes I-PRESENT_ILLNESS +[1], I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cuarta I-PRESENT_ILLNESS +causa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +muerte I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +jóvenes I-PRESENT_ILLNESS +varones I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +edades I-PRESENT_ILLNESS +comprendidas I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +[2]. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +modalidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +suicidio I-PRESENT_ILLNESS +depende I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +numerosos I-PRESENT_ILLNESS +factores; I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encuentran I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +disponibilidad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fácil I-PRESENT_ILLNESS +acceso I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +medios I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +utilizar, I-PRESENT_ILLNESS +patología I-PRESENT_ILLNESS +previa, I-PRESENT_ILLNESS +influencia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +medio, I-PRESENT_ILLNESS +etc. I-PRESENT_ILLNESS +Smith I-PRESENT_ILLNESS +[3] I-PRESENT_ILLNESS +encuentra I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +positiva I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +accesibilidad I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +armas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuego I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +proporción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +suicidios I-PRESENT_ILLNESS +causados I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tales I-PRESENT_ILLNESS +armas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +patología, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +editorial I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Revista I-PRESENT_ILLNESS +Panamericana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Salud I-PRESENT_ILLNESS +[4] I-PRESENT_ILLNESS +indica I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +factores I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +riesgo I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +suicidio I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +consumo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +drogas, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +alcoholismo, I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +trastornos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +personalidad, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +esquizofrenia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hombres I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +psicosis I-PRESENT_ILLNESS +orgánicas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mujeres. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +influencia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +medio I-PRESENT_ILLNESS +juega, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +mismo, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +importancia, I-PRESENT_ILLNESS +ascendiendo I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +proporción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +suicidios I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +50, I-PRESENT_ILLNESS +3% I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +jóvenes I-PRESENT_ILLNESS +hispanos I-PRESENT_ILLNESS +residentes I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +USA I-PRESENT_ILLNESS +utilizando I-PRESENT_ILLNESS +armas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuego I-PRESENT_ILLNESS +[5], I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ascendiendo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +1% I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +asiáticos I-PRESENT_ILLNESS +residentes I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +continente I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +45, I-PRESENT_ILLNESS +3% I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +asiáticos I-PRESENT_ILLNESS +residentes I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Estados I-PRESENT_ILLNESS +Unidos I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +grupo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edades I-PRESENT_ILLNESS +comprendido I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +[6]. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Hay I-PRESENT_ILLNESS +diversos I-PRESENT_ILLNESS +indicios I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +nos I-PRESENT_ILLNESS +permiten I-PRESENT_ILLNESS +etiquetar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +muerte I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +suicida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +heridas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +arma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuego. I-PRESENT_ILLNESS +Entre I-PRESENT_ILLNESS +ellos I-PRESENT_ILLNESS +encontramos I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +localización I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +herida, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +número I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +heridas, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +dirección I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +disparo, I-PRESENT_ILLNESS +señales I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pólvora I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +distancia I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +disparo I-PRESENT_ILLNESS +[7]. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Para I-PRESENT_ILLNESS +considerar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +muerte I-PRESENT_ILLNESS +suicida I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +disparo I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estar I-PRESENT_ILLNESS +realizado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +corta I-PRESENT_ILLNESS +distancia, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +trayectoria I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +acceso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano. I-PRESENT_ILLNESS +La B-EXPLORATION +configuración I-EXPLORATION +del I-EXPLORATION +orifico I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +va I-EXPLORATION +a I-EXPLORATION +proporcionar I-EXPLORATION +datos I-EXPLORATION +valiosísimos I-EXPLORATION +para I-EXPLORATION +determinar I-EXPLORATION +la I-EXPLORATION +distancia I-EXPLORATION +del I-EXPLORATION +disparo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +líneas I-EXPLORATION +generales, I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +proyectil I-EXPLORATION +suele I-EXPLORATION +ser I-EXPLORATION +circular I-EXPLORATION +u I-EXPLORATION +ovoide I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +salvo I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +casos I-EXPLORATION +[8]: I-EXPLORATION + I-EXPLORATION +● I-EXPLORATION +Disparos I-EXPLORATION +a I-EXPLORATION +cañón I-EXPLORATION +tocante I-EXPLORATION +o I-EXPLORATION +muy I-EXPLORATION +cercanos I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +situada I-EXPLORATION +sobre I-EXPLORATION +un I-EXPLORATION +plano I-EXPLORATION +óseo. I-EXPLORATION + I-EXPLORATION +● I-EXPLORATION +Disparos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +cartucho I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +velocidad I-EXPLORATION +(con I-EXPLORATION +gran I-EXPLORATION +energía I-EXPLORATION +cinética) I-EXPLORATION +o I-EXPLORATION +con I-EXPLORATION +proyectiles I-EXPLORATION +de I-EXPLORATION +caza I-EXPLORATION +o I-EXPLORATION +semiblindados. I-EXPLORATION + I-EXPLORATION +● I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +proyectil I-EXPLORATION +desestabilizado I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +impactar I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +víctima; I-EXPLORATION +ya I-EXPLORATION +sea I-EXPLORATION +por I-EXPLORATION +rebote I-EXPLORATION +o I-EXPLORATION +por I-EXPLORATION +interposición I-EXPLORATION +de I-EXPLORATION +algún I-EXPLORATION +material. I-EXPLORATION + I-EXPLORATION +Cuando I-EXPLORATION +el I-EXPLORATION +disparo I-EXPLORATION +se I-EXPLORATION +produce I-EXPLORATION +a I-EXPLORATION +cañón I-EXPLORATION +tocante, I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +está I-EXPLORATION +constituido I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +herida I-EXPLORATION +contusa, I-EXPLORATION +irregular, I-EXPLORATION +estrellada, I-EXPLORATION +y I-EXPLORATION +sobre I-EXPLORATION +una I-EXPLORATION +cavidad I-EXPLORATION +anfractuosa I-EXPLORATION +debida I-EXPLORATION +al I-EXPLORATION +despegue I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tegumentos: I-EXPLORATION +es I-EXPLORATION +el I-EXPLORATION +cuarto I-EXPLORATION +de I-EXPLORATION +mina, I-EXPLORATION +cuyas I-EXPLORATION +paredes I-EXPLORATION +están I-EXPLORATION +tapizadas I-EXPLORATION +por I-EXPLORATION +restos I-EXPLORATION +negruzcos I-EXPLORATION +compuestos I-EXPLORATION +de I-EXPLORATION +humo, I-EXPLORATION +partículas I-EXPLORATION +metálicas, I-EXPLORATION +granos I-EXPLORATION +de I-EXPLORATION +pólvora I-EXPLORATION +y I-EXPLORATION +restos I-EXPLORATION +tejidos I-EXPLORATION +mezclados I-EXPLORATION +con I-EXPLORATION +sangre I-EXPLORATION +[9]. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +configuración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +herida I-EXPLORATION +también I-EXPLORATION +influye I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +gases I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +sobreestiramiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +[10]. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +último I-EXPLORATION +la I-EXPLORATION +dirección I-EXPLORATION +del I-EXPLORATION +disparo I-EXPLORATION +ha I-EXPLORATION +de I-EXPLORATION +ser I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +mecanismo I-EXPLORATION +suicida. I-EXPLORATION +Un I-EXPLORATION +sujeto I-EXPLORATION +diestro I-EXPLORATION +habitualmente I-EXPLORATION +se I-EXPLORATION +dispara I-EXPLORATION +de I-EXPLORATION +derecha I-EXPLORATION +a I-EXPLORATION +izquierda. I-EXPLORATION +La I-EXPLORATION +configuración I-EXPLORATION +del I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +salida I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hueso I-EXPLORATION +va I-EXPLORATION +a I-EXPLORATION +ser I-EXPLORATION +primordial I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +interpretación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +dirección I-EXPLORATION +del I-EXPLORATION +disparo. I-EXPLORATION +Cuando I-EXPLORATION +el I-EXPLORATION +proyectil I-EXPLORATION +atraviesa I-EXPLORATION +el I-EXPLORATION +cráneo I-EXPLORATION +la I-EXPLORATION +confrontación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +orificios I-EXPLORATION +constituye I-EXPLORATION +un I-EXPLORATION +fiel I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +cual I-EXPLORATION +es I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +y I-EXPLORATION +cual, I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +salida. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +dos I-EXPLORATION +tablas I-EXPLORATION +del I-EXPLORATION +diploe I-EXPLORATION +craneal, I-EXPLORATION +la I-EXPLORATION +segunda I-EXPLORATION +atravesada I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +orifico I-EXPLORATION +mayor I-EXPLORATION +y I-EXPLORATION +más I-EXPLORATION +irregular, I-EXPLORATION +adoptando I-EXPLORATION +la I-EXPLORATION +típica I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +cono I-EXPLORATION +truncado I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +señalando I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +del I-EXPLORATION +proyectil I-EXPLORATION +[11]. I-EXPLORATION +q I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +joven, I-PRESENT_ILLNESS +conductor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +único I-PRESENT_ILLNESS +ocupante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +turismo, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +sufre I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +salida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +calzada I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +circulaba I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +100 I-PRESENT_ILLNESS +Km. I-PRESENT_ILLNESS +según I-PRESENT_ILLNESS +estimación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Atestados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Guardia I-PRESENT_ILLNESS +Civil I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Tráfico. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +vehículo I-PRESENT_ILLNESS +choca I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +acequia I-PRESENT_ILLNESS +quedando I-PRESENT_ILLNESS +deformado I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +habitáculo, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +necesaria I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +excarceración I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +parte I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +Bomberos. I-PRESENT_ILLNESS +Según I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +mismas I-PRESENT_ILLNESS +fuentes I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +debió I-PRESENT_ILLNESS +ocurrir I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +1.45 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +madrugada, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +hubiese I-PRESENT_ILLNESS +testigos I-PRESENT_ILLNESS +presenciales. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Ingresa B-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +UCI I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Regional I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +estado I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +coma I-DERIVED_FROM/TO +procedente I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +parte I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Neurocirugía, I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +parecer I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +haber I-DERIVED_FROM/TO +sufrido I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +TCE I-DERIVED_FROM/TO +severo I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +accidente I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tráfico. I-DERIVED_FROM/TO +En B-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +practican, I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +con I-EXPLORATION +esquirlas I-EXPLORATION +óseas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +temporal I-EXPLORATION +derecho I-EXPLORATION +e I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +metálica, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +proyectil I-EXPLORATION +de I-EXPLORATION +arma I-EXPLORATION +de I-EXPLORATION +fuego I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +contralateral. I-EXPLORATION +Ante I-EXPLORATION +ello, I-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +evidencia I-EXPLORATION +que I-EXPLORATION +presenta, I-EXPLORATION +tras I-EXPLORATION +rasurar I-EXPLORATION +los I-EXPLORATION +cabellos, I-EXPLORATION +un I-EXPLORATION +orifico I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +de I-EXPLORATION +proyectil I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +parietal I-EXPLORATION +derecha, I-EXPLORATION +sin I-EXPLORATION +orifico I-EXPLORATION +de I-EXPLORATION +salida. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +inmediata I-EVOLUTION +es I-EVOLUTION +hacia I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +muerte I-EVOLUTION +encefálica, I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +confirma I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +correspondiente I-EVOLUTION +registro I-EVOLUTION +electroencefalográfico. I-EVOLUTION +Previa B-EXPLORATION +autorización I-EXPLORATION +judicial, I-EXPLORATION +se I-EXPLORATION +procede I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +extracción I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +para I-EXPLORATION +trasplante I-EXPLORATION +y I-EXPLORATION +posteriormente I-EXPLORATION +se I-EXPLORATION +practica I-EXPLORATION +la I-EXPLORATION +autopsia I-EXPLORATION +forense. I-EXPLORATION + I-EXPLORATION +Hallazgos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +autopsia I-EXPLORATION + I-EXPLORATION +Examen I-EXPLORATION +Externo: I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +trata I-EXPLORATION +del I-EXPLORATION +cadáver I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +individuo I-EXPLORATION +de I-EXPLORATION +sexo I-EXPLORATION +masculino, I-EXPLORATION +raza I-EXPLORATION +caucasoide, I-EXPLORATION +de I-EXPLORATION +25 I-EXPLORATION +años I-EXPLORATION +de I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +constitución I-EXPLORATION +leptosomática. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +violencia I-EXPLORATION +corporal I-EXPLORATION +reciente I-EXPLORATION +se I-EXPLORATION +aprecian: I-EXPLORATION +un I-EXPLORATION +orificio I-EXPLORATION +redondeado I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm. I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +concéntrica I-EXPLORATION +perilesional I-EXPLORATION +de I-EXPLORATION +excoriación I-EXPLORATION +desecada I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +negro, I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +mm. I-EXPLORATION +de I-EXPLORATION +ancho I-EXPLORATION +(cintilla I-EXPLORATION +de I-EXPLORATION +contusión), I-EXPLORATION +con I-EXPLORATION +tumefacción I-EXPLORATION +y I-EXPLORATION +enrojecimiento I-EXPLORATION +periférico, I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +cabellos I-EXPLORATION +rasurados I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +impregnación I-EXPLORATION +antiséptica, I-EXPLORATION +situado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +temporal I-EXPLORATION +derecha, I-EXPLORATION +a I-EXPLORATION +7 I-EXPLORATION +cm. I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +externo I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +6 I-EXPLORATION +cm. I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +auditivo I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +lado; I-EXPLORATION +otorragia I-EXPLORATION +bilateral; I-EXPLORATION +epistaxis; I-EXPLORATION +hematoma I-EXPLORATION +en I-EXPLORATION +anteojos; I-EXPLORATION +excoriaciones I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +frontal I-EXPLORATION +izquierda; I-EXPLORATION +ángulo I-EXPLORATION +externo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +derecho; I-EXPLORATION +región I-EXPLORATION +parieto-occipital I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +manos. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +herida I-EXPLORATION +incisa I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +frontal I-EXPLORATION +derecha, I-EXPLORATION +equimosis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +reborde I-EXPLORATION +costal I-EXPLORATION +derecho, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +hematomas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +raíz I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +muslos, I-EXPLORATION +rodilla I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +piernas, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +signos I-EXPLORATION +característicos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +manipulación I-EXPLORATION +quirúrgica I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +extracción I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +para I-EXPLORATION +trasplante. I-EXPLORATION + I-EXPLORATION +Examen I-EXPLORATION +Interno: I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +autopsia I-EXPLORATION +cefálica, I-EXPLORATION +al I-EXPLORATION +poner I-EXPLORATION +al I-EXPLORATION +descubierto I-EXPLORATION +la I-EXPLORATION +bóveda I-EXPLORATION +craneal, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +colgajo I-EXPLORATION +cutáneo I-EXPLORATION +anterior I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +dos I-EXPLORATION +infiltraciones I-EXPLORATION +hemorrágicas, I-EXPLORATION +una I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +correspondiente I-EXPLORATION +al I-EXPLORATION +reborde I-EXPLORATION +supraorbitario I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +otra, I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +dimensión, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +externo I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +lado, I-EXPLORATION +subyacentes I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +descritas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +externo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +temporal I-EXPLORATION +derecha, I-EXPLORATION +en I-EXPLORATION +concordancia I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +cutáneo, I-EXPLORATION +existe I-EXPLORATION +un I-EXPLORATION +orificio I-EXPLORATION +óseo I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +mm. I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +cara I-EXPLORATION +externa I-EXPLORATION +y I-EXPLORATION +algo I-EXPLORATION +mayor I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +interna I-EXPLORATION +(signo I-EXPLORATION +del I-EXPLORATION +embudo). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +colgajo I-EXPLORATION +cutáneo I-EXPLORATION +posterior I-EXPLORATION +existe I-EXPLORATION +un I-EXPLORATION +importante I-EXPLORATION +hematoma I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +témporo-parietal I-EXPLORATION +izquierda, I-EXPLORATION +desprendiéndose I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +disección I-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +óseo I-EXPLORATION +irregular, I-EXPLORATION +de I-EXPLORATION +1.5 I-EXPLORATION +x I-EXPLORATION +1.5 I-EXPLORATION +cm., I-EXPLORATION +situado I-EXPLORATION +a I-EXPLORATION +12 I-EXPLORATION +cm. I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +externo I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +9 I-EXPLORATION +cm. I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +auditivo I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +lado, I-EXPLORATION +con I-EXPLORATION +borde I-EXPLORATION +biselado, I-EXPLORATION +correspondiendo I-EXPLORATION +el I-EXPLORATION +diámetro I-EXPLORATION +mayor I-EXPLORATION +al I-EXPLORATION +diploe I-EXPLORATION +externo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +lugar, I-EXPLORATION +al I-EXPLORATION +retirar I-EXPLORATION +la I-EXPLORATION +bóveda I-EXPLORATION +craneal I-EXPLORATION +aparece I-EXPLORATION +un I-EXPLORATION +proyectil I-EXPLORATION +de I-EXPLORATION +arma I-EXPLORATION +de I-EXPLORATION +fuego, I-EXPLORATION +deformado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +punta, I-EXPLORATION +situado I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +duramadre I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +hueso, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +mm. I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +y I-EXPLORATION +unos I-EXPLORATION +13 I-EXPLORATION +mm. I-EXPLORATION +de I-EXPLORATION +longitud, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +extensa I-EXPLORATION +hemorragia I-EXPLORATION +subaracnoidea I-EXPLORATION +difusa. I-EXPLORATION +Extraída I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +encefálica I-EXPLORATION +se I-EXPLORATION +comprueba I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +fractura I-EXPLORATION +conminuta I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +techos I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +órbitas I-EXPLORATION +oculares. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +disección I-EXPLORATION +del I-EXPLORATION +cerebro I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +laceración I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +trayecto I-EXPLORATION +que I-EXPLORATION +une I-EXPLORATION +los I-EXPLORATION +orificios I-EXPLORATION +descritos, I-EXPLORATION +con I-EXPLORATION +infiltración I-EXPLORATION +hemorrágica I-EXPLORATION +perifocal. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +necrópsico I-EXPLORATION +del I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +regiones I-EXPLORATION +anatómicas I-EXPLORATION +y I-EXPLORATION +vísceras I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +fueron I-EXPLORATION +extraídas I-EXPLORATION +para I-EXPLORATION +trasplante, I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +lesiones I-EXPLORATION +macroscópicas I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION + I-EXPLORATION +Estudios I-EXPLORATION +complementarios I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +remitió I-EXPLORATION +al I-EXPLORATION +Instituto I-EXPLORATION +Nacional I-EXPLORATION +de I-EXPLORATION +Toxicología I-EXPLORATION +y I-EXPLORATION +Ciencias I-EXPLORATION +Forenses I-EXPLORATION +de I-EXPLORATION +Sevilla I-EXPLORATION +el I-EXPLORATION +colgajo I-EXPLORATION +cutáneo I-EXPLORATION +de I-EXPLORATION +cuero I-EXPLORATION +cabelludo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +temporal I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +incluía I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +del I-EXPLORATION +proyectil, I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +criminalístico, I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +revelaron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +residuos, I-EXPLORATION +consistentes I-EXPLORATION +en I-EXPLORATION +negro I-EXPLORATION +de I-EXPLORATION +humo I-EXPLORATION +y I-EXPLORATION +elevadas I-EXPLORATION +concentraciones I-EXPLORATION +de I-EXPLORATION +plomo, I-EXPLORATION +antimonio I-EXPLORATION +y I-EXPLORATION +bario, I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +indica I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +disparo I-EXPLORATION +que I-EXPLORATION +originó I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +debió I-EXPLORATION +realizarse I-EXPLORATION +a I-EXPLORATION +escasa I-EXPLORATION +distancia. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +Policía I-EXPLORATION +Judicial I-EXPLORATION +envió I-EXPLORATION +al I-EXPLORATION +Departamento I-EXPLORATION +de I-EXPLORATION +Análisis I-EXPLORATION +del I-EXPLORATION +Centro I-EXPLORATION +de I-EXPLORATION +Investigación I-EXPLORATION +y I-EXPLORATION +Criminalística I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Guardia I-EXPLORATION +Civil I-EXPLORATION +tres I-EXPLORATION +portamuestras I-EXPLORATION +conteniendo I-EXPLORATION +adhesivos I-EXPLORATION +de I-EXPLORATION +recogida I-EXPLORATION +de I-EXPLORATION +residuos I-EXPLORATION +de I-EXPLORATION +disparo, I-EXPLORATION +aplicados I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +manos I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +sien I-EXPLORATION +del I-EXPLORATION +fallecido, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +casquillo I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +encontrado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +coche I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +búsqueda I-EXPLORATION +posterior I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +pistola I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +calibre, I-EXPLORATION +a I-EXPLORATION +raíz I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +investigaciones I-EXPLORATION +oportunas I-EXPLORATION +cuando I-EXPLORATION +ya I-EXPLORATION +el I-EXPLORATION +vehículo I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +desguace, I-EXPLORATION +dado I-EXPLORATION +que I-EXPLORATION +había I-EXPLORATION +pasado I-EXPLORATION +desapercibido I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +primer I-EXPLORATION +momento. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +revelaron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +portamuestras I-EXPLORATION +aplicado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +derecha, I-EXPLORATION +de I-EXPLORATION +partículas I-EXPLORATION +propias I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +detonación I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +fulminante I-EXPLORATION +similar I-EXPLORATION +al I-EXPLORATION +del I-EXPLORATION +casquillo, I-EXPLORATION +que I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +remitido. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +efectos I-EXPLORATION +de I-EXPLORATION +Interpretación I-EXPLORATION +Médico I-EXPLORATION +Forense I-EXPLORATION +se I-EXPLORATION +hicieron I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +consideraciones: I-EXPLORATION + I-EXPLORATION +A.- I-EXPLORATION +NATURALEZA I-EXPLORATION +DE I-EXPLORATION +LAS I-EXPLORATION +LESIONES. I-EXPLORATION +Se I-EXPLORATION +han I-EXPLORATION +encontrado I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +naturalezas I-EXPLORATION +diferentes: I-EXPLORATION + I-EXPLORATION +1. I-EXPLORATION +Lesiones I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +contusa. I-EXPLORATION +Consistentes I-EXPLORATION +en I-EXPLORATION +hematomas, I-EXPLORATION +erosiones I-EXPLORATION +y I-EXPLORATION +heridas I-EXPLORATION +contusas I-EXPLORATION +que I-EXPLORATION +por I-EXPLORATION +sus I-EXPLORATION +características I-EXPLORATION +y I-EXPLORATION +localización, I-EXPLORATION +son I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +producidas I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +accidentes I-EXPLORATION +de I-EXPLORATION +tráfico. I-EXPLORATION +Ninguna I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +reviste I-EXPLORATION +importancia I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +vista I-EXPLORATION +clínico, I-EXPLORATION +considerándose I-EXPLORATION +por I-EXPLORATION +tanto I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +fueron I-EXPLORATION +determinantes I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mecanismo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muerte. I-EXPLORATION + I-EXPLORATION +2.- I-EXPLORATION +Lesiones I-EXPLORATION +por I-EXPLORATION +proyectil I-EXPLORATION +de I-EXPLORATION +arma I-EXPLORATION +de I-EXPLORATION +fuego. I-EXPLORATION +La I-EXPLORATION +morfología I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +orificios I-EXPLORATION +encontrados I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cráneo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +hallazgo I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +proyectil, I-EXPLORATION +indica I-EXPLORATION +que I-EXPLORATION +nos I-EXPLORATION +encontramos I-EXPLORATION +ante I-EXPLORATION +un I-EXPLORATION +disparo I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +arma I-EXPLORATION +de I-EXPLORATION +fuego I-EXPLORATION +de I-EXPLORATION +proyectil I-EXPLORATION +único. I-EXPLORATION +La I-EXPLORATION +herida I-EXPLORATION +correspondiente I-EXPLORATION +al I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +se I-EXPLORATION +localiza I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +temporal I-EXPLORATION +derecha. I-EXPLORATION +Sigue I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +de I-EXPLORATION +derecha-izquierda, I-EXPLORATION +ligeramente I-EXPLORATION +de I-EXPLORATION +abajo-arriba I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +delante-atrás, I-EXPLORATION +atravesando I-EXPLORATION +completamente I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +encefálica I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +llegar I-EXPLORATION +a I-EXPLORATION +salir I-EXPLORATION +al I-EXPLORATION +exterior, I-EXPLORATION +quedando I-EXPLORATION +el I-EXPLORATION +proyectil I-EXPLORATION +alojado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +del I-EXPLORATION +cráneo. I-EXPLORATION +Las I-EXPLORATION +fracturas I-EXPLORATION +del I-EXPLORATION +techo I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +órbitas I-EXPLORATION +pudieran I-EXPLORATION +corresponder I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +denominadas I-EXPLORATION +fracturas I-EXPLORATION +secundarias I-EXPLORATION +ocasionadas I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +energía I-EXPLORATION +cinética I-EXPLORATION +procedente I-EXPLORATION +del I-EXPLORATION +proyectil I-EXPLORATION +[9]. I-EXPLORATION + I-EXPLORATION +B.- I-EXPLORATION +ETIOLOGÍA I-EXPLORATION +MÉDICO I-EXPLORATION +LEGAL I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +investigaciones I-EXPLORATION +policiales I-EXPLORATION +posteriores, I-EXPLORATION +indicaron I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +fallecido, I-EXPLORATION +sin I-EXPLORATION +antecedentes I-EXPLORATION +médicos I-EXPLORATION +de I-EXPLORATION +interés, I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +problemas I-EXPLORATION +económicos I-EXPLORATION +conocidos, I-EXPLORATION +siendo I-EXPLORATION +significativo I-EXPLORATION +el I-EXPLORATION +hecho I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +poco I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hechos I-EXPLORATION +había I-EXPLORATION +contratado I-EXPLORATION +un I-EXPLORATION +seguro I-EXPLORATION +de I-EXPLORATION +vida I-EXPLORATION +y I-EXPLORATION +había I-EXPLORATION +adquirido I-EXPLORATION +una I-EXPLORATION +pistola I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +ilegal. I-EXPLORATION +El I-EXPLORATION +minucioso I-EXPLORATION +examen I-EXPLORATION +del I-EXPLORATION +vehículo, I-EXPLORATION +una I-EXPLORATION +vez I-EXPLORATION +depositado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +desguace, I-EXPLORATION +permitió I-EXPLORATION +la I-EXPLORATION +recogida I-EXPLORATION +de I-EXPLORATION +varios I-EXPLORATION +cartuchos I-EXPLORATION +de I-EXPLORATION +pistola I-EXPLORATION +de I-EXPLORATION +calibre I-EXPLORATION +6, I-EXPLORATION +35 I-EXPLORATION +mm., I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +percutido. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +base I-EXPLORATION +a I-EXPLORATION +estos I-EXPLORATION +antecedentes I-EXPLORATION +y I-EXPLORATION +teniendo I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +la I-EXPLORATION +localización I-EXPLORATION +del I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada I-EXPLORATION +(región I-EXPLORATION +temporal I-EXPLORATION +derecha), I-EXPLORATION +la I-EXPLORATION +distancia I-EXPLORATION +del I-EXPLORATION +disparo I-EXPLORATION +(como I-EXPLORATION +mínimo I-EXPLORATION +a I-EXPLORATION +corta I-EXPLORATION +distancia I-EXPLORATION +como I-EXPLORATION +acredita I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +criminalístico), I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +residuos I-EXPLORATION +de I-EXPLORATION +disparo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +derecha I-EXPLORATION +del I-EXPLORATION +fallecido I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +circunstancias I-EXPLORATION +del I-EXPLORATION +caso I-EXPLORATION +(único I-EXPLORATION +ocupante I-EXPLORATION +con I-EXPLORATION +incarceración I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +e I-EXPLORATION +intervención I-EXPLORATION +de I-EXPLORATION +bomberos I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +extracción, I-EXPLORATION +presencia I-EXPLORATION +del I-EXPLORATION +arma I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +vehículo, I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +contratación I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +seguro, I-EXPLORATION +etc.) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +datos I-EXPLORATION +objetivos, I-EXPLORATION +consideramos I-EXPLORATION +que I-EXPLORATION +pudiera I-EXPLORATION +ser I-EXPLORATION +perfectamente I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +acto I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +suicida. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +ex B-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +bebedor I-PAST_MEDICAL_HISTORY +moderado I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +hallado I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +pública. I-PRESENT_ILLNESS +La B-EXPLORATION +autopsia I-EXPLORATION +se I-EXPLORATION +practica I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +19 I-EXPLORATION +horas I-EXPLORATION +del I-EXPLORATION +fallecimiento I-EXPLORATION +según I-EXPLORATION +las I-EXPLORATION +recomendaciones I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +armonización I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +autopsias I-EXPLORATION +médico-legales I-EXPLORATION +del I-EXPLORATION +Comité I-EXPLORATION +de I-EXPLORATION +Ministros I-EXPLORATION +del I-EXPLORATION +Consejo I-EXPLORATION +de I-EXPLORATION +Europa I-EXPLORATION +[3]. I-EXPLORATION +Concretamente I-EXPLORATION +se I-EXPLORATION +siguió I-EXPLORATION +el I-EXPLORATION +protocolo I-EXPLORATION +aprobado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Red I-EXPLORATION +de I-EXPLORATION +Muerte I-EXPLORATION +Súbita I-EXPLORATION +que I-EXPLORATION +incluye I-EXPLORATION +peso, I-EXPLORATION +talla I-EXPLORATION +y I-EXPLORATION +perímetro I-EXPLORATION +abdominal I-EXPLORATION +del I-EXPLORATION +cadáver; I-EXPLORATION +peso I-EXPLORATION +y I-EXPLORATION +examen I-EXPLORATION +macroscópico-microscópico I-EXPLORATION +de I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +órganos I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +investigación I-EXPLORATION +químico-toxicológica I-EXPLORATION +general I-EXPLORATION +en I-EXPLORATION +sangre. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +complementarios I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Delegación I-EXPLORATION +de I-EXPLORATION +Tenerife I-EXPLORATION +(estudio I-EXPLORATION +histopatológico) I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Departamento I-EXPLORATION +de I-EXPLORATION +Sevilla I-EXPLORATION +(análisis I-EXPLORATION +químico-toxicológico) I-EXPLORATION +del I-EXPLORATION +Instituto I-EXPLORATION +Nacional I-EXPLORATION +de I-EXPLORATION +Toxicología I-EXPLORATION +y I-EXPLORATION +Ciencias I-EXPLORATION +Forenses. I-EXPLORATION + I-EXPLORATION +a) I-EXPLORATION +Examen I-EXPLORATION +de I-EXPLORATION +autopsia: I-EXPLORATION + I-EXPLORATION +Talla I-EXPLORATION +162 I-EXPLORATION +cm, I-EXPLORATION +peso I-EXPLORATION +84 I-EXPLORATION +kg, I-EXPLORATION +perímetro I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +104 I-EXPLORATION +cm. I-EXPLORATION +El I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +(IMC) I-EXPLORATION += I-EXPLORATION +peso I-EXPLORATION +(kg) I-EXPLORATION +/ I-EXPLORATION +[talla I-EXPLORATION +(m) I-EXPLORATION +] I-EXPLORATION +² I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +32 I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +significa I-EXPLORATION +una I-EXPLORATION +obesidad I-EXPLORATION +de I-EXPLORATION +grado I-EXPLORATION +I I-EXPLORATION +con I-EXPLORATION +obesidad I-EXPLORATION +visceral I-EXPLORATION +[4, I-EXPLORATION +5]. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +externo I-EXPLORATION +sólo I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +intensa I-EXPLORATION +congestión I-EXPLORATION +cefálica. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +interno I-EXPLORATION +los I-EXPLORATION +pulmones I-EXPLORATION +estaban I-EXPLORATION +aumentados I-EXPLORATION +de I-EXPLORATION +peso I-EXPLORATION +(D: I-EXPLORATION +675 I-EXPLORATION +g, I-EXPLORATION +I: I-EXPLORATION +490 I-EXPLORATION +g), I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +congestión I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +grado I-EXPLORATION +importante. I-EXPLORATION +Cardiomegalia I-EXPLORATION +de I-EXPLORATION +485 I-EXPLORATION +g, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +medio I-EXPLORATION +esperado I-EXPLORATION +según I-EXPLORATION +peso I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +358 I-EXPLORATION +g I-EXPLORATION +(rango I-EXPLORATION +271-473 I-EXPLORATION +g) I-EXPLORATION +[6]. I-EXPLORATION +La I-EXPLORATION +pared I-EXPLORATION +libre I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +derecho I-EXPLORATION +tenía I-EXPLORATION +un I-EXPLORATION +espesor I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +mm I-EXPLORATION +(rango I-EXPLORATION +2-7 I-EXPLORATION +mm) I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +mm I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +septum I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +libre I-EXPLORATION +(rango I-EXPLORATION +10-15 I-EXPLORATION +mm). I-EXPLORATION +Abundante I-EXPLORATION +infiltrado I-EXPLORATION +graso I-EXPLORATION +en I-EXPLORATION +miocardio I-EXPLORATION +de I-EXPLORATION +ventrículo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +formando I-EXPLORATION +una I-EXPLORATION +banda I-EXPLORATION +subepicárdica I-EXPLORATION +de I-EXPLORATION +2.5 I-EXPLORATION +x I-EXPLORATION +0.5 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +desde I-EXPLORATION +mesocardio I-EXPLORATION +hasta I-EXPLORATION +ápex. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +otra I-EXPLORATION +zona I-EXPLORATION +más I-EXPLORATION +pequeña I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +grasa I-EXPLORATION +de I-EXPLORATION +0.5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +Las I-EXPLORATION +arterias I-EXPLORATION +coronarias I-EXPLORATION +estaban I-EXPLORATION +permeables I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +escasas I-EXPLORATION +placas I-EXPLORATION +de I-EXPLORATION +ateroma I-EXPLORATION +que I-EXPLORATION +determinaban I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +luminal I-EXPLORATION +inferior I-EXPLORATION +al I-EXPLORATION +25%. I-EXPLORATION + I-EXPLORATION +b) I-EXPLORATION +Estudio I-EXPLORATION +microscópico: I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico, I-EXPLORATION +utilizando I-EXPLORATION +Tricrómico I-EXPLORATION +de I-EXPLORATION +Masson, I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +abundante I-EXPLORATION +infiltrado I-EXPLORATION +graso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +miocardio I-EXPLORATION +constituido I-EXPLORATION +por I-EXPLORATION +adipocitos I-EXPLORATION +maduros I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +islotes I-EXPLORATION +de I-EXPLORATION +miocardiocitos I-EXPLORATION +con I-EXPLORATION +estructura I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +mínima I-EXPLORATION +fibrosis I-EXPLORATION +intersticial. I-EXPLORATION +Las I-EXPLORATION +arterias I-EXPLORATION +coronarias I-EXPLORATION +presentan I-EXPLORATION +placas I-EXPLORATION +fibrolipídicas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +íntima I-EXPLORATION +determinando I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +luminal I-EXPLORATION +no I-EXPLORATION +superior I-EXPLORATION +al I-EXPLORATION +25% I-EXPLORATION +(aterosclerosis I-EXPLORATION +leve). I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +ni I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +miocárdica I-EXPLORATION +reciente I-EXPLORATION +y/o I-EXPLORATION +fibrosis I-EXPLORATION +de I-EXPLORATION +reparación. I-EXPLORATION + I-EXPLORATION +c) I-EXPLORATION +Análisis I-EXPLORATION +químico-toxicológico: I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +investigación I-EXPLORATION +toxicológica I-EXPLORATION +general I-EXPLORATION +detectó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +alcohol I-EXPLORATION +etílico I-EXPLORATION +en I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +2.59 I-EXPLORATION +g/L. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Sra. I-PRESENT_ILLNESS +A, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +viene I-PRESENT_ILLNESS +citada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +programada I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +juzgado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +instrucción, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +fin I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dilucidar I-PRESENT_ILLNESS +si I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +víctima I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +negligencia I-PRESENT_ILLNESS +médica. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Como I-PRESENT_ILLNESS +prolegómeno I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +caso, I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +hospitalarias I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +sufrido I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +fuera I-PRESENT_ILLNESS +catalogado I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +luxación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rodilla I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +resolvió I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manera I-PRESENT_ILLNESS +espontánea. I-PRESENT_ILLNESS +Se B-TREATMENT +actúa I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +conservadora, I-TREATMENT +observándose I-TREATMENT +tras I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +inmovilización I-TREATMENT +inguino-pédica I-TREATMENT +una I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +clínica I-TREATMENT +que I-TREATMENT +no I-TREATMENT +se I-TREATMENT +corresponde I-TREATMENT +con I-TREATMENT +la I-TREATMENT +percepción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +propia I-TREATMENT +lesionada. I-TREATMENT +Desde I-TREATMENT +entonces I-TREATMENT +se I-TREATMENT +manifiesta I-TREATMENT +como I-TREATMENT +un I-TREATMENT +cuadro I-TREATMENT +clínico I-TREATMENT +de I-TREATMENT +anquilosis I-TREATMENT +de I-TREATMENT +rodilla, I-TREATMENT +siendo I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +rehabilitador I-TREATMENT +sin I-TREATMENT +éxito I-TREATMENT +alguno. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +proceso I-EVOLUTION +fue I-EVOLUTION +tórpida, I-EVOLUTION +proponiéndose I-EVOLUTION +finalmente I-EVOLUTION +intervención I-EVOLUTION +quirúrgica I-EVOLUTION +de I-EVOLUTION +rodilla I-EVOLUTION +bajo I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +clínico I-EVOLUTION +de I-EVOLUTION +"artrofibrosis", I-EVOLUTION +que I-EVOLUTION +es I-EVOLUTION +suspendida I-EVOLUTION +a I-EVOLUTION +criterio I-EVOLUTION +del I-EVOLUTION +cirujano, I-EVOLUTION +por I-EVOLUTION +no I-EVOLUTION +encontrar I-EVOLUTION +base I-EVOLUTION +clínica I-EVOLUTION +que I-EVOLUTION +justificara I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +padecida. I-EVOLUTION + I-EVOLUTION +Tras I-EVOLUTION +este I-EVOLUTION +último I-EVOLUTION +episodio, I-EVOLUTION +la I-EVOLUTION +interesada I-EVOLUTION +decide I-EVOLUTION +emitir I-EVOLUTION +denuncia I-EVOLUTION +por I-EVOLUTION +negligencia I-EVOLUTION +médica, I-EVOLUTION +haciéndola I-EVOLUTION +extensible I-EVOLUTION +a I-EVOLUTION +todos I-EVOLUTION +aquellos I-EVOLUTION +especialistas I-EVOLUTION +que I-EVOLUTION +estuvieron I-EVOLUTION +atendiéndola I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +principio. I-EVOLUTION + I-EVOLUTION +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +Médico I-PRESENT_ILLNESS +Forense I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +asistencia I-PRESENT_ILLNESS +recibida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +urgencias, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +poco I-PRESENT_ILLNESS +tiempo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +emitida I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +denuncia, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +citada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +programada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +dependencias I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Instituto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Medicina I-PRESENT_ILLNESS +Legal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Huelva, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +compañía I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +cónyuge I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +muleta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +descarga. I-PRESENT_ILLNESS +Se B-EXPLORATION +aprecia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +hipotrofia I-EXPLORATION +moderada I-EXPLORATION +global I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +total I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +movilidad I-EXPLORATION +de I-EXPLORATION +rodilla I-EXPLORATION +homolateral I-EXPLORATION +en I-EXPLORATION +flexoextensión. I-EXPLORATION +No I-EXPLORATION +existe I-EXPLORATION +componente I-EXPLORATION +inflamatorio I-EXPLORATION +asociado I-EXPLORATION +y I-EXPLORATION +presenta I-EXPLORATION +genu I-EXPLORATION +valgo I-EXPLORATION +bilateral. I-EXPLORATION +Se I-EXPLORATION +detecta I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +entrevista I-EXPLORATION +un I-EXPLORATION +marcado I-EXPLORATION +componente I-EXPLORATION +conversivo. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +mediante I-EXPLORATION +entrevista I-EXPLORATION +semiestructurada I-EXPLORATION +bajo I-EXPLORATION +los I-EXPLORATION +criterios I-EXPLORATION +propuestos I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +clasificación I-EXPLORATION +DSM I-EXPLORATION +IV-TR. I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +acordarse I-EXPLORATION +entrevista I-EXPLORATION +y I-EXPLORATION +exploración I-EXPLORATION +pormenorizada I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Psicólogo I-EXPLORATION +Forense I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +pasar I-EXPLORATION +el I-EXPLORATION +test I-EXPLORATION +MMPI I-EXPLORATION +(Inventario I-EXPLORATION +Multifásico I-EXPLORATION +de I-EXPLORATION +Personalidad I-EXPLORATION +de I-EXPLORATION +Minessotta), I-EXPLORATION +destacando I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +un I-EXPLORATION +marcado I-EXPLORATION +perfil I-EXPLORATION +represivo I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +elevada I-EXPLORATION +preocupación I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +salud I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +hipocondría, I-EXPLORATION +que I-EXPLORATION +daría I-EXPLORATION +finalmente I-EXPLORATION +lugar I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +manifestaciones I-EXPLORATION +histéricas I-EXPLORATION +a I-EXPLORATION +modo I-EXPLORATION +de I-EXPLORATION +quejas I-EXPLORATION +somáticas I-EXPLORATION +(somatizaciones). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +corroborar I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +mediante I-EXPLORATION +sesión I-EXPLORATION +programada I-EXPLORATION +de I-EXPLORATION +hipnosis, I-EXPLORATION +previo I-EXPLORATION +consentimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +interesada, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +objetivo I-EXPLORATION +de I-EXPLORATION +conseguir I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +anquilosada. I-EXPLORATION + I-EXPLORATION +Método: I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +proceso I-EXPLORATION +hipnótico I-EXPLORATION +se I-EXPLORATION +desarrolla I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +propias I-EXPLORATION +dependencias I-EXPLORATION +del I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +Legal I-EXPLORATION +de I-EXPLORATION +Huelva, I-EXPLORATION +previa I-EXPLORATION +sesión I-EXPLORATION +preparatoria I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +explican I-EXPLORATION +las I-EXPLORATION +bases I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +conseguir I-EXPLORATION +un I-EXPLORATION +adecuado I-EXPLORATION +vínculo I-EXPLORATION +explorador-explorada, I-EXPLORATION +estando I-EXPLORATION +presentes I-EXPLORATION +durante I-EXPLORATION +su I-EXPLORATION +desarrollo I-EXPLORATION +tanto I-EXPLORATION +el I-EXPLORATION +Médico I-EXPLORATION +Forense I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +Psicólogo I-EXPLORATION +Forense I-EXPLORATION +encargado I-EXPLORATION +de I-EXPLORATION +llevarlo I-EXPLORATION +a I-EXPLORATION +cabo. I-EXPLORATION +Para I-EXPLORATION +ello I-EXPLORATION +se I-EXPLORATION +coloca I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +Sra. I-EXPLORATION +A I-EXPLORATION +en I-EXPLORATION +posición I-EXPLORATION +de I-EXPLORATION +decúbito I-EXPLORATION +supino, I-EXPLORATION +sobre I-EXPLORATION +una I-EXPLORATION +camilla I-EXPLORATION +estándar I-EXPLORATION +de I-EXPLORATION +consulta, I-EXPLORATION +cuya I-EXPLORATION +base I-EXPLORATION +basculante I-EXPLORATION +fue I-EXPLORATION +recogida, I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +sana I-EXPLORATION +cayera I-EXPLORATION +en I-EXPLORATION +flexión I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +gravedad, I-EXPLORATION +quedando I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +izquierda I-EXPLORATION +en I-EXPLORATION +extensión I-EXPLORATION +completa I-EXPLORATION +y I-EXPLORATION +sobresaliendo I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +camilla. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +proceso I-EXPLORATION +se I-EXPLORATION +desarrolló I-EXPLORATION +bajo I-EXPLORATION +una I-EXPLORATION +atmósfera I-EXPLORATION +empática I-EXPLORATION +y I-EXPLORATION +relajada, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +buena I-EXPLORATION +predisposición I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +colaboración I-EXPLORATION +por I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente. I-EXPLORATION +La I-EXPLORATION +inducción I-EXPLORATION +hipnótica I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +instrucciones I-EXPLORATION +dirigidas I-EXPLORATION +a I-EXPLORATION +favorecer I-EXPLORATION +la I-EXPLORATION +relajación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente, I-EXPLORATION +empleando I-EXPLORATION +para I-EXPLORATION +ello I-EXPLORATION +una I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +relajación I-EXPLORATION +muscular I-EXPLORATION +(visualización I-EXPLORATION +corporal I-EXPLORATION +o I-EXPLORATION +"imaging"), I-EXPLORATION +seguida I-EXPLORATION +de I-EXPLORATION +"instrucciones I-EXPLORATION +de I-EXPLORATION +imaginación" I-EXPLORATION +(visualización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +escalera I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +desciende I-EXPLORATION +peldaño I-EXPLORATION +a I-EXPLORATION +peldaño, I-EXPLORATION +acompañando I-EXPLORATION +ésta I-EXPLORATION +del I-EXPLORATION +mensaje I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +"profundización I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estado I-EXPLORATION +hipnótico") I-EXPLORATION +y I-EXPLORATION +finalizando I-EXPLORATION +este I-EXPLORATION +primer I-EXPLORATION +estadio I-EXPLORATION +con I-EXPLORATION +instrucciones I-EXPLORATION +de I-EXPLORATION +actuación, I-EXPLORATION +en I-EXPLORATION +concreto I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +"elevación I-EXPLORATION +del I-EXPLORATION +brazo". I-EXPLORATION +Dichas I-EXPLORATION +técnicas I-EXPLORATION +están I-EXPLORATION +encaminadas I-EXPLORATION +tanto I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +mayor I-EXPLORATION +predisposición I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +sugestión I-EXPLORATION +como I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +Inducción I-EXPLORATION +Hipnótica I-EXPLORATION +ha I-EXPLORATION +logrado I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +focalice I-EXPLORATION +su I-EXPLORATION +atención I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +instrucciones I-EXPLORATION +emitidas I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +psicólogo I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +otras I-EXPLORATION +fuentes I-EXPLORATION +de I-EXPLORATION +información I-EXPLORATION +pasen I-EXPLORATION +a I-EXPLORATION +ser I-EXPLORATION +secundarias I-EXPLORATION +(ruidos I-EXPLORATION +ambientales, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +personas, I-EXPLORATION +etcétera), I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +logrado I-EXPLORATION +una I-EXPLORATION +buena I-EXPLORATION +disposición I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +instrucciones I-EXPLORATION +hipnóticas I-EXPLORATION +cobren I-EXPLORATION +más I-EXPLORATION +relevancia I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +pueda I-EXPLORATION +iniciar I-EXPLORATION +el I-EXPLORATION +trabajo I-EXPLORATION +sugestivo I-EXPLORATION +propuesto. I-EXPLORATION +Logrado I-EXPLORATION +el I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +sugestionabilidad I-EXPLORATION +perseguido, I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +orientar I-EXPLORATION +las I-EXPLORATION +sugestiones I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +síntoma I-EXPLORATION +motor, I-EXPLORATION +ligando I-EXPLORATION +elementos I-EXPLORATION +de I-EXPLORATION +relajación I-EXPLORATION +muscular I-EXPLORATION +con I-EXPLORATION +mensajes I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +positivo I-EXPLORATION +centrados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +[12, I-EXPLORATION +13]. I-EXPLORATION +Tras B-EVOLUTION +aproximadamente I-EVOLUTION +una I-EVOLUTION +hora I-EVOLUTION +de I-EVOLUTION +proceso, I-EVOLUTION +iniciado I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +técnica I-EVOLUTION +de I-EVOLUTION +relajación I-EVOLUTION +y I-EVOLUTION +finalizado I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +recuperación I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +de I-EVOLUTION +vigilia, I-EVOLUTION +se I-EVOLUTION +acabó I-EVOLUTION +consiguiendo I-EVOLUTION +una I-EVOLUTION +flexión I-EVOLUTION +de I-EVOLUTION +rodilla I-EVOLUTION +izquierda I-EVOLUTION +de I-EVOLUTION +90º, I-EVOLUTION +recuperando I-EVOLUTION +la I-EVOLUTION +posición I-EVOLUTION +anquilótica I-EVOLUTION +inicial I-EVOLUTION +una I-EVOLUTION +vez I-EVOLUTION +concluido. I-EVOLUTION + I-EVOLUTION +Posteriormente I-EVOLUTION +se I-EVOLUTION +realizaron I-EVOLUTION +dos I-EVOLUTION +entrevistas I-EVOLUTION +adicionales I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Sra. I-EVOLUTION +A, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +otra I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +cónyuge, I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +fin I-EVOLUTION +de I-EVOLUTION +conocer I-EVOLUTION +mejor I-EVOLUTION +el I-EVOLUTION +entorno I-EVOLUTION +psicobiográfico I-EVOLUTION +y I-EVOLUTION +contextualizar I-EVOLUTION +adecuadamente I-EVOLUTION +el I-EVOLUTION +proceso I-EVOLUTION +psicogénico. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +segunda I-PRESENT_ILLNESS +hija I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hermano I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sano, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +derivada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pediatra I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lenta I-PRESENT_ILLNESS +somatometría I-PRESENT_ILLNESS +(Percentil I-PRESENT_ILLNESS +3), I-PRESENT_ILLNESS +IMC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +kg/m2 I-PRESENT_ILLNESS +(desnutrición I-PRESENT_ILLNESS +leve) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rechazo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alimento. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +desnutrición, I-EXPLORATION +acrocianosis I-EXPLORATION +que I-EXPLORATION +aumentaba I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +llanto, I-EXPLORATION +taquicardia, I-EXPLORATION +ligera I-EXPLORATION +disnea I-EXPLORATION +y I-EXPLORATION +soplo I-EXPLORATION +pansistólico I-EXPLORATION +II-III I-EXPLORATION +en I-EXPLORATION +varias I-EXPLORATION +localizaciones I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +auscultación. I-EXPLORATION +Fue B-TREATMENT +diagnosticada I-TREATMENT +de I-TREATMENT +cardiopatía I-TREATMENT +congénita: I-TREATMENT +Transposición I-TREATMENT +de I-TREATMENT +grandes I-TREATMENT +vasos I-TREATMENT +con I-TREATMENT +septum I-TREATMENT +integro I-TREATMENT +(TGV I-TREATMENT +con I-TREATMENT +SI), I-TREATMENT +siendo I-TREATMENT +intervenida I-TREATMENT +quirúrgicamente I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +urgente. I-TREATMENT +En I-TREATMENT +primer I-TREATMENT +lugar I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +ampliación I-TREATMENT +mediante I-TREATMENT +cateterismo I-TREATMENT +del I-TREATMENT +foramen I-TREATMENT +oval, I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +fístula I-TREATMENT +subclavia-pulmonar I-TREATMENT +y I-TREATMENT +banding I-TREATMENT +en I-TREATMENT +arteria I-TREATMENT +pulmonar. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +fue I-EVOLUTION +desfavorable, I-EVOLUTION +falleciendo I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +de I-EVOLUTION +pediatría I-EVOLUTION +8 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +ingreso. I-EVOLUTION + I-EVOLUTION +Los B-EXPLORATION +padres I-EXPLORATION +solicitaron I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +autopsia I-EXPLORATION +médico-legal I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +mala I-EXPLORATION +actuación I-EXPLORATION +facultativa. I-EXPLORATION + I-EXPLORATION +Autopsia: I-EXPLORATION + I-EXPLORATION +a) I-EXPLORATION +Examen I-EXPLORATION +Externo I-EXPLORATION + I-EXPLORATION +Peso I-EXPLORATION +de I-EXPLORATION +6440 I-EXPLORATION +g, I-EXPLORATION +talla I-EXPLORATION +de I-EXPLORATION +64 I-EXPLORATION +cm I-EXPLORATION +(IMC: I-EXPLORATION +15.6 I-EXPLORATION +kg/m2), I-EXPLORATION +perímetro I-EXPLORATION +cefálico I-EXPLORATION +de I-EXPLORATION +39.5 I-EXPLORATION +cm, I-EXPLORATION +perímetro I-EXPLORATION +torácico I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +42 I-EXPLORATION +cm. I-EXPLORATION + I-EXPLORATION +b) I-EXPLORATION +Examen I-EXPLORATION +Interno I-EXPLORATION + I-EXPLORATION +Encéfalo I-EXPLORATION +de I-EXPLORATION +620 I-EXPLORATION +g I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +infarto I-EXPLORATION +cerebral I-EXPLORATION +isquémico I-EXPLORATION +extenso I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +parieto-occipital I-EXPLORATION +izquierdo I-EXPLORATION +correspondiente I-EXPLORATION +al I-EXPLORATION +territorio I-EXPLORATION +de I-EXPLORATION +irrigación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +cerebral I-EXPLORATION +media. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +extracción I-EXPLORATION +y I-EXPLORATION +fijación I-EXPLORATION +del I-EXPLORATION +bloque I-EXPLORATION +cardiopulmonar I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +posterior I-EXPLORATION +examen I-EXPLORATION +macroscópico, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +TGV I-EXPLORATION +intervenida I-EXPLORATION +quirúrgicamente I-EXPLORATION +presentando I-EXPLORATION +un I-EXPLORATION +banding I-EXPLORATION +en I-EXPLORATION +arteria I-EXPLORATION +pulmonar, I-EXPLORATION +una I-EXPLORATION +fístula I-EXPLORATION +entre I-EXPLORATION +subclavia I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +arteria I-EXPLORATION +pulmonar, I-EXPLORATION +y I-EXPLORATION +ampliación I-EXPLORATION +de I-EXPLORATION +comunicación I-EXPLORATION +interauricular I-EXPLORATION +(foramen I-EXPLORATION +oval), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +hipertrofia I-EXPLORATION +de I-EXPLORATION +ventrículo I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +adelgazamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo. I-EXPLORATION +Presentaba I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +vez I-EXPLORATION +una I-EXPLORATION +anomalía I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +coronarias, I-EXPLORATION +observándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +ostium I-EXPLORATION +coronarios I-EXPLORATION +que I-EXPLORATION +salían I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +seno. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +histológico I-EXPLORATION +del I-EXPLORATION +corazón I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +pericarditis I-EXPLORATION +serofibrinosa I-EXPLORATION +y, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +miocardio, I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +subendocárdica I-EXPLORATION +con I-EXPLORATION +calcificación I-EXPLORATION +distrófica I-EXPLORATION +secundarios I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cirugía. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +pulmones I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +membranas I-EXPLORATION +hialinas I-EXPLORATION +como I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +distrés I-EXPLORATION +respiratorio. I-EXPLORATION +Por I-EXPLORATION +otro I-EXPLORATION +lado, I-EXPLORATION +el I-EXPLORATION +encéfalo I-EXPLORATION +presentaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +encefalopatía I-EXPLORATION +anóxica I-EXPLORATION +e I-EXPLORATION +infarto I-EXPLORATION +parietal I-EXPLORATION +reciente. I-EXPLORATION + I-EXPLORATION +Así, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +macro I-EXPLORATION +y I-EXPLORATION +microscópicos, I-EXPLORATION +se I-EXPLORATION +determinó I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muerte I-EXPLORATION +fue I-EXPLORATION +un I-EXPLORATION +Infarto I-EXPLORATION +cerebral I-EXPLORATION +isquémico I-EXPLORATION +en I-EXPLORATION +paciente I-EXPLORATION +intervenida I-EXPLORATION +de I-EXPLORATION +Transposición I-EXPLORATION +de I-EXPLORATION +grandes I-EXPLORATION +arterias. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +reporta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +género I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tercer I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +sangrado I-PRESENT_ILLNESS +vaginal, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antecedente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +previo. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +hay I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +abuso I-PAST_MEDICAL_HISTORY +sexual I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +trauma I-PAST_MEDICAL_HISTORY +genital. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +abundante I-EXPLORATION +sangrado I-EXPLORATION +genital I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +consideraron I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +diagnósticos I-EXPLORATION +diferenciales: I-EXPLORATION +trauma, I-EXPLORATION +abuso I-EXPLORATION +sexual I-EXPLORATION +y I-EXPLORATION +maltrato I-EXPLORATION +infantil, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +caso I-EXPLORATION +es I-EXPLORATION +reportado I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +autoridad, I-EXPLORATION +quienes I-EXPLORATION +por I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +grupo I-EXPLORATION +élite I-EXPLORATION +de I-EXPLORATION +manejo I-EXPLORATION +de I-EXPLORATION +delitos I-EXPLORATION +sexuales, I-EXPLORATION +deciden I-EXPLORATION +remitir I-EXPLORATION +para I-EXPLORATION +examen I-EXPLORATION +médico-legal. I-EXPLORATION + I-EXPLORATION +Durante I-EXPLORATION +la I-EXPLORATION +anamnesis, I-EXPLORATION +el I-EXPLORATION +médico I-EXPLORATION +especialista I-EXPLORATION +forense I-EXPLORATION +tomó I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +información I-EXPLORATION +disponible I-EXPLORATION +y I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +información I-EXPLORATION +aportada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +madre, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +recalcaba I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +sospechaba I-EXPLORATION +de I-EXPLORATION +abuso I-EXPLORATION +sexual, I-EXPLORATION +prosiguió I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +genital, I-EXPLORATION +encontrando I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +menor I-EXPLORATION +presentaba I-EXPLORATION +genitales I-EXPLORATION +femeninos I-EXPLORATION +infantiles I-EXPLORATION +normoconfigurados I-EXPLORATION +con I-EXPLORATION +hematoma I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +meridiano I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +12 I-EXPLORATION +de I-EXPLORATION +0.3 I-EXPLORATION +x I-EXPLORATION +0.3 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +permitía I-EXPLORATION +ver I-EXPLORATION +el I-EXPLORATION +borde I-EXPLORATION +libre I-EXPLORATION +del I-EXPLORATION +himen, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +posible I-EXPLORATION +descartar I-EXPLORATION +desgarros I-EXPLORATION +a I-EXPLORATION +éste I-EXPLORATION +nivel, I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +sangrado I-EXPLORATION +reciente I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +vaginal, I-EXPLORATION +pañal I-EXPLORATION +y I-EXPLORATION +pantalón. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +otras I-EXPLORATION +lesiones. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +grupo I-EXPLORATION +élite I-EXPLORATION +de I-EXPLORATION +manejo I-EXPLORATION +de I-EXPLORATION +delitos I-EXPLORATION +sexuales I-EXPLORATION +entregó I-EXPLORATION +al I-EXPLORATION +médico I-EXPLORATION +especialista I-EXPLORATION +forense I-EXPLORATION +muestras I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +tomadas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +centro I-EXPLORATION +hospitalario I-EXPLORATION +donde I-EXPLORATION +fue I-EXPLORATION +inicialmente I-EXPLORATION +valorada I-EXPLORATION +la I-EXPLORATION +menor, I-EXPLORATION +muestras I-EXPLORATION +que I-EXPLORATION +ante I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +el I-EXPLORATION +médico I-EXPLORATION +especialista I-EXPLORATION +forense I-EXPLORATION +consideró I-EXPLORATION +pertinente I-EXPLORATION +enviar I-EXPLORATION +al I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +biología I-EXPLORATION +del I-EXPLORATION +Instituto I-EXPLORATION +Nacional I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +Legal I-EXPLORATION +y I-EXPLORATION +Ciencias I-EXPLORATION +Forenses I-EXPLORATION +para I-EXPLORATION +búsqueda I-EXPLORATION +de I-EXPLORATION +evidencia I-EXPLORATION +traza I-EXPLORATION +(espermatozoides I-EXPLORATION +y I-EXPLORATION +ADN) I-EXPLORATION +bajo I-EXPLORATION +cadena I-EXPLORATION +de I-EXPLORATION +custodia. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +conclusión, I-EXPLORATION +el I-EXPLORATION +médico I-EXPLORATION +especialista I-EXPLORATION +forense I-EXPLORATION +asocia I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +encontrada I-EXPLORATION +con I-EXPLORATION +trauma I-EXPLORATION +genital I-EXPLORATION +y I-EXPLORATION +describe I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +posible I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +determinar I-EXPLORATION +si I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +origen I-EXPLORATION +accidental I-EXPLORATION +o I-EXPLORATION +no. I-EXPLORATION + I-EXPLORATION +Posterior B-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +examen I-DERIVED_FROM/TO +médico-legal, I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +menor I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Infantil, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +gran I-DERIVED_FROM/TO +experiencia I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +manejo I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +abuso I-DERIVED_FROM/TO +sexual I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +maltrato I-DERIVED_FROM/TO +infantil. I-DERIVED_FROM/TO +El B-EXPLORATION +personal I-EXPLORATION +médico I-EXPLORATION +de I-EXPLORATION +dicho I-EXPLORATION +Hospital I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +valoración I-EXPLORATION +por I-EXPLORATION +otro I-EXPLORATION +médico I-EXPLORATION +especialista I-EXPLORATION +forense, I-EXPLORATION +quien I-EXPLORATION +acude I-EXPLORATION +al I-EXPLORATION +Hospital I-EXPLORATION +para I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +examen. I-EXPLORATION +Dicho I-EXPLORATION +examen I-EXPLORATION +es I-EXPLORATION +realizado I-EXPLORATION +bajo I-EXPLORATION +sedación, I-EXPLORATION +utilizando I-EXPLORATION +lupa I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +genital, I-EXPLORATION +encontrando I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +descrita I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +médico I-EXPLORATION +no I-EXPLORATION +era I-EXPLORATION +más I-EXPLORATION +que I-EXPLORATION +mucosa I-EXPLORATION +uretral I-EXPLORATION +prolapsada, I-EXPLORATION +que I-EXPLORATION +simulaba I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +meridiano I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +12 I-EXPLORATION +horas. I-EXPLORATION +Se I-EXPLORATION +hace I-EXPLORATION +entonces I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +prolapso I-EXPLORATION +uretral. I-EXPLORATION +La B-EVOLUTION +menor I-EVOLUTION +es I-EVOLUTION +llevada I-EVOLUTION +a I-EVOLUTION +manejo I-EVOLUTION +quirúrgico I-EVOLUTION +con I-EVOLUTION +corrección I-EVOLUTION +del I-EVOLUTION +prolapso. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +joven I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +aguas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +playa I-PRESENT_ILLNESS +Red I-PRESENT_ILLNESS +Frog I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Isla I-PRESENT_ILLNESS +Bastimentos. I-PRESENT_ILLNESS +Los I-PRESENT_ILLNESS +testigos I-PRESENT_ILLNESS +observaron I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +joven I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mar I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +"pidió I-PRESENT_ILLNESS +ayuda", I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +sumergió I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +volvió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +salir I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +metros I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sumergido I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +volvieron I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ver. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-EXPLORATION +recuperó I-EXPLORATION +el I-EXPLORATION +cadáver I-EXPLORATION +tres I-EXPLORATION +días I-EXPLORATION +después, I-EXPLORATION +en I-EXPLORATION +avanzado I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +descomposición, I-EXPLORATION +sin I-EXPLORATION +prendas I-EXPLORATION +de I-EXPLORATION +vestir, I-EXPLORATION +con I-EXPLORATION +antropofagia I-EXPLORATION +cadavérica I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +rostro. I-EXPLORATION +Presentaba I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +parrilla I-EXPLORATION +costal I-EXPLORATION +bilateralmente, I-EXPLORATION +también I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +pélvica I-EXPLORATION +anterior I-EXPLORATION +cubriendo I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +39 I-EXPLORATION +x I-EXPLORATION +22 I-EXPLORATION +cm. I-EXPLORATION +La I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +músculos I-EXPLORATION +presentaban I-EXPLORATION +bordes I-EXPLORATION +desgarrados, I-EXPLORATION +las I-EXPLORATION +costillas I-EXPLORATION +presentaban I-EXPLORATION +fracturas I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +astillados. I-EXPLORATION +Había I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +órganos I-EXPLORATION +internos I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +torácico I-EXPLORATION +y I-EXPLORATION +abdominal I-EXPLORATION +a I-EXPLORATION +excepción I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +esófago I-EXPLORATION +y I-EXPLORATION +vías I-EXPLORATION +respiratorias I-EXPLORATION +altas. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +subescapular I-EXPLORATION +bilateral I-EXPLORATION +presentaba I-EXPLORATION +lesiones I-EXPLORATION +contuso-cortantes I-EXPLORATION +(aspecto I-EXPLORATION +de I-EXPLORATION +sierra) I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +semiovalada. I-EXPLORATION +Además I-EXPLORATION +presentaba I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +músculos I-EXPLORATION +del I-EXPLORATION +glúteo I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +avulsivo I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +irregulares I-EXPLORATION +y I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +muscular I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +muslo I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION + +Un B-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +residente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Puerto I-PAST_MEDICAL_HISTORY +Vallarta, I-PAST_MEDICAL_HISTORY +se B-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pareja I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +interior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +campo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +golf I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +orilla I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +trampa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agua, I-PRESENT_ILLNESS +alrededor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +22: I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +h. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +sujeto I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +permiso I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +campo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +golf I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +acceso I-PRESENT_ILLNESS +restringido. I-PRESENT_ILLNESS +Según I-PRESENT_ILLNESS +relata I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +víctima, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +tocó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +espejo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +trampa I-PRESENT_ILLNESS +(se I-PRESENT_ILLNESS +asume I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +esto I-PRESENT_ILLNESS +ocurrió I-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +sostenía I-PRESENT_ILLNESS +coito I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pareja), I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +río I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +americano I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +metros I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +largo, I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +sujetó I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pie. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bomberos I-PRESENT_ILLNESS +municipal I-PRESENT_ILLNESS +arribó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +auxilio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +observó I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +mantenía I-PRESENT_ILLNESS +sujeto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +extremidad I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +aferraba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +brazos I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +árbol I-PRESENT_ILLNESS +cercano I-PRESENT_ILLNESS +(al I-PRESENT_ILLNESS +menos I-PRESENT_ILLNESS +permaneció I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +par I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +esta I-PRESENT_ILLNESS +situación I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +recibir I-PRESENT_ILLNESS +ayuda). I-PRESENT_ILLNESS +Los I-PRESENT_ILLNESS +bomberos I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +arrojaron I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +cuerda I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +rescatarlo I-PRESENT_ILLNESS +(ya I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +parte I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +dentro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +trampa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agua); I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +tensaron I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cuerda I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +liberarlo, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +giro I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +propio I-PRESENT_ILLNESS +cuerpo, I-PRESENT_ILLNESS +conocido I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +"giro I-PRESENT_ILLNESS +mortal", I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +provocó I-PRESENT_ILLNESS +politraumatismo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +pantorrilla I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +fracturas I-PRESENT_ILLNESS +expuestas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +espiral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +compuesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tibia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +peroné, I-PRESENT_ILLNESS +conminuta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +astrágalo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +partes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conexión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tejidos I-PRESENT_ILLNESS +blandos, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +laceraciones I-PRESENT_ILLNESS +mayores I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +músculos I-PRESENT_ILLNESS +gastrocnemio, I-PRESENT_ILLNESS +sóleo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tibial I-PRESENT_ILLNESS +anterior. I-PRESENT_ILLNESS +Al B-TREATMENT +rescatarlo I-TREATMENT +y I-TREATMENT +llevarlo I-TREATMENT +al I-TREATMENT +hospital, I-TREATMENT +los I-TREATMENT +médicos I-TREATMENT +decidieron I-TREATMENT +amputarle I-TREATMENT +la I-TREATMENT +extremidad I-TREATMENT +izquierda I-TREATMENT +por I-TREATMENT +debajo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +rodilla. I-TREATMENT + I-TREATMENT + +Un B-PRESENT_ILLNESS +joven I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +manifestó I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +agredido I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cocodrilo. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +encontró I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +shock I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +01: I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +inmediaciones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +campo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +golf I-PRESENT_ILLNESS +Marina I-PRESENT_ILLNESS +Vallarta I-PRESENT_ILLNESS +(la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +está I-PRESENT_ILLNESS +limitada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +cerca I-PRESENT_ILLNESS +perimetral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alambre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +púas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tiene I-PRESENT_ILLNESS +letreros I-PRESENT_ILLNESS +informativos I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +prohíben I-PRESENT_ILLNESS +ingresar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +privada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +alertan I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cocodrilos). I-PRESENT_ILLNESS +La B-EXPLORATION +víctima I-EXPLORATION +tenía I-EXPLORATION +amputado I-EXPLORATION +el I-EXPLORATION +brazo I-EXPLORATION +izquierdo, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +húmero. I-EXPLORATION +Fue B-TREATMENT +asistido I-TREATMENT +en I-TREATMENT +primera I-TREATMENT +instancia I-TREATMENT +por I-TREATMENT +elementos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +policía I-TREATMENT +municipal I-TREATMENT +y, I-TREATMENT +posteriormente, I-TREATMENT +recibió I-TREATMENT +atención I-TREATMENT +de I-TREATMENT +socorristas I-TREATMENT +de I-TREATMENT +un I-TREATMENT +hospital I-TREATMENT +privado, I-TREATMENT +quienes I-TREATMENT +le I-TREATMENT +aplicaron I-TREATMENT +sedantes. I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +trasladó I-TREATMENT +al I-TREATMENT +nosocomio, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +le I-TREATMENT +práctico I-TREATMENT +la I-TREATMENT +amputación I-TREATMENT +total I-TREATMENT +del I-TREATMENT +brazo I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +administró I-TREATMENT +como I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +inicio I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +Pentamin, I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +Amikasina, I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +Rosephin® I-TREATMENT +y I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +Histaline. I-TREATMENT +Como I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +mantenimiento, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +aplicó I-TREATMENT +una I-TREATMENT +ámpula I-TREATMENT +de I-TREATMENT +Pantosin I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +h, I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +vía I-TREATMENT +intravenosa I-TREATMENT +de I-TREATMENT +Amikasina, I-TREATMENT +30 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +h I-TREATMENT +vía I-TREATMENT +intravenosa I-TREATMENT +de I-TREATMENT +Ketorolaco, I-TREATMENT +una I-TREATMENT +ámpula I-TREATMENT +de I-TREATMENT +Pantozol® I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +vía I-TREATMENT +intravenosa, I-TREATMENT +una I-TREATMENT +ámpula I-TREATMENT +de I-TREATMENT +Stadium® I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +h I-TREATMENT +vía I-TREATMENT +intravenosa, I-TREATMENT +un I-TREATMENT +ámpula I-TREATMENT +de I-TREATMENT +toxoide I-TREATMENT +tetánico I-TREATMENT +y I-TREATMENT +una I-TREATMENT +tableta I-TREATMENT +de I-TREATMENT +Gabapentina; I-TREATMENT +además I-TREATMENT +de I-TREATMENT +solución I-TREATMENT +Hartmann I-TREATMENT +y I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +0.9% I-TREATMENT +alternadas. I-TREATMENT + I-TREATMENT +La B-PRESENT_ILLNESS +víctima, I-PRESENT_ILLNESS +residente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Guadalajara, I-PRESENT_ILLNESS +Jalisco, I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +entrevistada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +relató I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +recordar I-PRESENT_ILLNESS +lapsos I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +incidente. I-PRESENT_ILLNESS +Sin I-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pesar I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esto I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +declararse I-PRESENT_ILLNESS +también I-PRESENT_ILLNESS +desorientada I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ataque, I-PRESENT_ILLNESS +recuerda I-PRESENT_ILLNESS +encontrarse I-PRESENT_ILLNESS +dentro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +trampas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +campo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +golf I-PRESENT_ILLNESS +(cercana I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +playa). I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +espacio, I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +arremetida I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +veces I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +mordeduras I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sacudidas I-PRESENT_ILLNESS +(giros) I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +(presentó I-PRESENT_ILLNESS +heridas I-PRESENT_ILLNESS +avulsivas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +exterior I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +interior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +porción I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pecho, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +escoriaciones I-PRESENT_ILLNESS +leves I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +genitales). I-PRESENT_ILLNESS +Comenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +joven I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +golpeó I-PRESENT_ILLNESS +repetidamente I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cabeza I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +rocas, I-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sentir I-PRESENT_ILLNESS +cómo I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +reptil I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +sujetaba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +pierna, I-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +luchaba I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +mantenerse I-PRESENT_ILLNESS +asido I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +ramas I-PRESENT_ILLNESS +cercanas I-PRESENT_ILLNESS +(no I-PRESENT_ILLNESS +recuerda I-PRESENT_ILLNESS +si I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +momento, I-PRESENT_ILLNESS +ya I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +perdido I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +brazo). I-PRESENT_ILLNESS +Una I-PRESENT_ILLNESS +vez I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +soltó, I-PRESENT_ILLNESS +logró I-PRESENT_ILLNESS +llegar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +orilla I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +perdió I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +conocimiento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +ocasiones. I-PRESENT_ILLNESS +Ingresó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +trampa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agua, I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +llegar I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +edificio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +condominios I-PRESENT_ILLNESS +aledaño I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +campo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +golf I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +asistido I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +condóminos I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +llegada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +policía I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +socorristas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS + +Un B-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +residente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Puerto I-PAST_MEDICAL_HISTORY +Vallarta, I-PAST_MEDICAL_HISTORY +fue B-PRESENT_ILLNESS +atacado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +río I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +8: I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +junio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2010 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +orilla I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estero I-PRESENT_ILLNESS +Boca I-PRESENT_ILLNESS +Negra, I-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +realizaba I-PRESENT_ILLNESS +faenas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pesca I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +atarraya. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +víctima I-PRESENT_ILLNESS +relata I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +observó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +"saltar" I-PRESENT_ILLNESS +fuera I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +y, I-PRESENT_ILLNESS +aunque I-PRESENT_ILLNESS +intentó I-PRESENT_ILLNESS +esquivarlo, I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +atrapado I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +brazo I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +Posteriormente, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +reptil I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +haló I-PRESENT_ILLNESS +hacia I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +hundió. I-PRESENT_ILLNESS +Aunque I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +logró I-PRESENT_ILLNESS +liberarse, I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +amputación I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +desgarre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +antebrazo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +músculo I-PRESENT_ILLNESS +braquiorradial I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tríceps I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cabeza I-PRESENT_ILLNESS +lateral I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tríceps I-PRESENT_ILLNESS +braquial, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +exposición I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cóndilo I-PRESENT_ILLNESS +humeral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +articulación I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +fragmento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cúbito I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tuberosidad I-PRESENT_ILLNESS +radial. I-PRESENT_ILLNESS +La B-EVOLUTION +persona I-EVOLUTION +fue I-EVOLUTION +trasladada I-EVOLUTION +al I-EVOLUTION +hospital I-EVOLUTION +donde I-EVOLUTION +se I-EVOLUTION +recuperó I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +lesiones. I-EVOLUTION +Cabe B-PRESENT_ILLNESS +destacar I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +víctima I-PRESENT_ILLNESS +manifiesta I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +golpeado I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +ojos I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cocodrilo I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +lograr I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +liberación. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cadáver I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +melanoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +coroides I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +quirúrgicamente I-PAST_MEDICAL_HISTORY +(enucleación) I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +fallecimiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +que, I-PAST_MEDICAL_HISTORY +posteriormente, I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatectomía I-PAST_MEDICAL_HISTORY +parcial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cistectomía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +posibles I-PAST_MEDICAL_HISTORY +metástasis I-PAST_MEDICAL_HISTORY +(un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +inicial I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tumor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +coroides). I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +entonces, I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +revisiones I-PAST_MEDICAL_HISTORY +médicas, I-PAST_MEDICAL_HISTORY +según I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +familia, I-PAST_MEDICAL_HISTORY +han I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY +Inesperadamente B-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +respiratoria, I-PRESENT_ILLNESS +falleciendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +súbita I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +minutos, I-PRESENT_ILLNESS +encontrándose I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +cadáver, I-PRESENT_ILLNESS +restos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +biliosos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +externo I-EXPLORATION +destaca I-EXPLORATION +tinte I-EXPLORATION +ictérico I-EXPLORATION +generalizado, I-EXPLORATION +restos I-EXPLORATION +biliosos I-EXPLORATION +que I-EXPLORATION +salen I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +derecha, I-EXPLORATION +edema I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +(sobre I-EXPLORATION +todo I-EXPLORATION +en I-EXPLORATION +pie, I-EXPLORATION +antepié I-EXPLORATION +y I-EXPLORATION +tobillo), I-EXPLORATION +congestión I-EXPLORATION +conjuntival I-EXPLORATION +en I-EXPLORATION +ojo I-EXPLORATION +izquierdo, I-EXPLORATION +prótesis I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +derecho, I-EXPLORATION +abdomen I-EXPLORATION +globuloso I-EXPLORATION +con I-EXPLORATION +protusión I-EXPLORATION +umbilical, I-EXPLORATION +cicatrices I-EXPLORATION +quirúrgicas I-EXPLORATION +antiguas I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +subcostal I-EXPLORATION +y I-EXPLORATION +flanco I-EXPLORATION +abdominal I-EXPLORATION +derechos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +interno I-EXPLORATION +apreciamos I-EXPLORATION +una I-EXPLORATION +nodulación I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +encefálica I-EXPLORATION +frontal I-EXPLORATION +derecha, I-EXPLORATION +que I-EXPLORATION +penetra I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +sustancia I-EXPLORATION +blanca I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +pardo-negruzca. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +torácica I-EXPLORATION +encontramos I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +derrame I-EXPLORATION +pericárdico I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +turbio. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +disección I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +pulmonares I-EXPLORATION +observamos I-EXPLORATION +un I-EXPLORATION +trombo I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +vitales I-EXPLORATION +adherido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +introduce I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +ramas I-EXPLORATION +intraparenquimatosas. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha I-EXPLORATION +existía I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +adherida I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +latero-interna, I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +orejuela, I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +pardo-negruzca I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +pediculado I-EXPLORATION +con I-EXPLORATION +amplia I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +implantación. I-EXPLORATION +La I-EXPLORATION +superficie I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +discretamente I-EXPLORATION +excavada I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +hemorrágico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuadrante I-EXPLORATION +infero-interno. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +abdominal I-EXPLORATION +existían I-EXPLORATION +1.500 I-EXPLORATION +cc I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +ascítico I-EXPLORATION +con I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +heces, I-EXPLORATION +adherencias I-EXPLORATION +peritoneales I-EXPLORATION +marcadas, I-EXPLORATION +nódulos I-EXPLORATION +linfáticos I-EXPLORATION +paravertebrales I-EXPLORATION +aumentados I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +negruzca I-EXPLORATION +y I-EXPLORATION +duros I-EXPLORATION +al I-EXPLORATION +corte. I-EXPLORATION +Así I-EXPLORATION +mismo, I-EXPLORATION +también I-EXPLORATION +encontramos I-EXPLORATION +nódulos I-EXPLORATION +con I-EXPLORATION +semejantes I-EXPLORATION +características I-EXPLORATION +adheridos I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +peritoneales. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +hígado I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +con I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +coagulada I-EXPLORATION +y I-EXPLORATION +material I-EXPLORATION +necrótico I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +verduzca I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION +La I-EXPLORATION +cabeza I-EXPLORATION +del I-EXPLORATION +páncreas I-EXPLORATION +tenía I-EXPLORATION +aspecto I-EXPLORATION +congestivo I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +tacto I-EXPLORATION +presentaba I-EXPLORATION +consistencia I-EXPLORATION +dura I-EXPLORATION +y I-EXPLORATION +fibrosa. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +paredes I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +aparecían I-EXPLORATION +adelgazadas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +necrótico, I-EXPLORATION +con I-EXPLORATION +perforaciones I-EXPLORATION +en I-EXPLORATION +íleon I-EXPLORATION +y I-EXPLORATION +yeyuno I-EXPLORATION +que I-EXPLORATION +permitían I-EXPLORATION +la I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +fecaloideo I-EXPLORATION +y I-EXPLORATION +alimenticio I-EXPLORATION +sin I-EXPLORATION +digerir. I-EXPLORATION +Existían I-EXPLORATION +segmentos I-EXPLORATION +intestinales I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +obstructivo, I-EXPLORATION +que I-EXPLORATION +coincidían I-EXPLORATION +con I-EXPLORATION +implantes I-EXPLORATION +tumorales I-EXPLORATION +necróticos. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +intestino I-EXPLORATION +grueso I-EXPLORATION +presentaba I-EXPLORATION +también I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +tumoral I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +pardo-negruzca. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +estudios I-EXPLORATION +químico-toxicológicos I-EXPLORATION +de I-EXPLORATION +sangre, I-EXPLORATION +humor I-EXPLORATION +vítreo I-EXPLORATION +y I-EXPLORATION +líquido I-EXPLORATION +ascítico I-EXPLORATION +y I-EXPLORATION +estudios I-EXPLORATION +histopatológicos I-EXPLORATION +de I-EXPLORATION +encéfalo, I-EXPLORATION +corazón, I-EXPLORATION +pulmón I-EXPLORATION +y I-EXPLORATION +trombos I-EXPLORATION +pulmonares, I-EXPLORATION +hígado, I-EXPLORATION +páncreas, I-EXPLORATION +intestino I-EXPLORATION +(duodeno, I-EXPLORATION +yeyuno I-EXPLORATION +e I-EXPLORATION +íleon) I-EXPLORATION +y I-EXPLORATION +ganglios I-EXPLORATION +linfáticos I-EXPLORATION +paravertebrales I-EXPLORATION +y I-EXPLORATION +nódulos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +del I-EXPLORATION +peritoneo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +primeros I-EXPLORATION +se I-EXPLORATION +obtuvieron I-EXPLORATION +resultados I-EXPLORATION +negativos I-EXPLORATION +a I-EXPLORATION +todas I-EXPLORATION +aquellas I-EXPLORATION +sustancias I-EXPLORATION +estudiadas. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +histopatológicos I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +compuesta I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +poligonales I-EXPLORATION +y I-EXPLORATION +fusiformes I-EXPLORATION +dispuestas I-EXPLORATION +formando I-EXPLORATION +sábanas I-EXPLORATION +o I-EXPLORATION +nidos I-EXPLORATION +sólidos. I-EXPLORATION +Estos I-EXPLORATION +crecimientos I-EXPLORATION +tumorales I-EXPLORATION +infiltraban I-EXPLORATION +el I-EXPLORATION +miocardio I-EXPLORATION +auricular I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +acompañaban I-EXPLORATION +de I-EXPLORATION +reacción I-EXPLORATION +desmoplásica. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neoplasia I-EXPLORATION +existen I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +externa I-EXPLORATION +se I-EXPLORATION +identifica I-EXPLORATION +un I-EXPLORATION +trombo I-EXPLORATION +adherido I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +ulcerada. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +presentaban I-EXPLORATION +nucléolos I-EXPLORATION +prominentes I-EXPLORATION +y I-EXPLORATION +frecuentes I-EXPLORATION +figuras I-EXPLORATION +de I-EXPLORATION +mitosis. I-EXPLORATION +Con I-EXPLORATION +frecuencia, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +citoplasma I-EXPLORATION +existía I-EXPLORATION +abundante I-EXPLORATION +pigmento I-EXPLORATION +melánico. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +émbolos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +pulmonares I-EXPLORATION +presentaban I-EXPLORATION +distintos I-EXPLORATION +estadios I-EXPLORATION +evolutivos. I-EXPLORATION +Unos I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +organización, I-EXPLORATION +observándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +fibroblastos I-EXPLORATION +y I-EXPLORATION +yemas I-EXPLORATION +vasculares I-EXPLORATION +que I-EXPLORATION +iban I-EXPLORATION +infiltrando I-EXPLORATION +la I-EXPLORATION +formación I-EXPLORATION +trombótica I-EXPLORATION +; I-EXPLORATION +otros, I-EXPLORATION +en I-EXPLORATION +cambio, I-EXPLORATION +estaban I-EXPLORATION +completamente I-EXPLORATION +tapizados I-EXPLORATION +de I-EXPLORATION +endotelio I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +seno I-EXPLORATION +comenzaban I-EXPLORATION +a I-EXPLORATION +proliferar I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +arterial; I-EXPLORATION +y, I-EXPLORATION +por I-EXPLORATION +último, I-EXPLORATION +los I-EXPLORATION +más I-EXPLORATION +recientes I-EXPLORATION +estaban I-EXPLORATION +constituidos I-EXPLORATION +por I-EXPLORATION +fibrina I-EXPLORATION +y I-EXPLORATION +ocluían I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +luz I-EXPLORATION +residual I-EXPLORATION +y I-EXPLORATION +fueron I-EXPLORATION +los I-EXPLORATION +responsables I-EXPLORATION +del I-EXPLORATION +fallecimiento I-EXPLORATION +repentino I-EXPLORATION +del I-EXPLORATION +paciente. I-EXPLORATION +La I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +émbolos I-EXPLORATION +en I-EXPLORATION +diferentes I-EXPLORATION +estadios I-EXPLORATION +evolutivos I-EXPLORATION +implica I-EXPLORATION +que, I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +trombo I-EXPLORATION +adherido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +metástasis I-EXPLORATION +auricular, I-EXPLORATION +se I-EXPLORATION +han I-EXPLORATION +ido I-EXPLORATION +desprendiendo I-EXPLORATION +numerosos I-EXPLORATION +émbolos I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +espacio I-EXPLORATION +de I-EXPLORATION +tiempo I-EXPLORATION +que I-EXPLORATION +puede I-EXPLORATION +oscilar I-EXPLORATION +entre I-EXPLORATION +3 I-EXPLORATION +y I-EXPLORATION +4 I-EXPLORATION +semanas I-EXPLORATION +de I-EXPLORATION +evolución. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +macroscópicos I-EXPLORATION +y I-EXPLORATION +microscópicos I-EXPLORATION +sustentan I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +muerte I-EXPLORATION +súbita, I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +tromboembolismo I-EXPLORATION +pulmonar I-EXPLORATION +masivo, I-EXPLORATION +que I-EXPLORATION +ha I-EXPLORATION +tenido I-EXPLORATION +su I-EXPLORATION +origen I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +maligna I-EXPLORATION +metastásica I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +melanoma I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +ido I-EXPLORATION +organizando I-EXPLORATION +en I-EXPLORATION +distintos I-EXPLORATION +estadios I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +o I-EXPLORATION +4 I-EXPLORATION +semanas I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +ha I-EXPLORATION +finalizado I-EXPLORATION +ocluyendo I-EXPLORATION +completamente I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +pulmonares I-EXPLORATION +y I-EXPLORATION +ocasionando I-EXPLORATION +la I-EXPLORATION +muerte I-EXPLORATION +del I-EXPLORATION +sujeto. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +otro I-EXPLORATION +lado, I-EXPLORATION +y I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +anterior, I-EXPLORATION +nos I-EXPLORATION +encontramos I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +shock I-EXPLORATION +séptico I-EXPLORATION +por I-EXPLORATION +peritonitis I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +perforación I-EXPLORATION +intestinal, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +marco I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +metastásica I-EXPLORATION +generalizada I-EXPLORATION +cuyo I-EXPLORATION +origen I-EXPLORATION +es I-EXPLORATION +el I-EXPLORATION +melanoma I-EXPLORATION +de I-EXPLORATION +coroides. I-EXPLORATION + I-EXPLORATION + +En B-PRESENT_ILLNESS +enero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontró I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cadáver I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +avanzado I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +descomposición I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +orilla I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +embalse I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Canales I-PRESENT_ILLNESS +(Granada). I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +mancha I-EXPLORATION +verde I-EXPLORATION +generalizada, I-EXPLORATION +red I-EXPLORATION +vascular I-EXPLORATION +muy I-EXPLORATION +definida, I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +adipocera, I-EXPLORATION +maceración I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +faneras I-EXPLORATION +y I-EXPLORATION +entomofauna I-EXPLORATION +sarcosaprófaga. I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +procesos I-EXPLORATION +putrefactivos, I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +positiva I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +rasgos I-EXPLORATION +faciales I-EXPLORATION +era I-EXPLORATION +imposible, I-EXPLORATION +pero I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +varón I-EXPLORATION +que I-EXPLORATION +desapareció I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +domicilio I-EXPLORATION +a I-EXPLORATION +finales I-EXPLORATION +de I-EXPLORATION +noviembre I-EXPLORATION +del I-EXPLORATION +año I-EXPLORATION +anterior I-EXPLORATION +ya I-EXPLORATION +que, I-EXPLORATION +según I-EXPLORATION +informó I-EXPLORATION +la I-EXPLORATION +Policía, I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +era I-EXPLORATION +frecuentada I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +desaparecido I-EXPLORATION +desde I-EXPLORATION +que I-EXPLORATION +inició I-EXPLORATION +los I-EXPLORATION +trámites I-EXPLORATION +de I-EXPLORATION +divorcio. I-EXPLORATION +La I-EXPLORATION +temperatura I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lugar I-EXPLORATION +del I-EXPLORATION +levantamiento I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +5oC. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +lugar I-EXPLORATION +del I-EXPLORATION +levantamiento I-EXPLORATION +consistía I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +cornisa I-EXPLORATION +de I-EXPLORATION +terreno I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +levantaba I-EXPLORATION +por I-EXPLORATION +encima I-EXPLORATION +del I-EXPLORATION +pantano I-EXPLORATION +de I-EXPLORATION +Canales. I-EXPLORATION +El I-EXPLORATION +piso I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +textura I-EXPLORATION +arenosa I-EXPLORATION +con I-EXPLORATION +algunas I-EXPLORATION +formaciones I-EXPLORATION +arbustivas I-EXPLORATION +de I-EXPLORATION +escasa I-EXPLORATION +frondosidad. I-EXPLORATION +Se I-EXPLORATION +describieron I-EXPLORATION +restos I-EXPLORATION +mucilaginosos I-EXPLORATION +de I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +pudieron I-EXPLORATION +ser I-EXPLORATION +algas I-EXPLORATION +que I-EXPLORATION +quedaron I-EXPLORATION +depositadas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +llenado I-EXPLORATION +del I-EXPLORATION +embalse. I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +dificultad I-EXPLORATION +de I-EXPLORATION +acceso I-EXPLORATION +al I-EXPLORATION +lugar I-EXPLORATION +exacto I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +hallaba I-EXPLORATION +el I-EXPLORATION +cadáver, I-EXPLORATION +tuvieron I-EXPLORATION +que I-EXPLORATION +intervenir I-EXPLORATION +efectivos I-EXPLORATION +de I-EXPLORATION +Protección I-EXPLORATION +Civil I-EXPLORATION +para I-EXPLORATION +trasladar I-EXPLORATION +el I-EXPLORATION +cuerpo I-EXPLORATION +en I-EXPLORATION +lancha I-EXPLORATION +hasta I-EXPLORATION +un I-EXPLORATION +lugar I-EXPLORATION +seguro I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +continuaron I-EXPLORATION +las I-EXPLORATION +diligencias I-EXPLORATION +oportunas. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +caso I-EXPLORATION +que I-EXPLORATION +presentamos I-EXPLORATION +es I-EXPLORATION +paradigmático I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +sospecha I-EXPLORATION +una I-EXPLORATION +inmersión I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +previa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +colonización I-EXPLORATION +por I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +dípteros I-EXPLORATION +necrófagos I-EXPLORATION +y, I-EXPLORATION +por I-EXPLORATION +tanto, I-EXPLORATION +un I-EXPLORATION +retraso I-EXPLORATION +considerable I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +fallecimiento I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +llegada I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +primeros I-EXPLORATION +insectos I-EXPLORATION +de I-EXPLORATION +interés I-EXPLORATION +forense. I-EXPLORATION +A I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +meteorológicos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +conocimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +temporal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +desarrollo I-EXPLORATION +larvario I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +especie I-EXPLORATION +de I-EXPLORATION +díptero I-EXPLORATION +necrófago I-EXPLORATION +hallada I-EXPLORATION +sobre I-EXPLORATION +los I-EXPLORATION +restos I-EXPLORATION +humanos, I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +podido I-EXPLORATION +determinar I-EXPLORATION +el I-EXPLORATION +intervalo I-EXPLORATION +mínimo I-EXPLORATION +que I-EXPLORATION +transcurrió I-EXPLORATION +desde I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +cuerpo I-EXPLORATION +emergió I-EXPLORATION +del I-EXPLORATION +agua I-EXPLORATION +hasta I-EXPLORATION +su I-EXPLORATION +hallazgo. I-EXPLORATION + I-EXPLORATION +El B-DERIVED_FROM/TO +cuerpo I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +trasladado I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Instituto I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Medicina I-DERIVED_FROM/TO +Legal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Granada, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +practicó I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +autopsia I-DERIVED_FROM/TO +según I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +normativa I-DERIVED_FROM/TO +europea12. I-DERIVED_FROM/TO +La I-DERIVED_FROM/TO +recogida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evidencias I-DERIVED_FROM/TO +entomológicas I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +práctica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +autopsia I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +interpretación I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +todas I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +fases I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +investigación I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realizó I-DERIVED_FROM/TO +siguiendo I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +recomendaciones I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +European I-DERIVED_FROM/TO +Association I-DERIVED_FROM/TO +for I-DERIVED_FROM/TO +Forensic I-DERIVED_FROM/TO +Entomology I-DERIVED_FROM/TO +(EAFE) I-DERIVED_FROM/TO +13. I-DERIVED_FROM/TO +Las B-EXPLORATION +muestras I-EXPLORATION +fueron I-EXPLORATION +fotografiadas I-EXPLORATION +con I-EXPLORATION +testigo I-EXPLORATION +métrico I-EXPLORATION +y I-EXPLORATION +recogidas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +cefálica I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +médico I-EXPLORATION +forense I-EXPLORATION +encargada I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +autopsia, I-EXPLORATION +se I-EXPLORATION +conservaron I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +18oC I-EXPLORATION +y I-EXPLORATION +fueron I-EXPLORATION +trasportadas I-EXPLORATION +en I-EXPLORATION +recipiente I-EXPLORATION +isotérmico I-EXPLORATION +dos I-EXPLORATION +horas I-EXPLORATION +después I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +responsable I-EXPLORATION +del I-EXPLORATION +análisis I-EXPLORATION +entomológico I-EXPLORATION +forense. I-EXPLORATION +Doce I-EXPLORATION +larvas I-EXPLORATION +vivas I-EXPLORATION +fueron I-EXPLORATION +criadas I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +adulta I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +incubadora I-EXPLORATION +Heraeus I-EXPLORATION +B-12, I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +25oC, I-EXPLORATION +humedad I-EXPLORATION +relativa I-EXPLORATION +del I-EXPLORATION +80% I-EXPLORATION +y I-EXPLORATION +alimentadas I-EXPLORATION +con I-EXPLORATION +hígado I-EXPLORATION +de I-EXPLORATION +cerdo I-EXPLORATION +ad I-EXPLORATION +libitum I-EXPLORATION +para I-EXPLORATION +realizar I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +especie I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +adulta. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +fueron I-EXPLORATION +sacrificadas I-EXPLORATION +sumergiéndolas I-EXPLORATION +en I-EXPLORATION +agua I-EXPLORATION +cercana I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +ebullición I-EXPLORATION +durante I-EXPLORATION +1 I-EXPLORATION +minuto I-EXPLORATION +y, I-EXPLORATION +posteriormente, I-EXPLORATION +conservadas I-EXPLORATION +en I-EXPLORATION +alcohol I-EXPLORATION +al I-EXPLORATION +70% I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +larvas. I-EXPLORATION +De I-EXPLORATION +las I-EXPLORATION +larvas I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +criadas, I-EXPLORATION +emergieron I-EXPLORATION +9 I-EXPLORATION +adultos. I-EXPLORATION +Dos I-EXPLORATION +larvas I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +remitieron I-EXPLORATION +muertas I-EXPLORATION +fueron I-EXPLORATION +sometidas I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +aclaramiento I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +disolución I-EXPLORATION +de I-EXPLORATION +hidróxido I-EXPLORATION +sódico I-EXPLORATION +al I-EXPLORATION +10% I-EXPLORATION +m/v I-EXPLORATION +durante I-EXPLORATION +24 I-EXPLORATION +horas. I-EXPLORATION +Posteriormente, I-EXPLORATION +se I-EXPLORATION +montaron I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +preparación I-EXPLORATION +microscópica I-EXPLORATION +con I-EXPLORATION +DPX I-EXPLORATION +(VWR I-EXPLORATION +International®) I-EXPLORATION +para I-EXPLORATION +observar I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +detalle I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +morfoanatómicas. I-EXPLORATION +De I-EXPLORATION +los I-EXPLORATION +adultos, I-EXPLORATION +el I-EXPLORATION +muerto I-EXPLORATION +fue I-EXPLORATION +directamente I-EXPLORATION +conservado I-EXPLORATION +en I-EXPLORATION +alcohol I-EXPLORATION +al I-EXPLORATION +70% I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +otro I-EXPLORATION +sacrificado I-EXPLORATION +con I-EXPLORATION +acetato I-EXPLORATION +de I-EXPLORATION +etilo I-EXPLORATION +y I-EXPLORATION +posteriormente I-EXPLORATION +conservado I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +método I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +remitió I-EXPLORATION +muerta. I-EXPLORATION +La I-EXPLORATION +totalidad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +fueron I-EXPLORATION +identificadas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +especie14, I-EXPLORATION +15. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +recogieron I-EXPLORATION +muestras I-EXPLORATION +entomológicas I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +levantamiento I-EXPLORATION +del I-EXPLORATION +cadáver. I-EXPLORATION + I-EXPLORATION +Datos I-EXPLORATION +ambientales I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +datos I-EXPLORATION +meteorológicos I-EXPLORATION +diarios I-EXPLORATION +(en I-EXPLORATION +el I-EXPLORATION +presente I-EXPLORATION +trabajo, I-EXPLORATION +tomamos I-EXPLORATION +las I-EXPLORATION +temperaturas I-EXPLORATION +diarias I-EXPLORATION +al I-EXPLORATION +no I-EXPLORATION +disponer I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +horarias) I-EXPLORATION +fueron I-EXPLORATION +tomados I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +estaciones I-EXPLORATION +agroclimáticas I-EXPLORATION +distintas I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +fin I-EXPLORATION +de I-EXPLORATION +evaluar I-EXPLORATION +cuál I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +se I-EXPLORATION +ajustaba I-EXPLORATION +mejor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +temperatura I-EXPLORATION +del I-EXPLORATION +lugar I-EXPLORATION +del I-EXPLORATION +levantamiento16, I-EXPLORATION +17, I-EXPLORATION +ambas I-EXPLORATION +pertenecientes I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +red I-EXPLORATION +de I-EXPLORATION +estaciones I-EXPLORATION +agroclimáticas I-EXPLORATION +del I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Investigación I-EXPLORATION +Agraria I-EXPLORATION +y I-EXPLORATION +Pesquera I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Junta I-EXPLORATION +de I-EXPLORATION +Andalucía. I-EXPLORATION +La I-EXPLORATION +estación I-EXPLORATION +1 I-EXPLORATION +(IFAPA I-EXPLORATION +de I-EXPLORATION +Camino I-EXPLORATION +del I-EXPLORATION +Purchil, I-EXPLORATION +coordenadas I-EXPLORATION +UTM I-EXPLORATION +X=443423.0 I-EXPLORATION +Y=4114357.0, I-EXPLORATION +altura I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +mar: I-EXPLORATION +630 I-EXPLORATION +metros) I-EXPLORATION +está I-EXPLORATION +situada I-EXPLORATION +a I-EXPLORATION +unos I-EXPLORATION +13 I-EXPLORATION +kilómetros I-EXPLORATION +del I-EXPLORATION +lugar I-EXPLORATION +del I-EXPLORATION +levantamiento, I-EXPLORATION +la I-EXPLORATION +estación I-EXPLORATION +2 I-EXPLORATION +(Jerez I-EXPLORATION +del I-EXPLORATION +Marquesado, I-EXPLORATION +coordenadas I-EXPLORATION +UTM, I-EXPLORATION +X=486806.0 I-EXPLORATION +Y=4116224.0, I-EXPLORATION +altura I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +mar: I-EXPLORATION +1212 I-EXPLORATION +metros) I-EXPLORATION +se I-EXPLORATION +halla I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +distancia I-EXPLORATION +de I-EXPLORATION +27 I-EXPLORATION +kilómetros I-EXPLORATION +del I-EXPLORATION +lugar I-EXPLORATION +del I-EXPLORATION +levantamiento. I-EXPLORATION +Para I-EXPLORATION +poder I-EXPLORATION +llevar I-EXPLORATION +a I-EXPLORATION +cabo I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +de I-EXPLORATION +ese I-EXPLORATION +ajuste I-EXPLORATION +de I-EXPLORATION +temperaturas, I-EXPLORATION +se I-EXPLORATION +colocó I-EXPLORATION +un I-EXPLORATION +data I-EXPLORATION +logger I-EXPLORATION +(ILOG I-EXPLORATION +S/INT-ESCORT®) I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +proximidades I-EXPLORATION +del I-EXPLORATION +lugar I-EXPLORATION +del I-EXPLORATION +hallazgo I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +imposibilidad I-EXPLORATION +de I-EXPLORATION +acceder I-EXPLORATION +al I-EXPLORATION +sitio I-EXPLORATION +exacto I-EXPLORATION +del I-EXPLORATION +levantamiento I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +registraron I-EXPLORATION +las I-EXPLORATION +temperaturas I-EXPLORATION +máximas I-EXPLORATION +y I-EXPLORATION +mínimas I-EXPLORATION +durante I-EXPLORATION +cinco I-EXPLORATION +días, I-EXPLORATION +concretamente I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +1 I-EXPLORATION +de I-EXPLORATION +febrero I-EXPLORATION +de I-EXPLORATION +2011 I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION +5 I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +mes. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +fueron I-EXPLORATION +analizados I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +paquete I-EXPLORATION +estadístico I-EXPLORATION +SPSS I-EXPLORATION +15.0 I-EXPLORATION +y I-EXPLORATION +complementados I-EXPLORATION +con I-EXPLORATION +UNStat, I-EXPLORATION +aplicación I-EXPLORATION +desarrollada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Navarra. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +diferenciar I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +larvas I-EXPLORATION +que I-EXPLORATION +todavía I-EXPLORATION +se I-EXPLORATION +están I-EXPLORATION +alimentando I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +en I-EXPLORATION +descomposición I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +están I-EXPLORATION +alejando I-EXPLORATION +ya I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fuente I-EXPLORATION +de I-EXPLORATION +alimentación I-EXPLORATION +para I-EXPLORATION +pupar, I-EXPLORATION +se I-EXPLORATION +diseccionan I-EXPLORATION +dorsalmente I-EXPLORATION +las I-EXPLORATION +larvas I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +comprueba I-EXPLORATION +si I-EXPLORATION +existe I-EXPLORATION +un I-EXPLORATION +depósito I-EXPLORATION +de I-EXPLORATION +grasa I-EXPLORATION +subcuticular I-EXPLORATION +que I-EXPLORATION +impida I-EXPLORATION +la I-EXPLORATION +observación I-EXPLORATION +dorsal I-EXPLORATION +del I-EXPLORATION +tracto I-EXPLORATION +digestivo I-EXPLORATION +relleno I-EXPLORATION +de I-EXPLORATION +alimento. I-EXPLORATION +Ese I-EXPLORATION +depósito I-EXPLORATION +es I-EXPLORATION +observable I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +larvas I-EXPLORATION +migratorias3. I-EXPLORATION +Además, I-EXPLORATION +la I-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +longitud I-EXPLORATION +del I-EXPLORATION +tracto I-EXPLORATION +digestivo I-EXPLORATION +relleno I-EXPLORATION +permite I-EXPLORATION +discernir I-EXPLORATION +entre I-EXPLORATION +ambas I-EXPLORATION +fases18. I-EXPLORATION +Mientras I-EXPLORATION +las I-EXPLORATION +larvas I-EXPLORATION +se I-EXPLORATION +alimenten, I-EXPLORATION +el I-EXPLORATION +contenido I-EXPLORATION +digestivo I-EXPLORATION +va I-EXPLORATION +aumentando I-EXPLORATION +su I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +relleno I-EXPLORATION +mientras I-EXPLORATION +que, I-EXPLORATION +cuando I-EXPLORATION +entran I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +migratoria, I-EXPLORATION +existe I-EXPLORATION +un I-EXPLORATION +vaciado I-EXPLORATION +del I-EXPLORATION +contenido I-EXPLORATION +digestivo I-EXPLORATION +que I-EXPLORATION +implica I-EXPLORATION +un I-EXPLORATION +acortamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +tracto I-EXPLORATION +digestivo I-EXPLORATION +relleno. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +mórbida, I-PAST_MEDICAL_HISTORY +fumadora. I-PAST_MEDICAL_HISTORY +Múltiples I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +hospitalarios, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ellos I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +muerte, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sobreinfección I-PAST_MEDICAL_HISTORY +respiratoria. I-PAST_MEDICAL_HISTORY +Antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fiebre I-PAST_MEDICAL_HISTORY +reumática I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +infancia. I-PAST_MEDICAL_HISTORY +Diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +dilatada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +posible I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +enólico, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +aórtica I-PAST_MEDICAL_HISTORY +moderada, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardiaca I-PAST_MEDICAL_HISTORY +congestiva, I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +depresivo. I-PAST_MEDICAL_HISTORY +Múltiples I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +hospitalarios I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipoventilación I-PAST_MEDICAL_HISTORY +asociada, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ellos I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +muerte I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardiaca I-PAST_MEDICAL_HISTORY +congestiva I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +respiratoria I-PAST_MEDICAL_HISTORY +global I-PAST_MEDICAL_HISTORY +reagudizada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sobre-infección I-PAST_MEDICAL_HISTORY +respiratoria. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +primeras I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mañana I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +fallecimiento, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +familia I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +seguidamente I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia. I-PRESENT_ILLNESS +Avisados B-EVOLUTION +los I-EVOLUTION +Servicios I-EVOLUTION +de I-EVOLUTION +Urgencia I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +aplicar I-EVOLUTION +maniobras I-EVOLUTION +de I-EVOLUTION +RCP I-EVOLUTION +avanzada, I-EVOLUTION +acreditan I-EVOLUTION +su I-EVOLUTION +defunción. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +87 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +constancia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +inespecífico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +visitada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +familia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +domicilio I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +administró I-PRESENT_ILLNESS +metoclopramida. I-PRESENT_ILLNESS +Falleció B-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +pocas I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +atención I-EVOLUTION +médica, I-EVOLUTION +motivo I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +se I-EVOLUTION +practicó I-EVOLUTION +autopsia I-EVOLUTION +judicial. I-EVOLUTION + I-EVOLUTION +Del B-EXPLORATION +examen I-EXPLORATION +externo I-EXPLORATION +destacó I-EXPLORATION +la I-EXPLORATION +palidez I-EXPLORATION +cutáneo-mucosa I-EXPLORATION +y I-EXPLORATION +disposición I-EXPLORATION +en I-EXPLORATION +martillo I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +segundos I-EXPLORATION +dedos I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +pies. I-EXPLORATION +Durante I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +interno I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +calcificación I-EXPLORATION +mitral, I-EXPLORATION +ateromatosis I-EXPLORATION +coronaria I-EXPLORATION +con I-EXPLORATION +obstrucción I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mismas I-EXPLORATION +de I-EXPLORATION +entre I-EXPLORATION +un I-EXPLORATION +25-50%, I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular I-EXPLORATION +concéntrica, I-EXPLORATION +ateromatosis I-EXPLORATION +generalizada I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +grandes I-EXPLORATION +vasos I-EXPLORATION +y I-EXPLORATION +hemoperitoneo I-EXPLORATION +de I-EXPLORATION +3.000 I-EXPLORATION +cc, I-EXPLORATION +parcialmente I-EXPLORATION +coagulado. I-EXPLORATION +Hígado I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +peso I-EXPLORATION +de I-EXPLORATION +1.585 I-EXPLORATION +g I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +macroscópicamente I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +cirrosis I-EXPLORATION +macronodular I-EXPLORATION +generalizada I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +izquierdo I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +esférica I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +sin I-EXPLORATION +pedículo, I-EXPLORATION +blanda I-EXPLORATION +y I-EXPLORATION +móvil I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +con I-EXPLORATION +cápsula I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +gris-amarillento, I-EXPLORATION +muy I-EXPLORATION +vascularizada, I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +rotura I-EXPLORATION +parcial. I-EXPLORATION +Al I-EXPLORATION +corte I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +hepática I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +coloración I-EXPLORATION +más I-EXPLORATION +pálida I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +circundante, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +heterogéneo, I-EXPLORATION +con I-EXPLORATION +escasa I-EXPLORATION +pigmentación I-EXPLORATION +biliar I-EXPLORATION +y I-EXPLORATION +zonas I-EXPLORATION +necrohemorrágicas I-EXPLORATION +cercanas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +rotura I-EXPLORATION +capsular. I-EXPLORATION +La I-EXPLORATION +histopatología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +hepatocelular I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +interpretó I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +muerte I-EXPLORATION +como I-EXPLORATION +consecuencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +shock I-EXPLORATION +hipovolémico I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +hemoperitoneo I-EXPLORATION +por I-EXPLORATION +rotura I-EXPLORATION +del I-EXPLORATION +carcinoma I-EXPLORATION +hepatocelular I-EXPLORATION +(según I-EXPLORATION +clasificación I-EXPLORATION +CIE I-EXPLORATION +10: I-EXPLORATION +C22.0). I-EXPLORATION +Siendo I-EXPLORATION +este I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +complicación I-EXPLORATION +es I-EXPLORATION +extremadamente I-EXPLORATION +infrecuente I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +medio. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +desplomó I-PRESENT_ILLNESS +súbitamente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +pública. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +clínicos I-PAST_MEDICAL_HISTORY +constaba I-PAST_MEDICAL_HISTORY +estar I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Noonan I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +desarrollo I-PAST_MEDICAL_HISTORY +psicomotor I-PAST_MEDICAL_HISTORY +normal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +óbito. I-PAST_MEDICAL_HISTORY +En B-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia I-FAMILY_HISTORY +no I-FAMILY_HISTORY +existían I-FAMILY_HISTORY +otros I-FAMILY_HISTORY +miembros I-FAMILY_HISTORY +que I-FAMILY_HISTORY +tuvieran I-FAMILY_HISTORY +un I-FAMILY_HISTORY +fenotipo I-FAMILY_HISTORY +similar. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Hallazgos B-EXPLORATION +destacados I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +externo: I-EXPLORATION +cadáver I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +varón I-EXPLORATION +de I-EXPLORATION +175 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +altura I-EXPLORATION +y I-EXPLORATION +78 I-EXPLORATION +Kg I-EXPLORATION +de I-EXPLORATION +peso I-EXPLORATION +(IMC I-EXPLORATION +25, I-EXPLORATION +5 I-EXPLORATION +kg/m2) I-EXPLORATION +con I-EXPLORATION +diversas I-EXPLORATION +características I-EXPLORATION +anatómicas I-EXPLORATION +destacadas: I-EXPLORATION +frente I-EXPLORATION +amplia, I-EXPLORATION +mentón I-EXPLORATION +prominente, I-EXPLORATION +pabellones I-EXPLORATION +auriculares I-EXPLORATION +de I-EXPLORATION +inserción I-EXPLORATION +baja I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +lóbulos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +orejas I-EXPLORATION +hacia I-EXPLORATION +delante, I-EXPLORATION +ojos I-EXPLORATION +con I-EXPLORATION +hendiduras I-EXPLORATION +palpebrales I-EXPLORATION +hacia I-EXPLORATION +abajo, I-EXPLORATION +puente I-EXPLORATION +nasal I-EXPLORATION +grueso, I-EXPLORATION +cuello I-EXPLORATION +corto, I-EXPLORATION +deformidad I-EXPLORATION +esternal I-EXPLORATION +con I-EXPLORATION +pectus I-EXPLORATION +carinatum I-EXPLORATION +(tórax I-EXPLORATION +en I-EXPLORATION +quilla) I-EXPLORATION +prominencia I-EXPLORATION +del I-EXPLORATION +pubis I-EXPLORATION +y I-EXPLORATION +primer I-EXPLORATION +dedo I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +pies I-EXPLORATION +en I-EXPLORATION +garra. I-EXPLORATION + I-EXPLORATION +Hallazgos I-EXPLORATION +destacados I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +interno: I-EXPLORATION +corazón I-EXPLORATION +de I-EXPLORATION +395 I-EXPLORATION +g I-EXPLORATION +de I-EXPLORATION +peso I-EXPLORATION +(valor I-EXPLORATION +medio I-EXPLORATION +según I-EXPLORATION +peso I-EXPLORATION +corporal: I-EXPLORATION +345 I-EXPLORATION +g I-EXPLORATION +[rango I-EXPLORATION +261-455 I-EXPLORATION +g]). I-EXPLORATION +Grosor I-EXPLORATION +pared I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo: I-EXPLORATION +1, I-EXPLORATION +1cm, I-EXPLORATION +tabique I-EXPLORATION +interventricular: I-EXPLORATION +1, I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +ventrículo I-EXPLORATION +derecho: I-EXPLORATION +0, I-EXPLORATION +1 I-EXPLORATION +cm. I-EXPLORATION +Agujero I-EXPLORATION +oval I-EXPLORATION +no I-EXPLORATION +permeable. I-EXPLORATION +Válvulas I-EXPLORATION +aurículo-ventriculares I-EXPLORATION +y I-EXPLORATION +pulmonar I-EXPLORATION +normales. I-EXPLORATION +Válvula I-EXPLORATION +aórtica I-EXPLORATION +bicúspide. I-EXPLORATION +Severa I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +raíz I-EXPLORATION +aórtica I-EXPLORATION +con I-EXPLORATION +disección I-EXPLORATION +circular I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +íntima I-EXPLORATION +arterial I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +del I-EXPLORATION +anillo I-EXPLORATION +de I-EXPLORATION +inserción I-EXPLORATION +valvular I-EXPLORATION +con I-EXPLORATION +desprendimiento I-EXPLORATION +completo I-EXPLORATION +e I-EXPLORATION +intususpección I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +capa I-EXPLORATION +interna I-EXPLORATION +disecada I-EXPLORATION +hasta I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +calibre I-EXPLORATION +del I-EXPLORATION +cayado I-EXPLORATION +aórtico, I-EXPLORATION +extendiéndose I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +subclavia I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tronco I-EXPLORATION +braquiocefálico, I-EXPLORATION +y I-EXPLORATION +obstruyendo I-EXPLORATION +completamente I-EXPLORATION +las I-EXPLORATION +tres I-EXPLORATION +luces I-EXPLORATION +vasculares. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +ofreció I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +interés: I-EXPLORATION +signos I-EXPLORATION +moderados I-EXPLORATION +de I-EXPLORATION +hipertrofia I-EXPLORATION +miocitaria I-EXPLORATION +en I-EXPLORATION +miocardio I-EXPLORATION +ventricular I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +desorganizativo I-EXPLORATION +focal I-EXPLORATION +en I-EXPLORATION +tabique I-EXPLORATION +interventricular. I-EXPLORATION +Infiltración I-EXPLORATION +adiposa I-EXPLORATION +miocárdica I-EXPLORATION +ventricular I-EXPLORATION +derecha I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +posterior I-EXPLORATION +con I-EXPLORATION +fibrosis I-EXPLORATION +intersticial I-EXPLORATION +sin I-EXPLORATION +reacción I-EXPLORATION +inflamatoria I-EXPLORATION +crónica. I-EXPLORATION +Necrosis I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +media I-EXPLORATION +arterial I-EXPLORATION +aórtica. I-EXPLORATION +Arterioloesclerosis I-EXPLORATION +renal I-EXPLORATION +con I-EXPLORATION +microlitiasis I-EXPLORATION +y I-EXPLORATION +esteatosis I-EXPLORATION +hepática I-EXPLORATION +en I-EXPLORATION +grado I-EXPLORATION +leve. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +sujeto I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +soltero, B-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +convive I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +madre, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +cuidaba I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +menor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +vecino I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lugar I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +reside, I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +sorprendido I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pequeño I-PRESENT_ILLNESS +cuando I-PRESENT_ILLNESS +tocaba I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +genitales I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +niño, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +colocaba I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pene I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +erección I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +glútea I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pequeño. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +acusado I-PRESENT_ILLNESS +acepta I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +cometido I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +tener I-PRESENT_ILLNESS +explicación I-PRESENT_ILLNESS +ante I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +ocurrido. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +comprobó I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +estuvo I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2003 I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +Hospital I-PAST_MEDICAL_HISTORY +Psiquiátrico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Habana I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +Trastorno I-PAST_MEDICAL_HISTORY +Orgánico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Personalidad. I-PAST_MEDICAL_HISTORY +Refiere I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +producto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +múltiple I-PAST_MEDICAL_HISTORY +(trillizos) I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +solo I-PAST_MEDICAL_HISTORY +él I-PAST_MEDICAL_HISTORY +sobrevivió. I-PAST_MEDICAL_HISTORY +Estudió I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +enseñanza I-PAST_MEDICAL_HISTORY +especial I-PAST_MEDICAL_HISTORY +alcanzando I-PAST_MEDICAL_HISTORY +9o I-PAST_MEDICAL_HISTORY +grado, I-PAST_MEDICAL_HISTORY +luego I-PAST_MEDICAL_HISTORY +abandonó I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +estudios. I-PAST_MEDICAL_HISTORY +Huérfano I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +padre I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Trauma I-PAST_MEDICAL_HISTORY +craneoencefálico I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conciencia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +atención I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +neurología. I-PAST_MEDICAL_HISTORY +Lleva I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +desvinculado I-PAST_MEDICAL_HISTORY +laboralmente. I-PAST_MEDICAL_HISTORY +Según I-PAST_MEDICAL_HISTORY +explicó I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +única I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pareja I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +juventud. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Fue B-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +institución I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +objetivo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +realizar I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +evaluación I-DERIVED_FROM/TO +psiquiátrica I-DERIVED_FROM/TO +forense. I-DERIVED_FROM/TO +Los B-EXPLORATION +peritos I-EXPLORATION +psiquiatras I-EXPLORATION +actuantes I-EXPLORATION +solicitaron I-EXPLORATION +una I-EXPLORATION +evaluación I-EXPLORATION +por I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Neurofisiología I-EXPLORATION +Clínica I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +entrevista I-EXPLORATION +clínica I-EXPLORATION +al I-EXPLORATION +paciente, I-EXPLORATION +se I-EXPLORATION +registró I-EXPLORATION +un I-EXPLORATION +EEG I-EXPLORATION +en I-EXPLORATION +condiciones I-EXPLORATION +basales I-EXPLORATION +en I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +vigilia I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +Medicid I-EXPLORATION +V I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +programa I-EXPLORATION +Track I-EXPLORATION +Walker I-EXPLORATION +(Neuronic, I-EXPLORATION +SA I-EXPLORATION +Cuba). I-EXPLORATION +Se I-EXPLORATION +registraron I-EXPLORATION +3 I-EXPLORATION +minutos I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +ojos I-EXPLORATION +cerrados, I-EXPLORATION +2 I-EXPLORATION +minutos I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +ojos I-EXPLORATION +abiertos, I-EXPLORATION +3 I-EXPLORATION +minutos I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +hiperventilación I-EXPLORATION +y I-EXPLORATION +2 I-EXPLORATION +minutos I-EXPLORATION +de I-EXPLORATION +recuperación. I-EXPLORATION +Se I-EXPLORATION +seleccionaron I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +a I-EXPLORATION +24 I-EXPLORATION +ventanas I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +ojos I-EXPLORATION +cerrados, I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +artefactos I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +al I-EXPLORATION +análisis I-EXPLORATION +cuantitativo I-EXPLORATION +del I-EXPLORATION +EEG I-EXPLORATION +comparándose I-EXPLORATION +con I-EXPLORATION +individuos I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +misma I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +sexo I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +forman I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +datos I-EXPLORATION +normativa I-EXPLORATION +cubana. I-EXPLORATION +Se I-EXPLORATION +calculó I-EXPLORATION +el I-EXPLORATION +espectro I-EXPLORATION +de I-EXPLORATION +frecuencia I-EXPLORATION +en I-EXPLORATION +cada I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +derivaciones I-EXPLORATION +y I-EXPLORATION +luego I-EXPLORATION +las I-EXPLORATION +medidas I-EXPLORATION +espectrales I-EXPLORATION +de I-EXPLORATION +banda I-EXPLORATION +ancha; I-EXPLORATION +el I-EXPLORATION +Poder I-EXPLORATION +Absoluto I-EXPLORATION +(PA), I-EXPLORATION +que I-EXPLORATION +representa I-EXPLORATION +la I-EXPLORATION +energía I-EXPLORATION +que I-EXPLORATION +contiene I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +EEG I-EXPLORATION +(PA I-EXPLORATION +Total) I-EXPLORATION +o I-EXPLORATION +la I-EXPLORATION +contenida I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +banda I-EXPLORATION +de I-EXPLORATION +frecuencia I-EXPLORATION +particular I-EXPLORATION +(delta, I-EXPLORATION +theta, I-EXPLORATION +alfa I-EXPLORATION +y I-EXPLORATION +beta); I-EXPLORATION +el I-EXPLORATION +Poder I-EXPLORATION +Relativo I-EXPLORATION +(PR), I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +más I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +contribución I-EXPLORATION +de I-EXPLORATION +cada I-EXPLORATION +banda I-EXPLORATION +del I-EXPLORATION +EEG I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +energía I-EXPLORATION +total I-EXPLORATION +del I-EXPLORATION +espectro, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +Frecuencia I-EXPLORATION +Media I-EXPLORATION +(FM), I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +corresponde I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +frecuencia I-EXPLORATION +(en I-EXPLORATION +Hz) I-EXPLORATION +que I-EXPLORATION +constituyen I-EXPLORATION +el I-EXPLORATION +"centro I-EXPLORATION +de I-EXPLORATION +gravedad", I-EXPLORATION +ya I-EXPLORATION +sea I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +banda I-EXPLORATION +o I-EXPLORATION +bien I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +del I-EXPLORATION +espectro. I-EXPLORATION +Se I-EXPLORATION +estimaron I-EXPLORATION +los I-EXPLORATION +generadores I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +actividad I-EXPLORATION +lenta I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +7.031 I-EXPLORATION +Hz, I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +programa I-EXPLORATION +Localizador I-EXPLORATION +de I-EXPLORATION +Fuentes I-EXPLORATION +(Neuronic, I-EXPLORATION +SA I-EXPLORATION +Cuba) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +modelo I-EXPLORATION +bayesiano I-EXPLORATION +promediado I-EXPLORATION +(BMA) I-EXPLORATION +12, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +permite I-EXPLORATION +encontrar I-EXPLORATION +la I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +corriente I-EXPLORATION +primaria I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +cerebro, I-EXPLORATION +sin I-EXPLORATION +estar I-EXPLORATION +condicionada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +modelo I-EXPLORATION +asumido. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +evaluó I-EXPLORATION +la I-EXPLORATION +respuesta I-EXPLORATION +simpática I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel, I-EXPLORATION +utilizando I-EXPLORATION +dos I-EXPLORATION +diseños I-EXPLORATION +experimentales, I-EXPLORATION +el I-EXPLORATION +primero I-EXPLORATION +conformado I-EXPLORATION +con I-EXPLORATION +16 I-EXPLORATION +imágenes I-EXPLORATION +neutras I-EXPLORATION +obtenidas I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +estandarizadas I-EXPLORATION +del I-EXPLORATION +Sistema I-EXPLORATION +Internacional I-EXPLORATION +de I-EXPLORATION +Imágenes I-EXPLORATION +Afectivas I-EXPLORATION +(IAPS; I-EXPLORATION +Center I-EXPLORATION +for I-EXPLORATION +the I-EXPLORATION +Study I-EXPLORATION +of I-EXPLORATION +Emotion I-EXPLORATION +and I-EXPLORATION +Attention-NIMH, I-EXPLORATION +1999) I-EXPLORATION +13 I-EXPLORATION +y I-EXPLORATION +6 I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +menores I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +sexos I-EXPLORATION +desnudos, I-EXPLORATION +el I-EXPLORATION +segundo I-EXPLORATION +utilizó I-EXPLORATION +16 I-EXPLORATION +fotos I-EXPLORATION +neutras I-EXPLORATION +y I-EXPLORATION +6 I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +representativas I-EXPLORATION +de I-EXPLORATION +estímulos I-EXPLORATION +sexuales I-EXPLORATION +de I-EXPLORATION +adultos I-EXPLORATION +(parejas I-EXPLORATION +eróticas), I-EXPLORATION +todas I-EXPLORATION +obtenidas I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +internacional I-EXPLORATION +antes I-EXPLORATION +referido. I-EXPLORATION +Este I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +evaluación I-EXPLORATION +forma I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +método I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +experimental I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +emociones, I-EXPLORATION +tiene I-EXPLORATION +además I-EXPLORATION +la I-EXPLORATION +ventaja I-EXPLORATION +de I-EXPLORATION +emplear I-EXPLORATION +estímulos I-EXPLORATION +que I-EXPLORATION +pueden I-EXPLORATION +ser I-EXPLORATION +fácilmente I-EXPLORATION +presentados I-EXPLORATION +en I-EXPLORATION +contextos I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +formato I-EXPLORATION +analógico I-EXPLORATION +como I-EXPLORATION +digitalizado, I-EXPLORATION +permitiendo I-EXPLORATION +el I-EXPLORATION +control I-EXPLORATION +preciso I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +momento I-EXPLORATION +y I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +exposición. I-EXPLORATION +El I-EXPLORATION +IAPS I-EXPLORATION +consiste I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +conjunto I-EXPLORATION +estandarizado I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +en I-EXPLORATION +color I-EXPLORATION +con I-EXPLORATION +capacidad I-EXPLORATION +para I-EXPLORATION +evocar I-EXPLORATION +emociones I-EXPLORATION +y I-EXPLORATION +cuyos I-EXPLORATION +contenidos I-EXPLORATION +recorren I-EXPLORATION +un I-EXPLORATION +amplio I-EXPLORATION +abanico I-EXPLORATION +de I-EXPLORATION +categorías: I-EXPLORATION +deporte, I-EXPLORATION +moda, I-EXPLORATION +paisajes, I-EXPLORATION +desastres I-EXPLORATION +naturales, I-EXPLORATION +erotismo, I-EXPLORATION +violencia, I-EXPLORATION +etc., I-EXPLORATION +además, I-EXPLORATION +facilita I-EXPLORATION +enormemente I-EXPLORATION +las I-EXPLORATION +tareas I-EXPLORATION +de I-EXPLORATION +selección I-EXPLORATION +y I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +estímulos. I-EXPLORATION +Cada I-EXPLORATION +imagen I-EXPLORATION +del I-EXPLORATION +IAPS I-EXPLORATION +posee I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +que I-EXPLORATION +ha I-EXPLORATION +sido I-EXPLORATION +normalizado I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +dimensiones I-EXPLORATION +bipolares I-EXPLORATION +de I-EXPLORATION +valencia I-EXPLORATION +afectiva I-EXPLORATION +(con I-EXPLORATION +un I-EXPLORATION +rango I-EXPLORATION +que I-EXPLORATION +va I-EXPLORATION +desde I-EXPLORATION +lo I-EXPLORATION +agradable I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +desagradable) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +arousal I-EXPLORATION +o I-EXPLORATION +activación I-EXPLORATION +(cuyo I-EXPLORATION +rango I-EXPLORATION +oscila I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +excitación I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +calma). I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +experimentos I-EXPLORATION +fueron I-EXPLORATION +diseñados I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +programa I-EXPLORATION +Mindtracer I-EXPLORATION +(Neuronic I-EXPLORATION +SA, I-EXPLORATION +Cuba). I-EXPLORATION +Cada I-EXPLORATION +estímulo I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +duración I-EXPLORATION +de I-EXPLORATION +2000 I-EXPLORATION +milisegundos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +intervalo I-EXPLORATION +inter-estímulo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +200.000 I-EXPLORATION +milisegundos. I-EXPLORATION +El I-EXPLORATION +registro I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +BioDerm I-EXPLORATION +Modelo I-EXPLORATION +2701 I-EXPLORATION +y I-EXPLORATION +dos I-EXPLORATION +electrodos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +colocaron I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +falange I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dedos I-EXPLORATION +índice I-EXPLORATION +y I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +dominante. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +practicó I-PRESENT_ILLNESS +autopsia I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +buen I-PAST_MEDICAL_HISTORY +desarrollo I-PAST_MEDICAL_HISTORY +óseo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +muscular, I-PAST_MEDICAL_HISTORY +pastora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rebaño I-PAST_MEDICAL_HISTORY +caprino, I-PAST_MEDICAL_HISTORY +quien I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +encontrada I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +atacada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +felino I-PAST_MEDICAL_HISTORY +salvaje I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +pre-Puna I-PAST_MEDICAL_HISTORY +salteña, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Finca I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +Alfarcito, I-PAST_MEDICAL_HISTORY +situada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +entrada I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +Cerro I-PAST_MEDICAL_HISTORY +Negro, I-PAST_MEDICAL_HISTORY +departamento I-PAST_MEDICAL_HISTORY +Rosario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Lerma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Provincia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Salta, I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +Noroeste I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +República I-PAST_MEDICAL_HISTORY +Argentina. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +externo I-EXPLORATION +presentaba I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +lesiones I-EXPLORATION +traumáticas. I-EXPLORATION + I-EXPLORATION +Tres I-EXPLORATION +excoriaciones I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +maxilar I-EXPLORATION +y I-EXPLORATION +submaxilar I-EXPLORATION +inferior I-EXPLORATION +izquierda, I-EXPLORATION +inmediatamente I-EXPLORATION +por I-EXPLORATION +debajo I-EXPLORATION +de I-EXPLORATION +éstas, I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +izquierda I-EXPLORATION +del I-EXPLORATION +cuello, I-EXPLORATION +presentaba I-EXPLORATION +tres I-EXPLORATION +heridas I-EXPLORATION +cortantes, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +irregulares I-EXPLORATION +con I-EXPLORATION +retracción I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +hemática, I-EXPLORATION +separadas I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +otra I-EXPLORATION +por I-EXPLORATION +puentes I-EXPLORATION +cutáneos, I-EXPLORATION +las I-EXPLORATION +mismas I-EXPLORATION +medían I-EXPLORATION +4x2 I-EXPLORATION +cm, I-EXPLORATION +3, I-EXPLORATION +5x1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +2, I-EXPLORATION +5x1 I-EXPLORATION +cm I-EXPLORATION +respectivamente, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +lesiones I-EXPLORATION +por I-EXPLORATION +garras I-EXPLORATION +de I-EXPLORATION +felino. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +región I-EXPLORATION +clavicular I-EXPLORATION +izquierda I-EXPLORATION +presentaba I-EXPLORATION +excoriaciones I-EXPLORATION +pequeñas I-EXPLORATION +sobre I-EXPLORATION +equimosis. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +cuello, I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +parte I-EXPLORATION +media, I-EXPLORATION +herida I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +irregulares, I-EXPLORATION +retraídos I-EXPLORATION +e I-EXPLORATION +infiltrados, I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +que I-EXPLORATION +interesa I-EXPLORATION +piel, I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +y I-EXPLORATION +músculos I-EXPLORATION +angular I-EXPLORATION +y I-EXPLORATION +escaleno; I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +descendente I-EXPLORATION +de I-EXPLORATION +arriba I-EXPLORATION +hacia I-EXPLORATION +abajo. I-EXPLORATION + I-EXPLORATION +Presentaba I-EXPLORATION +herida I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +irregulares I-EXPLORATION +en I-EXPLORATION +dedo I-EXPLORATION +pulgar I-EXPLORATION +de I-EXPLORATION +mano I-EXPLORATION +izquierda I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +del I-EXPLORATION +pliegue I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +1a I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +2a I-EXPLORATION +falange. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +interno I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +descritas I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +izquierda I-EXPLORATION +del I-EXPLORATION +cuello I-EXPLORATION +comprometían I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo, I-EXPLORATION +aponeurosis I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +profunda I-EXPLORATION +de I-EXPLORATION +cuello, I-EXPLORATION +músculos I-EXPLORATION +esternocleidomastoideo, I-EXPLORATION +esternocleidohioideo I-EXPLORATION +y I-EXPLORATION +esternohioideo, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +desgarrado. I-EXPLORATION + I-EXPLORATION +Compromiso I-EXPLORATION +de I-EXPLORATION +vasos I-EXPLORATION +superficiales I-EXPLORATION +y I-EXPLORATION +profundos, I-EXPLORATION +con I-EXPLORATION +sección I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +yugular I-EXPLORATION +interna I-EXPLORATION +izquierda; I-EXPLORATION +provocando I-EXPLORATION +una I-EXPLORATION +hemorragia I-EXPLORATION +aguda I-EXPLORATION +vital, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +fue I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +del I-EXPLORATION +deceso. I-EXPLORATION + I-EXPLORATION + +El B-PRESENT_ILLNESS +cadáver I-PRESENT_ILLNESS +carbonizado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +campesina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que B-PAST_MEDICAL_HISTORY +vivía I-PAST_MEDICAL_HISTORY +sola I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +apartado I-PAST_MEDICAL_HISTORY +lugar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +provincia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Panamá, I-PAST_MEDICAL_HISTORY +fue B-PRESENT_ILLNESS +encontrado I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +restos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +vivienda I-PRESENT_ILLNESS +rural I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +madera, I-PRESENT_ILLNESS +completamente I-PRESENT_ILLNESS +quemada. I-PRESENT_ILLNESS +El B-DERIVED_FROM/TO +cuerpo I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +morgue I-DERIVED_FROM/TO +judicial I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ciudad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Panamá I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +identificación I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +determinación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +causa I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +muerte. I-DERIVED_FROM/TO +No B-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +registros I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +fallecida. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Examen B-EXPLORATION +necrópsico I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +recibió I-EXPLORATION +un I-EXPLORATION +cuerpo I-EXPLORATION +incompleto, I-EXPLORATION +quemado I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +carbonización, I-EXPLORATION +con I-EXPLORATION +amputaciones I-EXPLORATION +térmicas I-EXPLORATION +y I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +estructuras I-EXPLORATION +anatómicas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tronco I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +miembros. I-EXPLORATION +Fue I-EXPLORATION +identificado I-EXPLORATION +por I-EXPLORATION +sus I-EXPLORATION +características I-EXPLORATION +antropológicas I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +información I-EXPLORATION +recibida I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +investigadores. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +revisar I-EXPLORATION +las I-EXPLORATION +cavidades, I-EXPLORATION +las I-EXPLORATION +vísceras I-EXPLORATION +estaban I-EXPLORATION +bien I-EXPLORATION +conservadas. I-EXPLORATION +Había I-EXPLORATION +coágulos I-EXPLORATION +cocidos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemitórax I-EXPLORATION +izquierdo. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +vías I-EXPLORATION +aéreas I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +partículas I-EXPLORATION +de I-EXPLORATION +carbón, I-EXPLORATION +y I-EXPLORATION +tampoco I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +partículas I-EXPLORATION +de I-EXPLORATION +hollín I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +microscópico. I-EXPLORATION +El I-EXPLORATION +saco I-EXPLORATION +pericárdico I-EXPLORATION +estaba I-EXPLORATION +roto I-EXPLORATION +y I-EXPLORATION +contenía I-EXPLORATION +coágulos I-EXPLORATION +cocidos I-EXPLORATION +; I-EXPLORATION +al I-EXPLORATION +evacuarlos, I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +herida I-EXPLORATION +punzo-cortante, I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +× I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +cm, I-EXPLORATION +que I-EXPLORATION +interesaba I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +microscópico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +fragmentación I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +miocárdicas I-EXPLORATION +y I-EXPLORATION +hemorragia I-EXPLORATION +reciente. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +estableció I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muerte I-EXPLORATION +fue I-EXPLORATION +la I-EXPLORATION +herida I-EXPLORATION +punzo-cortante I-EXPLORATION +que I-EXPLORATION +interesó I-EXPLORATION +el I-EXPLORATION +corazón, I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +deceso I-EXPLORATION +ocurrió I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exposición I-EXPLORATION +térmica. I-EXPLORATION +Basándose B-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +resultados I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +necropsia, I-EVOLUTION +los I-EVOLUTION +investigadores I-EVOLUTION +interrogaron I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +familiar I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fallecida, I-EVOLUTION +quien I-EVOLUTION +confesó I-EVOLUTION +ser I-EVOLUTION +el I-EVOLUTION +autor I-EVOLUTION +del I-EVOLUTION +femicidio. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +soltera, B-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +niños I-PAST_MEDICAL_HISTORY +menores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +convivía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +les I-PAST_MEDICAL_HISTORY +provocó I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +muerte. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +mantenía I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +adecuada I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +respectivos I-PAST_MEDICAL_HISTORY +padres. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +hecho I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +embarazada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +resultó I-PAST_MEDICAL_HISTORY +evidente I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +actitud I-PAST_MEDICAL_HISTORY +irresponsable I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +sexuales I-PAST_MEDICAL_HISTORY +íntimas, I-PAST_MEDICAL_HISTORY +ya I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +mantenía I-PAST_MEDICAL_HISTORY +protección, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +asistido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +captarse I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +embarazo, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +resultó I-PAST_MEDICAL_HISTORY +finalmente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +aborto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +solicitud I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +evaluada, I-PAST_MEDICAL_HISTORY +argumentando I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +deseado, I-PAST_MEDICAL_HISTORY +pues I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pareja I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +rota. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +vínculo I-PAST_MEDICAL_HISTORY +laboral I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +psicosocial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +evaluada I-PAST_MEDICAL_HISTORY +destacan I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +siguientes I-PAST_MEDICAL_HISTORY +elementos: I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +pequeña I-PAST_MEDICAL_HISTORY +consideró I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hija I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +deseada, I-PAST_MEDICAL_HISTORY +sintiendo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +esto I-PAST_MEDICAL_HISTORY +resentimiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +celos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +hermanos. I-PAST_MEDICAL_HISTORY +Nunca I-PAST_MEDICAL_HISTORY +"sintió" I-PAST_MEDICAL_HISTORY +amor I-PAST_MEDICAL_HISTORY +maternal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +reconoció I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +figura I-PAST_MEDICAL_HISTORY +afectiva I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +padre, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +pesar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +padres I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +divorciaron I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +ella I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +desarrolló I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +familiar I-PAST_MEDICAL_HISTORY +disfuncional, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +padrastro I-PAST_MEDICAL_HISTORY +maltratador I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +todas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +casa. I-PAST_MEDICAL_HISTORY +Refirió I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sufrido I-PAST_MEDICAL_HISTORY +maltrato, I-PAST_MEDICAL_HISTORY +incluso I-PAST_MEDICAL_HISTORY +físico, I-PAST_MEDICAL_HISTORY +proveniente I-PAST_MEDICAL_HISTORY +tanto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +padrastro. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +desarrollo I-PAST_MEDICAL_HISTORY +escolar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +enseñanza I-PAST_MEDICAL_HISTORY +primaria I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +adecuado; I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +gustaba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pequeña I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +líder I-PAST_MEDICAL_HISTORY +ante I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +amigos. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +adolescente I-PAST_MEDICAL_HISTORY +rebelde I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +impulsiva. I-PAST_MEDICAL_HISTORY +Ha I-PAST_MEDICAL_HISTORY +tenido I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +parejas, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ellas I-PAST_MEDICAL_HISTORY +considera I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +formales, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +han I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +caracterizadas I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +maltrato. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +comprobó I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +estuvo I-PAST_MEDICAL_HISTORY +ingresada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2012, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Sala I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Psiquiatría I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +Hospital I-PAST_MEDICAL_HISTORY +General, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +atentado I-PAST_MEDICAL_HISTORY +contra I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +menores, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +diagnosticó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +trastorno I-PAST_MEDICAL_HISTORY +situacional I-PAST_MEDICAL_HISTORY +ansioso. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +mental I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +realizado I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hechos I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +describen I-EXPLORATION +alteraciones I-EXPLORATION +psiquiátricas. I-EXPLORATION +Explica I-EXPLORATION +que I-EXPLORATION +estaba I-EXPLORATION +"cansada I-EXPLORATION +de I-EXPLORATION +pasar I-EXPLORATION +trabajo, I-EXPLORATION +que I-EXPLORATION +intentó I-EXPLORATION +matarse I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +pudo". I-EXPLORATION +Redactó I-EXPLORATION +tres I-EXPLORATION +notas I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +dirigían I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +padres I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +víctimas I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +madre. I-EXPLORATION +Sobre I-EXPLORATION +el I-EXPLORATION +hecho I-EXPLORATION +refirió I-EXPLORATION +"mi I-EXPLORATION +cabeza I-EXPLORATION +tenía I-EXPLORATION +deseos I-EXPLORATION +de I-EXPLORATION +hacer I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +hice, I-EXPLORATION +pero I-EXPLORATION +que I-EXPLORATION +nos I-EXPLORATION +fuéramos I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +juntos, I-EXPLORATION +lo I-EXPLORATION +intenté I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +pude". I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hemoptisis. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacan I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +neumonía I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +año, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +resolución I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +mejoría I-PAST_MEDICAL_HISTORY +radiológica I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +convencional, I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +persistencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +infiltrado I-PAST_MEDICAL_HISTORY +alveolar I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +radiografías I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tórax I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +control. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +VIH, I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +inmunosupresión. I-PAST_MEDICAL_HISTORY +Trabaja I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +mecánico I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +contacto I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ambientes I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +usan I-PAST_MEDICAL_HISTORY +soldaduras, I-PAST_MEDICAL_HISTORY +grasas, I-PAST_MEDICAL_HISTORY +ácidos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +irritantes. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +analítica I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +respiratoria I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +revela I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +alveolar I-EXPLORATION +bilateral I-EXPLORATION +similar I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +radiografías I-EXPLORATION +anteriores. I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +entonces I-EXPLORATION +hacer I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +torácica I-EXPLORATION +con I-EXPLORATION +cortes I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +resolución, I-EXPLORATION +que I-EXPLORATION +consiste I-EXPLORATION +en I-EXPLORATION +cortes I-EXPLORATION +finos I-EXPLORATION +de I-EXPLORATION +1mm I-EXPLORATION +de I-EXPLORATION +colimación I-EXPLORATION +a I-EXPLORATION +intervalos I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +mm I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +pulmonar, I-EXPLORATION +en I-EXPLORATION +inspiración I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +decúbito I-EXPLORATION +supino. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +muestra I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +opacificación I-EXPLORATION +alveolar I-EXPLORATION +en I-EXPLORATION +vidrio I-EXPLORATION +deslustrado I-EXPLORATION +dispersos I-EXPLORATION +con I-EXPLORATION +superposición I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +liso I-EXPLORATION +lineal I-EXPLORATION +septal I-EXPLORATION +inter I-EXPLORATION +e I-EXPLORATION +intralobular, I-EXPLORATION +conocido I-EXPLORATION +como I-EXPLORATION +patrón I-EXPLORATION +'crazy-paving' I-EXPLORATION +o I-EXPLORATION +en I-EXPLORATION +empedrado, I-EXPLORATION +con I-EXPLORATION +extensa I-EXPLORATION +afectación I-EXPLORATION +dispersa I-EXPLORATION +y I-EXPLORATION +parcheada I-EXPLORATION +del I-EXPLORATION +pulmón I-EXPLORATION +izquierdo I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +perihiliar I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +medio I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Teniendo I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +el I-EXPLORATION +patrón I-EXPLORATION +radiológico I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +TCAR I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exposición I-EXPLORATION +a I-EXPLORATION +agentes I-EXPLORATION +tóxicos I-EXPLORATION +inhalados, I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +se I-EXPLORATION +reduce I-EXPLORATION +a I-EXPLORATION +PAP I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +neumonía I-EXPLORATION +lipoidea. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +entonces I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +con I-EXPLORATION +BAL, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +resulta I-EXPLORATION +concluyente, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +completa I-EXPLORATION +con I-EXPLORATION +biopsia I-EXPLORATION +transbronquial; I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +ultraestructural I-EXPLORATION +identifica I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +alvéolos I-EXPLORATION +un I-EXPLORATION +material I-EXPLORATION +granular I-EXPLORATION +amorfo I-EXPLORATION +eosinófilo I-EXPLORATION +PAS I-EXPLORATION +positivo I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +alveolar I-EXPLORATION +algún I-EXPLORATION +lipófago I-EXPLORATION +con I-EXPLORATION +microvacuolas, I-EXPLORATION +llegando I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +PAP. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +disminución I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +nivel I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +conciencia I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +consumo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +heroína I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +depresión I-DERIVED_FROM/TO +respiratoria I-DERIVED_FROM/TO +(presión I-DERIVED_FROM/TO +parcial I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +O2 I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +sangre I-DERIVED_FROM/TO +arterial: I-DERIVED_FROM/TO +73 I-DERIVED_FROM/TO +mmHg I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +fracción I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +oxígeno I-DERIVED_FROM/TO +inspirado I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +50%), I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +revierte I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +oxigenoterapia I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +naloxona. I-DERIVED_FROM/TO +Presenta I-DERIVED_FROM/TO +tumefacción I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +brazo I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +glúteo I-DERIVED_FROM/TO +derechos I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +anuria. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +destacan I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +datos: I-EXPLORATION +GOT: I-EXPLORATION +1.212 I-EXPLORATION +UI/l, I-EXPLORATION +GPT: I-EXPLORATION +343 I-EXPLORATION +UI/l, I-EXPLORATION +CPK I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +pocas I-EXPLORATION +horas I-EXPLORATION +del I-EXPLORATION +ingreso: I-EXPLORATION +47.876 I-EXPLORATION +UI/l, I-EXPLORATION +creatinina: I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +potasio: I-EXPLORATION +6, I-EXPLORATION +1 I-EXPLORATION +mmol/l. I-EXPLORATION +A I-EXPLORATION +tenor I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +se I-EXPLORATION +diagnostica I-EXPLORATION +de I-EXPLORATION +posible I-EXPLORATION +síndrome I-EXPLORATION +compartimental I-EXPLORATION +con I-EXPLORATION +rabdomiolisis I-EXPLORATION +e I-EXPLORATION +IRA I-EXPLORATION +secundaria. I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +su I-TREATMENT +paso I-TREATMENT +a I-TREATMENT +quirófano I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +realizan I-TREATMENT +fasciotomías I-TREATMENT +de I-TREATMENT +tríceps I-TREATMENT +y I-TREATMENT +glúteo I-TREATMENT +derechos, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +dopamina I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +pre-ß, I-TREATMENT +manitol I-TREATMENT +a I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +g/kg I-TREATMENT +y I-TREATMENT +corrección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hiperpotasemia I-TREATMENT +con I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +habitual: I-TREATMENT +sueros I-TREATMENT +glucosados I-TREATMENT +con I-TREATMENT +insulina I-TREATMENT +y I-TREATMENT +bicarbonato. I-TREATMENT +Durante B-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +presenta I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +edema I-EVOLUTION +agudo I-EVOLUTION +de I-EVOLUTION +pulmón I-EVOLUTION +por I-EVOLUTION +sobrecarga I-EVOLUTION +hídrica I-EVOLUTION +que I-EVOLUTION +responde I-EVOLUTION +bien I-EVOLUTION +al I-EVOLUTION +tratamiento. I-EVOLUTION +Es I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +sin I-EVOLUTION +secuelas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +76 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cardiología I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +infarto I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +miocardio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +localización I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +complicado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +cardiaca. I-PRESENT_ILLNESS +Se B-TREATMENT +decide I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +venoso I-TREATMENT +central I-TREATMENT +accediendo I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +subclavia I-TREATMENT +derecha. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +anómalo I-EXPLORATION +del I-EXPLORATION +catéter I-EXPLORATION +que I-EXPLORATION +desciende I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +derecho I-EXPLORATION +del I-EXPLORATION +mediastino I-EXPLORATION +para I-EXPLORATION +desviarse I-EXPLORATION +posteriormente I-EXPLORATION +siguiendo I-EXPLORATION +un I-EXPLORATION +perfil I-EXPLORATION +cardiaco I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +objetivo I-EXPLORATION +de I-EXPLORATION +descartar I-EXPLORATION +la I-EXPLORATION +canulación I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +vaso I-EXPLORATION +arterial I-EXPLORATION +(subclavia I-EXPLORATION +o I-EXPLORATION +carótida I-EXPLORATION +común I-EXPLORATION +derechas), I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +gasometría I-EXPLORATION +(pH: I-EXPLORATION +7, I-EXPLORATION +35, I-EXPLORATION +pO2: I-EXPLORATION +40, I-EXPLORATION +pCO2: I-EXPLORATION +48) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +registra I-EXPLORATION +la I-EXPLORATION +curva I-EXPLORATION +de I-EXPLORATION +presión I-EXPLORATION +intraluminal I-EXPLORATION +(15 I-EXPLORATION +mmHg). I-EXPLORATION +Ambas I-EXPLORATION +demuestran I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +flujo I-EXPLORATION +venoso I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía. I-EXPLORATION + I-EXPLORATION +A B-TREATMENT +continuación, I-TREATMENT +se I-TREATMENT +implanta I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +Swan-Ganz I-TREATMENT +en I-TREATMENT +la I-TREATMENT +rama I-TREATMENT +principal I-TREATMENT +derecha I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +pulmonar, I-TREATMENT +también I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +subclavia I-TREATMENT +derecha. I-TREATMENT +Se B-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +coronario I-EXPLORATION +(diámetro I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm). I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +coronario I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +el I-EXPLORATION +catéter I-EXPLORATION +abocando I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha, I-EXPLORATION +al I-EXPLORATION +ventrículo I-EXPLORATION +derecho I-EXPLORATION +y, I-EXPLORATION +finalmente, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar. I-EXPLORATION +Ninguna I-EXPLORATION +otra I-EXPLORATION +vena I-EXPLORATION +conecta I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION +Todos I-EXPLORATION +estos I-EXPLORATION +datos I-EXPLORATION +son I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +malformación I-EXPLORATION +venosa I-EXPLORATION +que I-EXPLORATION +consiste I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +VCSI I-EXPLORATION +con I-EXPLORATION +desembocadura I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +coronario, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +permeabilidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +anastomosis I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +sistema I-EXPLORATION +venoso I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +89 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +aurícular I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +EPOC, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +cutaneomucosa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +coluria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +astenia. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +palpaba I-EXPLORATION +zona I-EXPLORATION +indurada I-EXPLORATION +no I-EXPLORATION +dolorosa I-EXPLORATION +en I-EXPLORATION +epigastrio I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +irrelevante. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +destacaban I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +parámetros: I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +12, I-EXPLORATION +88 I-EXPLORATION +mg/dl I-EXPLORATION +(rango, I-EXPLORATION +0, I-EXPLORATION +1-1), I-EXPLORATION +bilirrubina I-EXPLORATION +directa I-EXPLORATION +de I-EXPLORATION +9, I-EXPLORATION +92 I-EXPLORATION +mg/dl I-EXPLORATION +(rango, I-EXPLORATION +0, I-EXPLORATION +01-0, I-EXPLORATION +25), I-EXPLORATION +AST I-EXPLORATION +de I-EXPLORATION +244 I-EXPLORATION +U/L I-EXPLORATION +(rango, I-EXPLORATION +5-35), I-EXPLORATION +ALT I-EXPLORATION +de I-EXPLORATION +272 I-EXPLORATION +U/L I-EXPLORATION +(rango, I-EXPLORATION +5-44), I-EXPLORATION +GGT I-EXPLORATION +de I-EXPLORATION +420 I-EXPLORATION +U/L I-EXPLORATION +(rango, I-EXPLORATION +5-46) I-EXPLORATION +y I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +de I-EXPLORATION +1.926 I-EXPLORATION +U/L I-EXPLORATION +(rango, I-EXPLORATION +90-360) I-EXPLORATION +con I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +bioquímicos, I-EXPLORATION +incluidos I-EXPLORATION +amilasa I-EXPLORATION +y I-EXPLORATION +lipasa, I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +urgencia, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +voluminosa I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +pancreática, I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +quístico I-EXPLORATION +multitabicada I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +lobulados, I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +principal I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +vías I-EXPLORATION +biliares I-EXPLORATION +intrahepáticas. I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +del I-EXPLORATION +páncreas, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +multiquístico I-EXPLORATION +con I-EXPLORATION +tabiques I-EXPLORATION +y I-EXPLORATION +calcificaciones I-EXPLORATION +«en I-EXPLORATION +puesta I-EXPLORATION +de I-EXPLORATION +sol», I-EXPLORATION +que I-EXPLORATION +provocaba I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +Wirsung; I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +cistoadenoma I-EXPLORATION +seroso I-EXPLORATION +pancreático. I-EXPLORATION +Además I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +biliar I-EXPLORATION +muy I-EXPLORATION +distendida I-EXPLORATION +y I-EXPLORATION +marcada I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +colédoco. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +edad I-TREATMENT +y I-TREATMENT +los I-TREATMENT +antecedentes I-TREATMENT +personales I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +considerada I-TREATMENT +subsidiaria I-TREATMENT +de I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +colangiopancreatografía I-EXPLORATION +retrógrada I-EXPLORATION +endoscópica I-EXPLORATION +(CPRE). I-EXPLORATION +Al I-EXPLORATION +realizar I-EXPLORATION +la I-EXPLORATION +CPRE I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +cierta I-EXPLORATION +dificultad I-EXPLORATION +de I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +rodilla I-EXPLORATION +duodenal I-EXPLORATION +superior, I-EXPLORATION +en I-EXPLORATION +probable I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +compresión I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +primaria I-EXPLORATION +pancreática. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +colangiografía I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +colédoco I-EXPLORATION +proximal I-EXPLORATION +con I-EXPLORATION +estenosis I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +3-4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud. I-EXPLORATION +Se B-TREATMENT +colocó I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +biliar I-TREATMENT +metálica I-TREATMENT +autoexpandible I-TREATMENT +tipo I-TREATMENT +Wallstent I-TREATMENT +(Boston I-TREATMENT +Scientific, I-TREATMENT +Natick, I-TREATMENT +MA, I-TREATMENT +USA) I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +longitud I-TREATMENT +y I-TREATMENT +1 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +calibre I-TREATMENT +sin I-TREATMENT +incidencias, I-TREATMENT +comprobando I-TREATMENT +la I-TREATMENT +correcta I-TREATMENT +colocación I-TREATMENT +y I-TREATMENT +drenaje I-TREATMENT +posterior. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +progresiva I-EVOLUTION +despigmentación I-EVOLUTION +cutaneomucosa I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +de I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +bilirrubina. I-EVOLUTION +Finalmente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +69 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Guinea I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +llevaba I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +mes I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +España. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +atención I-PRESENT_ILLNESS +primaria I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +tiempo I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +expectoración, I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +mialgias, I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +(que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +objetiva I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta). I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +remiten I-EXPLORATION +muestras I-EXPLORATION +al I-EXPLORATION +laboratorio I-EXPLORATION +para I-EXPLORATION +bioquímica I-EXPLORATION +básica I-EXPLORATION +y I-EXPLORATION +hemograma. I-EXPLORATION +Sólo I-EXPLORATION +son I-EXPLORATION +destacables I-EXPLORATION +una I-EXPLORATION +ligera I-EXPLORATION +anemia I-EXPLORATION +11, I-EXPLORATION +3 I-EXPLORATION +g/dL I-EXPLORATION +de I-EXPLORATION +hemoglobina I-EXPLORATION +y I-EXPLORATION +eosinofilia I-EXPLORATION +2, I-EXPLORATION +6*1.000/ml. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +revisión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +teñida I-EXPLORATION +con I-EXPLORATION +Giemsa I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +microfilarias I-EXPLORATION +envainadas. I-EXPLORATION + B-EVOLUTION +Dadas I-EVOLUTION +las I-EVOLUTION +diferencias I-EVOLUTION +de I-EVOLUTION +periodicidad I-EVOLUTION +de I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +microfilarias I-EVOLUTION +en I-EVOLUTION +sangre I-EVOLUTION +periférica I-EVOLUTION +(diurna I-EVOLUTION +y I-EVOLUTION +nocturna), I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +ingresar I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +para I-EVOLUTION +tomar I-EVOLUTION +una I-EVOLUTION +segunda I-EVOLUTION +muestra I-EVOLUTION +de I-EVOLUTION +sangre I-EVOLUTION +que I-EVOLUTION +confirmase I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +filariasis. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +segunda I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +periférica, I-EXPLORATION +tras I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +Knott I-EXPLORATION +y I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +Giemsa, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +microfilarias I-EXPLORATION +envainadas I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +envainar. I-EXPLORATION + I-EXPLORATION +Se B-DERIVED_FROM/TO +remitió I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +muestra I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Centro I-DERIVED_FROM/TO +Nacional I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Microbiología, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +identificaron I-DERIVED_FROM/TO +como I-DERIVED_FROM/TO +Loa I-DERIVED_FROM/TO +loa I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Mansonella I-DERIVED_FROM/TO +perstans. I-DERIVED_FROM/TO +Se B-TREATMENT +inició I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +dietilcarbamicina I-TREATMENT +6 I-TREATMENT +mg I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +única I-TREATMENT +y I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +mebendazol I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +durante I-TREATMENT +30 I-TREATMENT +días I-TREATMENT +bajo I-TREATMENT +supervisión I-TREATMENT +médica I-TREATMENT +los I-TREATMENT +primeros I-TREATMENT +días I-TREATMENT +en I-TREATMENT +previsión I-TREATMENT +de I-TREATMENT +una I-TREATMENT +posible I-TREATMENT +reacción I-TREATMENT +de I-TREATMENT +Herxheimer. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +buena, I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cifra I-EVOLUTION +de I-EVOLUTION +eosinófilos, I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +prurito I-EVOLUTION +y I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +microfilarias I-EVOLUTION +en I-EVOLUTION +sangre I-EVOLUTION +periférica. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +no B-PAST_MEDICAL_HISTORY +fumador. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +hospitalarios I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +intoxicación I-PAST_MEDICAL_HISTORY +aguda I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +organofosforados. I-PAST_MEDICAL_HISTORY +Aporta I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +informes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +reconocimientos I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +periódicos I-PAST_MEDICAL_HISTORY +realizados I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +23 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +trabajado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +empresa I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fabricaba I-PAST_MEDICAL_HISTORY +diversos I-PAST_MEDICAL_HISTORY +productos I-PAST_MEDICAL_HISTORY +fitosanitarios I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +obtención I-PAST_MEDICAL_HISTORY +empleaba I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +amplio I-PAST_MEDICAL_HISTORY +número I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +disolventes I-PAST_MEDICAL_HISTORY +orgánicos, I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +ellos I-PAST_MEDICAL_HISTORY +acetona, I-PAST_MEDICAL_HISTORY +acetofenona, I-PAST_MEDICAL_HISTORY +ciclohexanona, I-PAST_MEDICAL_HISTORY +nafta, I-PAST_MEDICAL_HISTORY +tolueno I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +xileno, I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +específico I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +esporádicamente I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +exposición I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +organofosforados I-PAST_MEDICAL_HISTORY +(determinación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +acetilcolinesterasa I-PAST_MEDICAL_HISTORY +intraeritrocitaria), I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nefropatías, I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +analíticas I-PAST_MEDICAL_HISTORY +generales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sangre I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +orina I-PAST_MEDICAL_HISTORY +son I-PAST_MEDICAL_HISTORY +normales, I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +tensiones I-PAST_MEDICAL_HISTORY +arteriales I-PAST_MEDICAL_HISTORY +oscilan I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +100/60 I-PAST_MEDICAL_HISTORY +mm/Hg I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +120/80 I-PAST_MEDICAL_HISTORY +mm/Hg. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +reconocimientos I-PAST_MEDICAL_HISTORY +realizados I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +detectó I-PAST_MEDICAL_HISTORY +proteinuria I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +microhematuria, I-PAST_MEDICAL_HISTORY +creatinina I-PAST_MEDICAL_HISTORY +sérica I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +06 I-PAST_MEDICAL_HISTORY +mg/dl; I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +nuevo I-PAST_MEDICAL_HISTORY +reconocimiento I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +siguiente I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +creatinina I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +43 I-PAST_MEDICAL_HISTORY +mg/dl, I-PAST_MEDICAL_HISTORY +hematuria I-PAST_MEDICAL_HISTORY +(10 I-PAST_MEDICAL_HISTORY +hematíes/campo), I-PAST_MEDICAL_HISTORY +proteinuria I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +g/día. I-PAST_MEDICAL_HISTORY +Hace B-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +glomerulonefritis I-PRESENT_ILLNESS +proliferativa I-PRESENT_ILLNESS +mesangial I-PRESENT_ILLNESS +difusa I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +depósitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +IgA. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +20% I-EXPLORATION +de I-EXPLORATION +glomérulos I-EXPLORATION +con I-EXPLORATION +esclerosis I-EXPLORATION +severa, I-EXPLORATION +un I-EXPLORATION +10% I-EXPLORATION +estaban I-EXPLORATION +obliterados, I-EXPLORATION +había I-EXPLORATION +una I-EXPLORATION +fibrosis I-EXPLORATION +intersticial, I-EXPLORATION +atrofia I-EXPLORATION +tubular, I-EXPLORATION +discreto I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +crónico I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +inmunofluorescencia I-EXPLORATION +se I-EXPLORATION +detectaban I-EXPLORATION +depósitos I-EXPLORATION +mesangiales I-EXPLORATION +difusos I-EXPLORATION +de I-EXPLORATION +IgA I-EXPLORATION +y I-EXPLORATION +C3; I-EXPLORATION +a B-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +ello, I-EVOLUTION +siguió I-EVOLUTION +trabajando I-EVOLUTION +hasta I-EVOLUTION +hace I-EVOLUTION +un I-EVOLUTION +año, I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +diagnosticado I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +enfermedad I-EVOLUTION +renal I-EVOLUTION +crónica I-EVOLUTION +de I-EVOLUTION +grado I-EVOLUTION +3. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +analíticas I-EVOLUTION +renales, I-EVOLUTION +realizadas I-EVOLUTION +cada I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +desde I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +vienen I-EVOLUTION +expresadas I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +tabla I-EVOLUTION +2. I-EVOLUTION +Las I-EVOLUTION +determinaciones I-EVOLUTION +puntuales I-EVOLUTION +de I-EVOLUTION +beta I-EVOLUTION +2-microglobulina I-EVOLUTION +y I-EVOLUTION +NAG I-EVOLUTION +urinarios I-EVOLUTION +se I-EVOLUTION +encontraban I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +de I-EVOLUTION +normalidad. I-EVOLUTION +Después I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +cesado I-EVOLUTION +su I-EVOLUTION +actividad I-EVOLUTION +laboral I-EVOLUTION +la I-EVOLUTION +proteinuria I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +hematuria I-EVOLUTION +se I-EVOLUTION +normalizaron I-EVOLUTION +pero I-EVOLUTION +la I-EVOLUTION +creatinina I-EVOLUTION +sérica I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +conocidas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bronquitis I-PAST_MEDICAL_HISTORY +asmática, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +portadora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +marcapasos I-PAST_MEDICAL_HISTORY +(desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años), I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +quirúrgicamente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +prótesis I-PAST_MEDICAL_HISTORY +valvular I-PAST_MEDICAL_HISTORY +mitral I-PAST_MEDICAL_HISTORY +(hacía I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cáncer I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mama I-PAST_MEDICAL_HISTORY +(dieciocho I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes). I-PAST_MEDICAL_HISTORY +Seguía B-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +habitual I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +acenocumarol, I-PRESENT_ILLNESS +furosemida, I-PRESENT_ILLNESS +bisoprolol, I-PRESENT_ILLNESS +espironolactona, I-PRESENT_ILLNESS +enalapril, I-PRESENT_ILLNESS +pantoprazol I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hierro I-PRESENT_ILLNESS +oral. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +occipital I-PRESENT_ILLNESS +unilateral, I-PRESENT_ILLNESS +irradiada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +temporal, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +opresivo, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cedía I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +analgésicos I-PRESENT_ILLNESS +habituales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +hiporexia, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +ponderal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +Kg I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +claudicación I-PRESENT_ILLNESS +mandibular I-PRESENT_ILLNESS +intermitente. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +destacaba I-EXPLORATION +palidez I-EXPLORATION +de I-EXPLORATION +mucosas. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +adenopatías. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +como I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +craneal. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +no I-EXPLORATION +existía I-EXPLORATION +anemia I-EXPLORATION +y I-EXPLORATION +sí I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +neutrofilia. I-EXPLORATION +Asimismo I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +glucemia I-EXPLORATION +de I-EXPLORATION +128 I-EXPLORATION +mg/dl. I-EXPLORATION +La I-EXPLORATION +PCR I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +99 I-EXPLORATION +mg/dl. I-EXPLORATION +La I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +(VSG) I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +83 I-EXPLORATION +mm I-EXPLORATION +(en I-EXPLORATION +la I-EXPLORATION +1a I-EXPLORATION +hora). I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +otras I-EXPLORATION +alteraciones I-EXPLORATION +analíticas. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +craneal I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +lesiones I-EXPLORATION +ocupantes I-EXPLORATION +de I-EXPLORATION +espacio I-EXPLORATION +y I-EXPLORATION +sí I-EXPLORATION +una I-EXPLORATION +hiperostosis I-EXPLORATION +cortical I-EXPLORATION +frontoparietal I-EXPLORATION +interna. I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +inicial I-TREATMENT +de I-TREATMENT +arteritis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +temporal, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +corticoideo I-TREATMENT +con I-TREATMENT +metilprednisolona I-TREATMENT +a I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +mg/Kg I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +mejorando I-TREATMENT +la I-TREATMENT +clínica I-TREATMENT +inicial. I-TREATMENT +Tres B-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +temporal, I-EXPLORATION +confirmándose I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico. I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +cuarenta I-EVOLUTION +y I-EVOLUTION +ocho I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +dicha I-EVOLUTION +biopsia, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +dolor I-EVOLUTION +intenso I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +lengua, I-EVOLUTION +con I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +lesión I-EVOLUTION +ulcerada I-EVOLUTION +en I-EVOLUTION +hemilengua I-EVOLUTION +derecha, I-EVOLUTION +realizándose B-EXPLORATION +cultivos I-EXPLORATION +microbiológicos, I-EXPLORATION +siendo I-EXPLORATION +negativos, I-EXPLORATION +TC I-EXPLORATION +cervical, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +hemilengua I-EXPLORATION +derecha I-EXPLORATION +sin I-EXPLORATION +adenopatías I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +de I-EXPLORATION +etiología I-EXPLORATION +isquémica. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +resolviéndose I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +lingual I-EVOLUTION +espontáneamente, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta, I-EVOLUTION +para I-EVOLUTION +realizar I-EVOLUTION +seguimiento I-EVOLUTION +y I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +en I-EVOLUTION +consultas I-EVOLUTION +externas. I-EVOLUTION + I-EVOLUTION +Dos I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +urgencias I-EVOLUTION +por I-EVOLUTION +debilidad I-EVOLUTION +en I-EVOLUTION +hemicuerpo I-EVOLUTION +derecho I-EVOLUTION +y I-EVOLUTION +alteración I-EVOLUTION +del I-EVOLUTION +lenguaje. I-EVOLUTION +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +hemiparesia I-EXPLORATION +derecha I-EXPLORATION +(balance I-EXPLORATION +motor I-EXPLORATION +de I-EXPLORATION +extremidad I-EXPLORATION +superior I-EXPLORATION +3-/5 I-EXPLORATION +y I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +2/5), I-EXPLORATION +afasia I-EXPLORATION +global, I-EXPLORATION +paresia I-EXPLORATION +facial I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +hemianopsia I-EXPLORATION +homónima I-EXPLORATION +derecha. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +craneal I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +extenso I-EXPLORATION +infarto I-EXPLORATION +agudo I-EXPLORATION +isquémico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +territorio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +cerebral I-EXPLORATION +media I-EXPLORATION +y I-EXPLORATION +arteria I-EXPLORATION +cerebral I-EXPLORATION +posterior I-EXPLORATION +izquierdas. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +electrocardiograma I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +ritmo I-EXPLORATION +de I-EXPLORATION +marcapasos. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +coagulación, I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +INR I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +48. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +otras I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +como I-EXPLORATION +angiorresonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +cerebral, I-EXPLORATION +ecografía-doppler I-EXPLORATION +transcraneal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +troncos I-EXPLORATION +supraaórticos, I-EXPLORATION +ni I-EXPLORATION +ecocardiograma I-EXPLORATION +(transtorácico I-EXPLORATION +ni I-EXPLORATION +transesofágico). I-EXPLORATION +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +larga I-DERIVED_FROM/TO +estancia I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +realización I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +rehabilitación I-DERIVED_FROM/TO +intensiva. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +77 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disartria, I-PRESENT_ILLNESS +disfasia I-PRESENT_ILLNESS +expresiva, I-PRESENT_ILLNESS +hemiparesia I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deterioro I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia. I-PRESENT_ILLNESS +Fue B-PAST_MEDICAL_HISTORY +informado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +esencial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +miligramos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +captopril I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +horas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aspirina I-PAST_MEDICAL_HISTORY +100 I-PAST_MEDICAL_HISTORY +miligramos I-PAST_MEDICAL_HISTORY +diarios. I-PAST_MEDICAL_HISTORY +Adicionalmente, I-PAST_MEDICAL_HISTORY +informaron I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +trauma I-PAST_MEDICAL_HISTORY +occipital I-PAST_MEDICAL_HISTORY +cerrado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +transitoria I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conciencia, I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +tropezar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +caer; I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +embargo, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +aquel I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +acudió I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +atención I-PAST_MEDICAL_HISTORY +médica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +presentaba I-EXPLORATION +intensa I-EXPLORATION +agitación I-EXPLORATION +motora, I-EXPLORATION +con I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +175/98 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +Hg, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +96 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +de I-EXPLORATION +20/minuto I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +36, I-EXPLORATION +4 I-EXPLORATION +grados I-EXPLORATION +centígrados. I-EXPLORATION +Se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +excoriación I-EXPLORATION +superficial I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +cicatrización I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +parieto-occipital I-EXPLORATION +izquierda. I-EXPLORATION +Las I-EXPLORATION +pupilas I-EXPLORATION +eran I-EXPLORATION +iguales I-EXPLORATION +y I-EXPLORATION +reaccionaban I-EXPLORATION +simétricamente I-EXPLORATION +al I-EXPLORATION +reflejo I-EXPLORATION +foto-motor I-EXPLORATION +directo I-EXPLORATION +y I-EXPLORATION +consensual. I-EXPLORATION +Al I-EXPLORATION +realizar I-EXPLORATION +estímulos I-EXPLORATION +dolorosos, I-EXPLORATION +realizaba I-EXPLORATION +apertura I-EXPLORATION +ocular, I-EXPLORATION +emitía I-EXPLORATION +palabras I-EXPLORATION +y I-EXPLORATION +localizaba I-EXPLORATION +el I-EXPLORATION +sitio I-EXPLORATION +estimulado, I-EXPLORATION +sin I-EXPLORATION +embargo, I-EXPLORATION +con I-EXPLORATION +hemiparesia I-EXPLORATION +derecha I-EXPLORATION +(Escala I-EXPLORATION +de I-EXPLORATION +coma I-EXPLORATION +de I-EXPLORATION +Glasgow: I-EXPLORATION +10/15). I-EXPLORATION +El I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Babinski I-EXPLORATION +estaba I-EXPLORATION +presente I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +bilateral. I-EXPLORATION + I-EXPLORATION +Fue I-EXPLORATION +realizado I-EXPLORATION +un I-EXPLORATION +escáner I-EXPLORATION +cerebral I-EXPLORATION +de I-EXPLORATION +urgencia, I-EXPLORATION +previa B-TREATMENT +administración I-TREATMENT +de I-TREATMENT +haloperidol I-TREATMENT +para I-TREATMENT +disminuir I-TREATMENT +la I-TREATMENT +agitación, I-TREATMENT +la B-EVOLUTION +cual I-EVOLUTION +tuvo I-EVOLUTION +pobre I-EVOLUTION +calidad I-EVOLUTION +técnica I-EVOLUTION +dada I-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +movimientos I-EVOLUTION +del I-EVOLUTION +paciente. I-EVOLUTION +En B-EXPLORATION +dicho I-EXPLORATION +estudio, I-EXPLORATION +fue I-EXPLORATION +observada I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +extra-axial, I-EXPLORATION +hiperdensa I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +al I-EXPLORATION +parénquima I-EXPLORATION +cerebral, I-EXPLORATION +con I-EXPLORATION +forma I-EXPLORATION +semilunar I-EXPLORATION +de I-EXPLORATION +concavidad I-EXPLORATION +medial I-EXPLORATION +de I-EXPLORATION +17 I-EXPLORATION +milímetros I-EXPLORATION +de I-EXPLORATION +espesor, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +frontal, I-EXPLORATION +parietal I-EXPLORATION +y I-EXPLORATION +occipital I-EXPLORATION +izquierda, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +desviaba I-EXPLORATION +las I-EXPLORATION +estructuras I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +en I-EXPLORATION +14 I-EXPLORATION +milímetros, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +parecía I-EXPLORATION +corresponder I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +subdural. I-EXPLORATION +La I-EXPLORATION +magnitud I-EXPLORATION +desproporcionada I-EXPLORATION +del I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +edema I-EXPLORATION +adyacente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +alertaron I-EXPLORATION +sobre I-EXPLORATION +las I-EXPLORATION +posibles I-EXPLORATION +características I-EXPLORATION +neoplásicas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +cerebral I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +imagen, I-EXPLORATION +extra-axial, I-EXPLORATION +hiperdensa I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +al I-EXPLORATION +parénquima I-EXPLORATION +cerebral, I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +dorso-lateral I-EXPLORATION +fronto-temporo-parietal I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +intensa I-EXPLORATION +captación I-EXPLORATION +del I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +endovenoso, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +infiltraba I-EXPLORATION +la I-EXPLORATION +profundidad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +surcos I-EXPLORATION +cerebrales I-EXPLORATION +frontales. I-EXPLORATION +Adicionalmente, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ventana I-EXPLORATION +ósea I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +adelgazamiento I-EXPLORATION +del I-EXPLORATION +cráneo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +temporo-parietal I-EXPLORATION +izquierda I-EXPLORATION +a I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +craneotomía I-TREATMENT +fronto-parietal I-TREATMENT +izquierda I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +el I-TREATMENT +hueso I-TREATMENT +erosionado I-TREATMENT +e I-TREATMENT +infiltrado I-TREATMENT +por I-TREATMENT +una I-TREATMENT +lesión I-TREATMENT +violácea, I-TREATMENT +firme, I-TREATMENT +muy I-TREATMENT +vascularizada, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +extendía I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +duramadre, I-TREATMENT +llegando I-TREATMENT +a I-TREATMENT +las I-TREATMENT +leptomeninges, I-TREATMENT +infiltrándolas I-TREATMENT +y I-TREATMENT +más I-TREATMENT +profundamente I-TREATMENT +al I-TREATMENT +parénquima I-TREATMENT +cerebral I-TREATMENT +de I-TREATMENT +la I-TREATMENT +región I-TREATMENT +frontal, I-TREATMENT +temporal I-TREATMENT +y I-TREATMENT +parietal. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +resección I-TREATMENT +parcial, I-TREATMENT +dejando I-TREATMENT +material I-TREATMENT +anormal I-TREATMENT +adherido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +superficie I-TREATMENT +cerebral. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +de I-EVOLUTION +conciencia, I-EVOLUTION +alcanzando I-EVOLUTION +a I-EVOLUTION +estar I-EVOLUTION +alerta, I-EVOLUTION +con I-EVOLUTION +notable I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fuerza I-EVOLUTION +muscular I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +lado I-EVOLUTION +derecho, I-EVOLUTION +aunque I-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +disfasia I-EVOLUTION +sensitiva. I-EVOLUTION + I-EVOLUTION +Ante B-EXPLORATION +la I-EXPLORATION +impresión I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +metástasis I-EXPLORATION +meníngea I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +primario I-EXPLORATION +desconocido I-EXPLORATION +fueron I-EXPLORATION +solicitadas I-EXPLORATION +tomografía I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +solo I-EXPLORATION +se I-EXPLORATION +documento I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +próstata. I-EXPLORATION +Al I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +prostático I-EXPLORATION +pétreo I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +indefinidos I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +El I-EXPLORATION +antígeno I-EXPLORATION +prostático I-EXPLORATION +específico I-EXPLORATION +sérico I-EXPLORATION +obtenido I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +588 I-EXPLORATION +ng/dL, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +próstata I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +pobremente I-EXPLORATION +diferenciado. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +intracraneal I-EXPLORATION +también I-EXPLORATION +correspondió I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +metastásico I-EXPLORATION +pobremente I-EXPLORATION +diferenciado. I-EXPLORATION + I-EXPLORATION +Por B-TREATMENT +deseo I-TREATMENT +de I-TREATMENT +sus I-TREATMENT +familiares, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +ningún I-TREATMENT +tratamiento I-TREATMENT +oncológico I-TREATMENT +complementario I-TREATMENT +y B-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con B-TREATMENT +cuidados I-TREATMENT +ambulatorios I-TREATMENT +paliativos. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +curso I-PRESENT_ILLNESS +lentamente I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +describe I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +«pinchazos» I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +puntas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dedos, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +«acorchamiento», I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +inicialmente I-PRESENT_ILLNESS +notaba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +manos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tacto, I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +que, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +mes, I-PRESENT_ILLNESS +también I-PRESENT_ILLNESS +afecta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +pies. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +neurológica, I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +hipoestesia I-EXPLORATION +táctil I-EXPLORATION +con I-EXPLORATION +distribución I-EXPLORATION +en I-EXPLORATION +«guante» I-EXPLORATION +y I-EXPLORATION +«calcetín», I-EXPLORATION +apalestesia I-EXPLORATION +maleolar I-EXPLORATION +e I-EXPLORATION +hipopalestesia I-EXPLORATION +en I-EXPLORATION +crestas I-EXPLORATION +tibiales I-EXPLORATION +y I-EXPLORATION +codos. I-EXPLORATION +Los I-EXPLORATION +reflejos I-EXPLORATION +estaban I-EXPLORATION +presentes I-EXPLORATION +y I-EXPLORATION +eran I-EXPLORATION +simétricos. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +parestesias, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sensibilidad I-EXPLORATION +vibratoria I-EXPLORATION +y I-EXPLORATION +preservación I-EXPLORATION +de I-EXPLORATION +reflejos I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +exploración I-EXPLORATION +neurológica, I-EXPLORATION +obliga I-EXPLORATION +a I-EXPLORATION +considerar I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +sufra I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +medular I-EXPLORATION +cervical I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cordones I-EXPLORATION +posteriores. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +analítica I-EXPLORATION +(incluyendo I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +vitamina I-EXPLORATION +B12), I-EXPLORATION +una I-EXPLORATION +RM I-EXPLORATION +cervical I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +neurofisiológico. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +RM I-EXPLORATION +cervical I-EXPLORATION +(Magnetom-Trio, I-EXPLORATION +Siemens, I-EXPLORATION +Erlangen, I-EXPLORATION +Germany) I-EXPLORATION +mostró I-EXPLORATION +en I-EXPLORATION +secuencias I-EXPLORATION +potenciadas I-EXPLORATION +en I-EXPLORATION +T2 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +plano I-EXPLORATION +sagital I-EXPLORATION +una I-EXPLORATION +hiperintensidad I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +sin I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cordonal I-EXPLORATION +posterior I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +desde I-EXPLORATION +C1-C2 I-EXPLORATION +a I-EXPLORATION +C6-C7. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +cortes I-EXPLORATION +axiales I-EXPLORATION +y I-EXPLORATION +coronales I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +afectación I-EXPLORATION +era I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +simétrica. I-EXPLORATION +Estos I-EXPLORATION +hallazgos I-EXPLORATION +son I-EXPLORATION +característicos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +DCS. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +polineuropatía I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +velocidades I-EXPLORATION +de I-EXPLORATION +conducción, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +potenciales I-EXPLORATION +evocados I-EXPLORATION +somatosensoriales I-EXPLORATION +estaban I-EXPLORATION +desestructurados I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +latencias I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +cuatro I-EXPLORATION +miembros, I-EXPLORATION +indicando I-EXPLORATION +una I-EXPLORATION +afectación I-EXPLORATION +cordonal I-EXPLORATION +posterior. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +anemia I-EXPLORATION +megaloblástica, I-EXPLORATION +con I-EXPLORATION +4, I-EXPLORATION +44 I-EXPLORATION +10E12/L I-EXPLORATION +de I-EXPLORATION +hematíes I-EXPLORATION +(4, I-EXPLORATION +7-5, I-EXPLORATION +1 I-EXPLORATION +10E12/L), I-EXPLORATION +VCM: I-EXPLORATION +108 I-EXPLORATION +fL I-EXPLORATION +(80-95 I-EXPLORATION +fL) I-EXPLORATION +y I-EXPLORATION +HCM: I-EXPLORATION +34, I-EXPLORATION +9 I-EXPLORATION +pg I-EXPLORATION +(27-31 I-EXPLORATION +pg), I-EXPLORATION +siendo I-EXPLORATION +la I-EXPLORATION +hemoglobina I-EXPLORATION +(15, I-EXPLORATION +5 I-EXPLORATION +g/dl) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +hematocrito I-EXPLORATION +(47,9%) I-EXPLORATION +normales. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +en I-EXPLORATION +suero I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +78 I-EXPLORATION +pg/mL I-EXPLORATION +(210-930 I-EXPLORATION +pg/mL) I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +de I-EXPLORATION +ácido I-EXPLORATION +fólico I-EXPLORATION +de I-EXPLORATION +26, I-EXPLORATION +5 I-EXPLORATION +ng/mL I-EXPLORATION +(2, I-EXPLORATION +2-16, I-EXPLORATION +9 I-EXPLORATION +ng/mL), I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +determinaciones I-EXPLORATION +bioquímicas I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +normales. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +células I-EXPLORATION +parietales I-EXPLORATION +gástricas I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +(1/40), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +anticuerpos I-EXPLORATION +anti-FI I-EXPLORATION +(factor I-EXPLORATION +intrínseco) I-EXPLORATION +(>97, I-EXPLORATION +9; I-EXPLORATION +normal: I-EXPLORATION +0-25). I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +gástrica I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +atrófico, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +DSC I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +cianocobalamina I-TREATMENT +(1.000 I-TREATMENT +µ/día I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +intramuscular, I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +y I-TREATMENT +después I-TREATMENT +mensualmente). I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +meses I-EVOLUTION +siguientes I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +progresiva I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +alteraciones I-EVOLUTION +sensitivas. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +refería I-EVOLUTION +una I-EVOLUTION +leve I-EVOLUTION +e I-EVOLUTION +inconstante I-EVOLUTION +sensación I-EVOLUTION +de I-EVOLUTION +«hormigueos» I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +pies I-EVOLUTION +y B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +solo I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +hipopalestesia I-EXPLORATION +maleolar. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +resolución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +anemia I-EXPLORATION +megaloblásica I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +(438 I-EXPLORATION +pg/mL). I-EXPLORATION +Una I-EXPLORATION +RM I-EXPLORATION +medular I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +equipo, I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +completa I-EXPLORATION +desaparición I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intensidad I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +del I-EXPLORATION +cordón I-EXPLORATION +medular. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +destacan I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +bronquial, I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +mórbida, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +apnea I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +sueño, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hiperparatiroidismo I-PAST_MEDICAL_HISTORY +secundarios, I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mama I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +QT I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +RT, I-PAST_MEDICAL_HISTORY +valvulopatía I-PAST_MEDICAL_HISTORY +mitral I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardiaca, I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular, I-PAST_MEDICAL_HISTORY +HTA, I-PAST_MEDICAL_HISTORY +DM I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +glaucoma I-PAST_MEDICAL_HISTORY +bilateral, I-PAST_MEDICAL_HISTORY +colelitiasis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +colecistitis I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematoquecia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +cambios I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ritmo I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +asociados I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +marcado I-PRESENT_ILLNESS +empeoramiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +habitual. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +molestia I-EXPLORATION +difusa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho, I-EXPLORATION +y I-EXPLORATION +analíticamente I-EXPLORATION +presentaba I-EXPLORATION +anemia I-EXPLORATION +con I-EXPLORATION +Hb I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +3 I-EXPLORATION +g/dl I-EXPLORATION +(N: I-EXPLORATION +12-16), I-EXPLORATION +fibrinógeno I-EXPLORATION +de I-EXPLORATION +727 I-EXPLORATION +mg/dl I-EXPLORATION +(N:150-400), I-EXPLORATION +hiperglucemia I-EXPLORATION +e I-EXPLORATION +insuficiencia I-EXPLORATION +renal I-EXPLORATION +ya I-EXPLORATION +conocida I-EXPLORATION +con I-EXPLORATION +cifra I-EXPLORATION +de I-EXPLORATION +urea I-EXPLORATION +de I-EXPLORATION +148 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +1 I-EXPLORATION +mg/dl, I-EXPLORATION +ambas I-EXPLORATION +cifras I-EXPLORATION +similares I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +de I-EXPLORATION +analíticas I-EXPLORATION +previas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +colonoscopia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +doble I-EXPLORATION +luz I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +hepático I-EXPLORATION +del I-EXPLORATION +colon, I-EXPLORATION +presentando I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +natural I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +calibre, I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +salía I-EXPLORATION +un I-EXPLORATION +contenido I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +bilioso. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +TC I-EXPLORATION +abdominal, I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +aerobilia, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +escleroatrófica I-EXPLORATION +en I-EXPLORATION +íntimo I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +ángulo I-EXPLORATION +hepático I-EXPLORATION +del I-EXPLORATION +colon, I-EXPLORATION +cuya I-EXPLORATION +pared I-EXPLORATION +aparecía I-EXPLORATION +engrosada, I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +subyacente. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +completar I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +finalmente I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +trayecto I-EXPLORATION +fistuloso I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +ángulo I-EXPLORATION +hepático I-EXPLORATION +del I-EXPLORATION +colon, I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +calibre I-EXPLORATION +aproximado I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +6 I-EXPLORATION +mm, I-EXPLORATION +que I-EXPLORATION +parecía I-EXPLORATION +comunicar I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +colédoco, I-EXPLORATION +obteniéndose I-EXPLORATION +posteriormente I-EXPLORATION +relleno I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +final I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +colecistitis I-EXPLORATION +crónica I-EXPLORATION +con I-EXPLORATION +fístula I-EXPLORATION +biliar I-EXPLORATION +interna I-EXPLORATION +a I-EXPLORATION +ángulo I-EXPLORATION +hepático I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +y I-EXPLORATION +hemorragia I-EXPLORATION +digestiva I-EXPLORATION +baja I-EXPLORATION +secundaria. I-EXPLORATION + I-EXPLORATION +Durante B-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +precisó I-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes, I-TREATMENT +permaneciendo B-EVOLUTION +hemodinámicamente I-EVOLUTION +estable I-EVOLUTION +y I-EVOLUTION +afebril, I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +diarrea I-EVOLUTION +ni I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +hematoquecia. I-EVOLUTION +Dada B-TREATMENT +la I-TREATMENT +pluripatología I-TREATMENT +de I-TREATMENT +base I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +la I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +agudo I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +un I-TREATMENT +manejo I-TREATMENT +conservador, I-TREATMENT +descartando I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +y I-TREATMENT +CPRE I-TREATMENT +terapeútica. I-TREATMENT +Evolucionó B-EVOLUTION +favorablemente I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +Continuaba I-EVOLUTION +asintomática I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +aunque I-EVOLUTION +falleció I-EVOLUTION +un I-EVOLUTION +tiempo I-EVOLUTION +después I-EVOLUTION +por I-EVOLUTION +patología I-EVOLUTION +cardiorrespiratoria. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tiroidectomía I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +linfadenectomía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +papilar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tiroides I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +levotiroxina I-PAST_MEDICAL_HISTORY +sódica I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipercolesterolemia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +pravastatina. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +blanquecina, I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea. I-PRESENT_ILLNESS +Inicialmente B-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +dos I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +antibióticos I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fiebre. I-TREATMENT +Posteriormente B-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +hemoptoica, I-PRESENT_ILLNESS +autolimitada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +siguientes. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +general. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +(IMC) I-EXPLORATION +de I-EXPLORATION +38, I-EXPLORATION +67 I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +obesidad I-EXPLORATION +grado I-EXPLORATION +2 I-EXPLORATION +y I-EXPLORATION +roncus I-EXPLORATION +espiratorios I-EXPLORATION +bilaterales. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +alteraciones I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +Mantoux I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +pulmonar I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +obstrucción I-EXPLORATION +muy I-EXPLORATION +leve I-EXPLORATION +al I-EXPLORATION +flujo I-EXPLORATION +aéreo I-EXPLORATION +(capacidad I-EXPLORATION +vital I-EXPLORATION +forzada I-EXPLORATION +[CVF] I-EXPLORATION +2.570 I-EXPLORATION +cc I-EXPLORATION +(110% I-EXPLORATION +del I-EXPLORATION +valor I-EXPLORATION +teórico); I-EXPLORATION +volumen I-EXPLORATION +espirado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +segundo I-EXPLORATION +[VEF1] I-EXPLORATION +1.730 I-EXPLORATION +cc I-EXPLORATION +(92,7%); I-EXPLORATION +FEV1/FVC I-EXPLORATION +67%; I-EXPLORATION +test I-EXPLORATION +broncodilatador I-EXPLORATION +negativo). I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +inferior I-EXPLORATION +derecho I-EXPLORATION +(LID). I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +atelectasia I-EXPLORATION +sin I-EXPLORATION +broncograma I-EXPLORATION +aéreo I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +LID I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +proximal I-EXPLORATION +del I-EXPLORATION +bronquio I-EXPLORATION +de I-EXPLORATION +dicho I-EXPLORATION +segmento, I-EXPLORATION +ocupado I-EXPLORATION +por I-EXPLORATION +material I-EXPLORATION +hipodenso I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +densidad I-EXPLORATION +grasa I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +nodular, I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +6 I-EXPLORATION +cm.. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +fibrobroncoscopia I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +polipoide I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +lisa I-EXPLORATION +que I-EXPLORATION +obstruía I-EXPLORATION +por I-EXPLORATION +completo I-EXPLORATION +el I-EXPLORATION +bronquio I-EXPLORATION +basal I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +LID. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +bronquial I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +bronquial I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +maduro I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +lipoma I-EXPLORATION +endobronquial. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +lipoma I-TREATMENT +endobronquial I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +endoscópico I-TREATMENT +mediante I-TREATMENT +resección I-TREATMENT +láser. I-TREATMENT +Se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +fotocoagulación I-TREATMENT +superficial I-TREATMENT +con I-TREATMENT +láser I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +intento I-TREATMENT +infructuoso I-TREATMENT +de I-TREATMENT +extracción I-TREATMENT +con I-TREATMENT +asa I-TREATMENT +de I-TREATMENT +diatermia I-TREATMENT +por I-TREATMENT +dificultad I-TREATMENT +para I-TREATMENT +ver I-TREATMENT +la I-TREATMENT +parte I-TREATMENT +distal I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +extrayéndose I-TREATMENT +sólo I-TREATMENT +una I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +envió I-TREATMENT +para I-TREATMENT +análisis I-TREATMENT +anatomopatológico, I-TREATMENT +quedando I-TREATMENT +el I-TREATMENT +resto I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +fotocoagulada I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +superficial. I-TREATMENT +Un B-EVOLUTION +mes I-EVOLUTION +después, I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +un I-EVOLUTION +segundo I-EVOLUTION +procedimiento, I-EVOLUTION +siendo I-EVOLUTION +extraído I-EVOLUTION +todo I-EVOLUTION +el I-EVOLUTION +material I-EVOLUTION +restante. I-EVOLUTION +No I-EVOLUTION +se I-EVOLUTION +objetivaron I-EVOLUTION +complicaciones I-EVOLUTION +tras I-EVOLUTION +los I-EVOLUTION +procedimientos. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +69 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +presentando I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +peneano I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +erección I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +completa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas, I-PRESENT_ILLNESS +hemoglobina I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +sangre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8, I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +mg/dl I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +140 I-PRESENT_ILLNESS +hematíes I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +campo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +análisis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +orina. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encuentra I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2001 I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +vesical I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +urotelio I-PAST_MEDICAL_HISTORY +T2b, I-PAST_MEDICAL_HISTORY +G3 I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +RTU I-PAST_MEDICAL_HISTORY +vesical I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +ciclos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +quimioterapia I-PAST_MEDICAL_HISTORY +consistente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +taxol I-PAST_MEDICAL_HISTORY +245 I-PAST_MEDICAL_HISTORY +mg, I-PAST_MEDICAL_HISTORY +cisplatino I-PAST_MEDICAL_HISTORY +136 I-PAST_MEDICAL_HISTORY +mg, I-PAST_MEDICAL_HISTORY +gemcitabina I-PAST_MEDICAL_HISTORY +1.456 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +radioterapia I-PAST_MEDICAL_HISTORY +externa I-PAST_MEDICAL_HISTORY +64Gy I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +mitad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ciclos I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +concluyó I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +remisión I-PAST_MEDICAL_HISTORY +completa I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +2005. I-PAST_MEDICAL_HISTORY +Los I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +sucesivos I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +recidivas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tumores I-PAST_MEDICAL_HISTORY +vesicales I-PAST_MEDICAL_HISTORY +superficiales I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +electrocoagulan. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2008 I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +elevación I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +PSA I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +ng/ml I-PAST_MEDICAL_HISTORY +realizando I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +próstata I-PAST_MEDICAL_HISTORY +informada I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +próstata I-PAST_MEDICAL_HISTORY +3+3, I-PAST_MEDICAL_HISTORY +Gleason I-PAST_MEDICAL_HISTORY +6. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +trató I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +braquiterapia I-PAST_MEDICAL_HISTORY +intersticial I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +semillas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Iodo125 I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2009. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +finales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2010 I-PAST_MEDICAL_HISTORY +refirió I-PAST_MEDICAL_HISTORY +molestias I-PAST_MEDICAL_HISTORY +premiccionales I-PAST_MEDICAL_HISTORY +observando I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +cistoscopia I-PAST_MEDICAL_HISTORY +lesión I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +uretra I-PAST_MEDICAL_HISTORY +prostática. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realizó I-EXPLORATION +RTU-biópsica I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +urotelio I-EXPLORATION +con I-EXPLORATION +diferenciación I-EXPLORATION +escamosa. I-EXPLORATION +La B-TREATMENT +lesión I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +mediante I-TREATMENT +resección I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +gemcitabina I-TREATMENT +3.300 I-TREATMENT +mg I-TREATMENT +(1.750 I-TREATMENT +mg/m2), I-TREATMENT +cisplatino I-TREATMENT +94 I-TREATMENT +mg I-TREATMENT +(50 I-TREATMENT +mg/m2) I-TREATMENT +finalizado I-TREATMENT +en I-TREATMENT +marzo I-TREATMENT +de I-TREATMENT +2011. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +revisión I-EVOLUTION +de I-EVOLUTION +abril I-EVOLUTION +de I-EVOLUTION +2012 I-EVOLUTION +continuaba I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +PSA I-EVOLUTION +hasta I-EVOLUTION +valor I-EVOLUTION +de I-EVOLUTION +0, I-EVOLUTION +6 I-EVOLUTION +ng/ml; I-EVOLUTION +la B-EXPLORATION +cistoscopia I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +inflamatorio-cicatricial I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +uretra I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +por I-EXPLORATION +emisión I-EXPLORATION +de I-EXPLORATION +positrones I-EXPLORATION +(PET/CT). I-EXPLORATION +Se I-EXPLORATION +veían I-EXPLORATION +varias I-EXPLORATION +imágenes I-EXPLORATION +hipermetabólicas, I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +e I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +vejiga, I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +vesícula I-EXPLORATION +seminal I-EXPLORATION +y I-EXPLORATION +depósito I-EXPLORATION +en I-EXPLORATION +uretra I-EXPLORATION +peneana I-EXPLORATION +englobando I-EXPLORATION +cuerpo I-EXPLORATION +cavernoso I-EXPLORATION +izquierdo, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +afectación I-EXPLORATION +ganglionar. I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +recomendó I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +que I-TREATMENT +no I-TREATMENT +llegó I-TREATMENT +a I-TREATMENT +recibir. I-TREATMENT + I-TREATMENT +Revisada I-TREATMENT +su I-TREATMENT +historia I-TREATMENT +clínica I-TREATMENT +en I-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +Urgencias I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +el I-TREATMENT +ingreso. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +tratamiento I-TREATMENT +sintomático, I-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +hemoderivados, I-TREATMENT +tomografía I-TREATMENT +axial I-TREATMENT +computerizada I-TREATMENT +de I-TREATMENT +abdomen I-TREATMENT +(TAC) I-TREATMENT +para I-TREATMENT +re-estadificación I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +de I-TREATMENT +segunda I-TREATMENT +línea I-TREATMENT +mediante I-TREATMENT +vinflunina I-TREATMENT +bitartrato I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +(280 I-TREATMENT +mg/m2) I-TREATMENT +dosis I-TREATMENT +única. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +edema I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +erección I-EVOLUTION +desaparecieron I-EVOLUTION +y I-EVOLUTION +recibió I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +tras I-EVOLUTION +cinco I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +ingreso. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +lumbar I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +brusca I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +progresó I-PRESENT_ILLNESS +rápidamente I-PRESENT_ILLNESS +hacia I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +paraplejia I-PRESENT_ILLNESS +completa. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacaban I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +penicilina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +clasificada I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +idiopática, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +siete I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enalapril-hidroclorotiazida I-PAST_MEDICAL_HISTORY +(20-12.5mg/24h). I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refirió I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +súbito, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +llegó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +despertar I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +noche. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +irradiaba I-PRESENT_ILLNESS +hacia I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dificultaba I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +negaba I-PRESENT_ILLNESS +antecedente I-PRESENT_ILLNESS +traumático I-PRESENT_ILLNESS +alguno. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +un I-EXPLORATION +balance I-EXPLORATION +motor I-EXPLORATION +de I-EXPLORATION +3/5 I-EXPLORATION +en I-EXPLORATION +psoas I-EXPLORATION +y I-EXPLORATION +cuádriceps I-EXPLORATION +con I-EXPLORATION +0/5 I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +flexo-extensión I-EXPLORATION +plantar. I-EXPLORATION +Igualmente I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +anestesia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +hipoestesia I-EXPLORATION +termoalgésica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +izquierda I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +anestesia I-EXPLORATION +perineal, I-EXPLORATION +globo I-EXPLORATION +vesical I-EXPLORATION +e I-EXPLORATION +incontinencia I-EXPLORATION +fecal. I-EXPLORATION +El I-EXPLORATION +balance I-EXPLORATION +motor I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +superiores I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +5/5. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +fiebre I-EXPLORATION +o I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +meníngea. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +urgente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +lumbar, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +alteración I-EXPLORATION +alguna. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RMN) I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +lumbar I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +intradural I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +del I-EXPLORATION +saco I-EXPLORATION +dural I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +L2-L3-L4 I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +satélite I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +sacro. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +radiológica I-TREATMENT +inicial I-TREATMENT +de I-TREATMENT +ependimoma I-TREATMENT +se I-TREATMENT +intervino I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +practicando I-TREATMENT +una I-TREATMENT +laminectomía I-TREATMENT +y I-TREATMENT +fijación I-TREATMENT +pedicular I-TREATMENT +L2-L3-L4. I-TREATMENT +Al I-TREATMENT +proceder I-TREATMENT +a I-TREATMENT +la I-TREATMENT +apertura I-TREATMENT +dural I-TREATMENT +observamos I-TREATMENT +una I-TREATMENT +tumoración I-TREATMENT +de I-TREATMENT +color I-TREATMENT +rojo I-TREATMENT +violáceo, I-TREATMENT +encapsulada, I-TREATMENT +que I-TREATMENT +desplazaba I-TREATMENT +las I-TREATMENT +raíces I-TREATMENT +nerviosas I-TREATMENT +lateralmente. I-TREATMENT +Mediante I-TREATMENT +microcirugía I-TREATMENT +se I-TREATMENT +disecó I-TREATMENT +con I-TREATMENT +facilidad I-TREATMENT +el I-TREATMENT +tumor I-TREATMENT +de I-TREATMENT +las I-TREATMENT +raíces I-TREATMENT +adyacentes I-TREATMENT +y I-TREATMENT +se I-TREATMENT +extirpó I-TREATMENT +en I-TREATMENT +su I-TREATMENT +totalidad I-TREATMENT +en I-TREATMENT +una I-TREATMENT +única I-TREATMENT +pieza. I-TREATMENT +La I-TREATMENT +lesión I-TREATMENT +se I-TREATMENT +encontraba I-TREATMENT +adherida I-TREATMENT +únicamente I-TREATMENT +al I-TREATMENT +filum I-TREATMENT +terminal. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +transcurrió I-EVOLUTION +sin I-EVOLUTION +complicaciones, I-EVOLUTION +experimentando I-EVOLUTION +una I-EVOLUTION +progresiva I-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +motora I-EVOLUTION +e I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +esfínteres. I-EVOLUTION +Ante I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +anatomopatológico I-EVOLUTION +de I-EVOLUTION +paraganglioma, I-EVOLUTION +se I-EVOLUTION +solicitaron I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +catecolaminas I-EVOLUTION +en I-EVOLUTION +sangre I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +orina, I-EVOLUTION +resultando I-EVOLUTION +todos I-EVOLUTION +ellos I-EVOLUTION +normales. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +centro I-EVOLUTION +rehabilitador I-EVOLUTION +para I-EVOLUTION +completar I-EVOLUTION +su I-EVOLUTION +recuperación. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +estudiado B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alteración I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ritmo I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rectorragias, I-PRESENT_ILLNESS +que B-EXPLORATION +tras I-EXPLORATION +endoscopia I-EXPLORATION +y I-EXPLORATION +biopsia I-EXPLORATION +es I-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +recto, I-EXPLORATION +bien I-EXPLORATION +diferenciado, I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado, I-EXPLORATION +con I-EXPLORATION +diferenciación I-EXPLORATION +mucinosa I-EXPLORATION +en I-EXPLORATION +menos I-EXPLORATION +del I-EXPLORATION +50%, I-EXPLORATION +con I-EXPLORATION +estadiaje I-EXPLORATION +clínico-radiológico I-EXPLORATION +(tomografía I-EXPLORATION +computerizada I-EXPLORATION +y I-EXPLORATION +resonancia I-EXPLORATION +magnética) I-EXPLORATION +T3 I-EXPLORATION +N2M0. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +inicialmente I-TREATMENT +con I-TREATMENT +radioquimioterapia I-TREATMENT +neoadyuvante; I-TREATMENT +radioterapia I-TREATMENT +en I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +ciclo I-TREATMENT +largo I-TREATMENT +con I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +de I-TREATMENT +50, I-TREATMENT +4 I-TREATMENT +Gy I-TREATMENT +durante I-TREATMENT +5 I-TREATMENT +semanas, I-TREATMENT +y I-TREATMENT +capecitabina I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +a I-TREATMENT +razón I-TREATMENT +de I-TREATMENT +825 I-TREATMENT +mg/m2/12h I-TREATMENT +(1650 I-TREATMENT +mg/12h), I-TREATMENT +cada I-TREATMENT +15 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Ocho I-TREATMENT +semanas I-TREATMENT +después I-TREATMENT +de I-TREATMENT +finalizar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +fue I-TREATMENT +intervenido I-TREATMENT +quirúrgicamente I-TREATMENT +realizándose I-TREATMENT +una I-TREATMENT +amputación I-TREATMENT +abdominoperineal I-TREATMENT +extendida. I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +mucinoso I-EXPLORATION +de I-EXPLORATION +recto, I-EXPLORATION +a I-EXPLORATION +4, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +margen I-EXPLORATION +anal, I-EXPLORATION +cuya I-EXPLORATION +infiltración I-EXPLORATION +sobrepasaba I-EXPLORATION +2 I-EXPLORATION +mm I-EXPLORATION +la I-EXPLORATION +muscular I-EXPLORATION +propia, I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +quirúrgicos I-EXPLORATION +proximal I-EXPLORATION +y I-EXPLORATION +distal I-EXPLORATION +sin I-EXPLORATION +tumor, I-EXPLORATION +y I-EXPLORATION +margen I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +circular I-EXPLORATION +a I-EXPLORATION +20 I-EXPLORATION +mm I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +2 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +metastatizada, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +ganglios I-EXPLORATION +positivos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +10 I-EXPLORATION +disecados. I-EXPLORATION +La I-EXPLORATION +escisión I-EXPLORATION +mesorrectal I-EXPLORATION +(en I-EXPLORATION +el I-EXPLORATION +plano I-EXPLORATION +del I-EXPLORATION +mesorrecto) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +canal I-EXPLORATION +anal I-EXPLORATION +(en I-EXPLORATION +el I-EXPLORATION +plano I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +elevadores) I-EXPLORATION +fueron I-EXPLORATION +satisfactorias I-EXPLORATION +(ypT3bN1). I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +postoperatorio I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +cursó I-EVOLUTION +sin I-EVOLUTION +complicaciones, I-EVOLUTION +y B-TREATMENT +posteriormente I-TREATMENT +recibió I-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +capecitabina I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +a I-TREATMENT +razón I-TREATMENT +de I-TREATMENT +2.000 I-TREATMENT +mg/12h I-TREATMENT +cada I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +controlado I-EVOLUTION +por I-EVOLUTION +los I-EVOLUTION +servicios I-EVOLUTION +de I-EVOLUTION +Oncología I-EVOLUTION +y I-EVOLUTION +Cirugía I-EVOLUTION +General, I-EVOLUTION +con I-EVOLUTION +TC, I-EVOLUTION +colonoscopia I-EVOLUTION +y I-EVOLUTION +marcadores I-EVOLUTION +tumorales I-EVOLUTION +normales I-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION +En I-EVOLUTION +su I-EVOLUTION +revisión I-EVOLUTION +rutinaria I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +nódulos I-EVOLUTION +subcutáneos I-EVOLUTION +faciales I-EVOLUTION +en I-EVOLUTION +zona I-EVOLUTION +frontal, I-EVOLUTION +en I-EVOLUTION +axila I-EVOLUTION +izquierda, I-EVOLUTION +pectoral I-EVOLUTION +derecho, I-EVOLUTION +flanco I-EVOLUTION +izquierdo I-EVOLUTION +y I-EVOLUTION +extremidades I-EVOLUTION +inferiores. I-EVOLUTION +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +corrobora I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +nódulos I-EXPLORATION +subcutáneos I-EXPLORATION +de I-EXPLORATION +entre I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +y I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +localizaciones I-EXPLORATION +descritas, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +y I-EXPLORATION +rodaderos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +TC I-EXPLORATION +tóracoabdominal I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +hepático I-EXPLORATION +y I-EXPLORATION +pulmonar, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +lesiones I-EXPLORATION +subcutáneas I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +pectoral I-EXPLORATION +derecha I-EXPLORATION +área I-EXPLORATION +axilar I-EXPLORATION +izquierda, I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +anterior, I-EXPLORATION +flanco I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +áreas I-EXPLORATION +glúteas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +exéresis-biopsia I-EXPLORATION +de I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +nódulos I-EXPLORATION +subcutáneos I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +pectoral I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +subcutánea I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +bien I-EXPLORATION +diferenciado I-EXPLORATION +de I-EXPLORATION +recto. I-EXPLORATION +Ante B-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +tumoral I-EVOLUTION +diseminada I-EVOLUTION +se I-EVOLUTION +valoró I-EVOLUTION +nuevamente I-EVOLUTION +tratamiento I-EVOLUTION +quimioterápico I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +llegó I-EVOLUTION +a I-EVOLUTION +recibir I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +rápido I-EVOLUTION +deterioro I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +que I-EVOLUTION +le I-EVOLUTION +llevó I-EVOLUTION +al I-EVOLUTION +exitus. I-EVOLUTION + I-EVOLUTION + +Secundigesta B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Colombia, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +mórbida I-PAST_MEDICAL_HISTORY +(IMC I-PAST_MEDICAL_HISTORY +43) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cólicos I-PAST_MEDICAL_HISTORY +biliares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +30+ I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gestación I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +generalizado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +pseudogripal I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +febrícula, I-PRESENT_ILLNESS +artromialgias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +rascado I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +urticariformes I-EXPLORATION +y I-EXPLORATION +febrícula I-EXPLORATION +de I-EXPLORATION +37oC. I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +el I-EXPLORATION +bienestar I-EXPLORATION +fetal I-EXPLORATION +mediante I-EXPLORATION +ecografía I-EXPLORATION +obstétrica I-EXPLORATION +(feto I-EXPLORATION +en I-EXPLORATION +cefálica I-EXPLORATION +dorso I-EXPLORATION +anterior, I-EXPLORATION +placenta I-EXPLORATION +posterior I-EXPLORATION +normoinserta, I-EXPLORATION +y I-EXPLORATION +líquido I-EXPLORATION +amniótico I-EXPLORATION +normal) I-EXPLORATION +y I-EXPLORATION +registro I-EXPLORATION +cardiotocográfico I-EXPLORATION +(patrón I-EXPLORATION +reactivo, I-EXPLORATION +adinamia). I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +hemograma I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +alteraciones I-EXPLORATION +significativas, I-EXPLORATION +excepto I-EXPLORATION +anemia I-EXPLORATION +moderada I-EXPLORATION +(Hb I-EXPLORATION +10 I-EXPLORATION +g/dl), I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +transaminasas I-EXPLORATION +(AST I-EXPLORATION +y I-EXPLORATION +ALT I-EXPLORATION +208 I-EXPLORATION +y I-EXPLORATION +238 I-EXPLORATION +U/L) I-EXPLORATION +y I-EXPLORATION +ácidos I-EXPLORATION +biliares I-EXPLORATION +56, I-EXPLORATION +9 I-EXPLORATION +µmol/L. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +el I-TREATMENT +ingreso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +por I-TREATMENT +colestasis I-TREATMENT +gravídica I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ácido I-TREATMENT +ursodesoxicólico I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +13 I-TREATMENT +mg/kg/día, I-TREATMENT +loratadina I-TREATMENT +10 I-TREATMENT +mg/ I-TREATMENT +24h I-TREATMENT +y I-TREATMENT +colestiramina I-TREATMENT +3 I-TREATMENT +gr/ I-TREATMENT +8h. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +de I-EVOLUTION +hasta I-EVOLUTION +38, I-EVOLUTION +6 I-EVOLUTION +oC, I-EVOLUTION +tos I-EVOLUTION +no I-EVOLUTION +productiva, I-EVOLUTION +disnea I-EVOLUTION +y I-EVOLUTION +otalgia, I-EVOLUTION +siendo I-EVOLUTION +la I-EVOLUTION +auscultación I-EVOLUTION +broncopulmonar I-EVOLUTION +normal I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +saturación I-EVOLUTION +de I-EVOLUTION +98%. I-EVOLUTION +Se B-TREATMENT +solicitó I-TREATMENT +radiografía I-TREATMENT +de I-TREATMENT +tórax, I-TREATMENT +hemocultivos I-TREATMENT +y I-TREATMENT +frotis I-TREATMENT +nasofaríngeo I-TREATMENT +(PCR I-TREATMENT +gripe) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +ampicilina I-TREATMENT +2g/4h, I-TREATMENT +gentamicina I-TREATMENT +240 I-TREATMENT +mg/24h I-TREATMENT +y I-TREATMENT +oseltamivir I-TREATMENT +75 I-TREATMENT +mg. I-TREATMENT +Al B-EXPLORATION +mismo I-EXPLORATION +tiempo, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +colelitiasis/colecistitis I-EXPLORATION +dada I-EXPLORATION +la I-EXPLORATION +frecuente I-EXPLORATION +asociación I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +procesos I-EXPLORATION +con I-EXPLORATION +colestasis, I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +en I-EXPLORATION +mujeres I-EXPLORATION +obesas I-EXPLORATION +y I-EXPLORATION +multíparas, I-EXPLORATION +condiciones I-EXPLORATION +que I-EXPLORATION +cumplía I-EXPLORATION +la I-EXPLORATION +paciente. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +evolución I-EXPLORATION +analítica I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +cólicos I-EXPLORATION +biliares, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +ecografía I-EXPLORATION +que, I-EXPLORATION +en I-EXPLORATION +esta I-EXPLORATION +ocasión, I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +colelitiasis. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +frotis I-EXPLORATION +nasofaríngeo I-EXPLORATION +para I-EXPLORATION +gripe I-EXPLORATION +resultó I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemocultivo I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +Listeria I-EXPLORATION +monocytogenes I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +ampicilina, I-EXPLORATION +gentamicina I-EXPLORATION +y I-EXPLORATION +penicilina I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +oseltamivir I-TREATMENT +y I-TREATMENT +se I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +pautado. I-TREATMENT +Así I-TREATMENT +mismo, I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +preparados I-TREATMENT +orales I-TREATMENT +de I-TREATMENT +hierro. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +tórpida I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +colestasis I-EVOLUTION +con I-EVOLUTION +descenso I-EVOLUTION +parcial I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +transaminasas I-EVOLUTION +y I-EVOLUTION +episodios I-EVOLUTION +aislados I-EVOLUTION +de I-EVOLUTION +prurito I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +del I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION +Las I-EVOLUTION +determinaciones I-EVOLUTION +analíticas I-EVOLUTION +sucesivas I-EVOLUTION +evidenciaron I-EVOLUTION +modificaciones I-EVOLUTION +con I-EVOLUTION +elevaciones I-EVOLUTION +y I-EVOLUTION +descensos I-EVOLUTION +de I-EVOLUTION +transaminasas I-EVOLUTION +y I-EVOLUTION +ácidos I-EVOLUTION +biliares, I-EVOLUTION +tal I-EVOLUTION +y I-EVOLUTION +como I-EVOLUTION +se I-EVOLUTION +recoge I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +tabla I-EVOLUTION +1. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +listeriosis I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable, I-EVOLUTION +permaneciendo I-EVOLUTION +apirética I-EVOLUTION +y I-EVOLUTION +evidenciándose I-EVOLUTION +el I-EVOLUTION +descenso I-EVOLUTION +paulatino I-EVOLUTION +de I-EVOLUTION +PCR I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +antibiótico. I-EVOLUTION + I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +bienestar I-EXPLORATION +fetal I-EXPLORATION +seriado I-EXPLORATION +mediante I-EXPLORATION +ecografía I-EXPLORATION +obstétrica I-EXPLORATION +y I-EXPLORATION +registro I-EXPLORATION +cardiotocográfico I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +semana I-EXPLORATION +32+ I-EXPLORATION +4, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +espontánea I-EXPLORATION +el I-EXPLORATION +trabajo I-EXPLORATION +de I-EXPLORATION +parto I-EXPLORATION +tras I-EXPLORATION +completar I-EXPLORATION +14 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +ampicilina I-EXPLORATION +y I-EXPLORATION +7 I-EXPLORATION +días I-EXPLORATION +con I-EXPLORATION +gentamicina, I-EXPLORATION +ambas I-EXPLORATION +por I-EXPLORATION +vía I-EXPLORATION +endovenosa. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +comprobó I-EXPLORATION +bienestar I-EXPLORATION +fetal I-EXPLORATION +intraparto I-EXPLORATION +mediante I-EXPLORATION +monitorización I-EXPLORATION +maternofetal, I-EXPLORATION +objetivando I-EXPLORATION +líquido I-EXPLORATION +amniótico I-EXPLORATION +meconial. I-EXPLORATION +El B-EVOLUTION +parto I-EVOLUTION +fue I-EVOLUTION +eutócico, I-EVOLUTION +obteniendo I-EVOLUTION +una I-EVOLUTION +niña I-EVOLUTION +de I-EVOLUTION +2.225 I-EVOLUTION +g I-EVOLUTION +de I-EVOLUTION +peso, I-EVOLUTION +test I-EVOLUTION +de I-EVOLUTION +Apgar I-EVOLUTION +9/10 I-EVOLUTION +y I-EVOLUTION +pH I-EVOLUTION +de I-EVOLUTION +cordón I-EVOLUTION +7, I-EVOLUTION +36 I-EVOLUTION +arterial I-EVOLUTION +y I-EVOLUTION +7, I-EVOLUTION +37 I-EVOLUTION +venoso. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +RN I-EVOLUTION +ingresó I-EVOLUTION +en I-EVOLUTION +neonatología I-EVOLUTION +por I-EVOLUTION +prematuridad I-EVOLUTION +y I-EVOLUTION +antecedente I-EVOLUTION +de I-EVOLUTION +listeriosis I-EVOLUTION +materna. I-EVOLUTION +Los B-EXPLORATION +cultivos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizaron I-EXPLORATION +(frotis I-EXPLORATION +faríngeo, I-EXPLORATION +vermis, I-EXPLORATION +umbilical, I-EXPLORATION +hemocultivo, I-EXPLORATION +urocultivo I-EXPLORATION +y I-EXPLORATION +coprocultivo) I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +siendo I-EXPLORATION +dada I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +10 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +vida. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +puerperal I-EVOLUTION +fue I-EVOLUTION +normal I-EVOLUTION +con I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +parto. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +examen I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +placenta I-EXPLORATION +evidenció I-EXPLORATION +múltiples I-EXPLORATION +infartos I-EXPLORATION +«sépticos» I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +aisladas I-EXPLORATION +formaciones I-EXPLORATION +bacilares I-EXPLORATION +Gram I-EXPLORATION +positivas, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +Listeria. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Marruecos, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +reside I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +España I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +intermitente I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +motivos I-PAST_MEDICAL_HISTORY +laborales. I-PAST_MEDICAL_HISTORY +Fue B-PRESENT_ILLNESS +trasladado I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +país I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +ingresado I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +suboclusivo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +respondió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +médico. I-PRESENT_ILLNESS +En B-TREATMENT +el I-TREATMENT +informe I-TREATMENT +que I-TREATMENT +aportó I-TREATMENT +constaba I-TREATMENT +que I-TREATMENT +se I-TREATMENT +le I-TREATMENT +practicó I-TREATMENT +enterolisis I-TREATMENT +después I-TREATMENT +de I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +ayuno I-TREATMENT +terapéutico I-TREATMENT +sin I-TREATMENT +observarse I-TREATMENT +mejoría. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +presentó I-EVOLUTION +retraso I-EVOLUTION +del I-EVOLUTION +vaciado I-EVOLUTION +gástrico I-EVOLUTION +e I-EVOLUTION +íleo I-EVOLUTION +prolongado, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +tuvo I-EVOLUTION +que I-EVOLUTION +ser I-EVOLUTION +reintervenido. I-EVOLUTION +Se B-TREATMENT +le I-TREATMENT +hizo I-TREATMENT +una I-TREATMENT +colectomía I-TREATMENT +derecha I-TREATMENT +ampliada, I-TREATMENT +anastomosis I-TREATMENT +gastroyeyunal, I-TREATMENT +ileostomía I-TREATMENT +lateral I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +colostomía I-TREATMENT +lateral I-TREATMENT +izquierda. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +constaba I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +14 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +íleon I-EXPLORATION +y I-EXPLORATION +140 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +extirparon, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +unas I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +retráctiles I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +muy I-EXPLORATION +dilatadas, I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +inflamadas I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +con I-EXPLORATION +extensa I-EXPLORATION +necrosis, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +peritonítica I-EXPLORATION +extensa I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +adherencias, I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +encontraron I-EXPLORATION +lesiones I-EXPLORATION +específicas. I-EXPLORATION +Después B-TREATMENT +de I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +ayuno I-TREATMENT +total I-TREATMENT +con I-TREATMENT +fluidoterapia I-TREATMENT +iv I-TREATMENT +por I-TREATMENT +intolerancia I-TREATMENT +a I-TREATMENT +la I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +(NE), I-TREATMENT +y B-EVOLUTION +habiendo I-EVOLUTION +perdido I-EVOLUTION +más I-EVOLUTION +de I-EVOLUTION +25 I-EVOLUTION +kilos I-EVOLUTION +de I-EVOLUTION +peso, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +solicitó I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +voluntaria I-EVOLUTION +para I-EVOLUTION +trasladarse I-EVOLUTION +a I-EVOLUTION +España. I-EVOLUTION + I-EVOLUTION +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuadros I-PAST_MEDICAL_HISTORY +suboclusivos I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +resueltos I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +intervenciones I-PAST_MEDICAL_HISTORY +quirúrgicas: I-PAST_MEDICAL_HISTORY +laparoscopia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +resección I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vólvulo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +13 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +resección I-PAST_MEDICAL_HISTORY +duodenal I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +gastroenteroanastomosis I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +29 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +drenaje I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +absceso I-PAST_MEDICAL_HISTORY +perihepático I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +afectación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pared I-PAST_MEDICAL_HISTORY +intercostal I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +probable I-PAST_MEDICAL_HISTORY +perforación I-PAST_MEDICAL_HISTORY +duodenal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +etiología I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +filiada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Entre B-FAMILY_HISTORY +los I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +destacaba I-FAMILY_HISTORY +un I-FAMILY_HISTORY +hermano I-FAMILY_HISTORY +fallecido I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +39 I-FAMILY_HISTORY +años I-FAMILY_HISTORY +en I-FAMILY_HISTORY +una I-FAMILY_HISTORY +cirugía I-FAMILY_HISTORY +abdominal I-FAMILY_HISTORY +urgente I-FAMILY_HISTORY +(supuestamente I-FAMILY_HISTORY +por I-FAMILY_HISTORY +cáncer I-FAMILY_HISTORY +de I-FAMILY_HISTORY +colon I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +ser I-FAMILY_HISTORY +documentado I-FAMILY_HISTORY +por I-FAMILY_HISTORY +autopsia) I-FAMILY_HISTORY +e I-FAMILY_HISTORY +hijo I-FAMILY_HISTORY +de I-FAMILY_HISTORY +8 I-FAMILY_HISTORY +años I-FAMILY_HISTORY +con I-FAMILY_HISTORY +cuadros I-FAMILY_HISTORY +suboclusivos I-FAMILY_HISTORY +similares I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +que I-FAMILY_HISTORY +presenta I-FAMILY_HISTORY +el I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +desde I-FAMILY_HISTORY +su I-FAMILY_HISTORY +infancia. I-FAMILY_HISTORY + I-FAMILY_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presentaba I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +desnutrición I-EXPLORATION +severa I-EXPLORATION +y I-EXPLORATION +anasarca, I-EXPLORATION +y I-EXPLORATION +edemas I-EXPLORATION +con I-EXPLORATION +fóvea I-EXPLORATION +hasta I-EXPLORATION +rodillas. I-EXPLORATION +Abdomen I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible I-EXPLORATION +con I-EXPLORATION +molestias I-EXPLORATION +difusas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +y I-EXPLORATION +peristaltismo I-EXPLORATION +ausente. I-EXPLORATION +No I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal. I-EXPLORATION +Dos I-EXPLORATION +estomas I-EXPLORATION +sin I-EXPLORATION +contenido I-EXPLORATION +en I-EXPLORATION +línea I-EXPLORATION +de I-EXPLORATION +laparatomía I-EXPLORATION +media. I-EXPLORATION +Peso I-EXPLORATION +58, I-EXPLORATION +6 I-EXPLORATION +Kg I-EXPLORATION +(IMC I-EXPLORATION +16, I-EXPLORATION +2 I-EXPLORATION +Kg/m2). I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +salvo I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +analíticos. I-EXPLORATION + I-EXPLORATION +Fue I-EXPLORATION +ingresado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +Cirugía; I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +colocó I-EXPLORATION +una I-EXPLORATION +sonda I-EXPLORATION +de I-EXPLORATION +aspiración, I-EXPLORATION +se I-EXPLORATION +pautó I-EXPLORATION +antieméticos I-EXPLORATION +y I-EXPLORATION +procinéticos, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +comenzó I-EXPLORATION +a I-EXPLORATION +renutrir I-EXPLORATION +progresivamente I-EXPLORATION +con I-EXPLORATION +nutrición I-EXPLORATION +parenteral I-EXPLORATION +total I-EXPLORATION +(NPT). I-EXPLORATION +Se B-EVOLUTION +mantuvo I-EVOLUTION +la I-EVOLUTION +NPT I-EVOLUTION +durante I-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +hasta I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +pasó I-EVOLUTION +a I-EVOLUTION +NE I-EVOLUTION +continua, I-EVOLUTION +y I-EVOLUTION +finalmente, I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +retirar I-EVOLUTION +la I-EVOLUTION +sonda I-EVOLUTION +de I-EVOLUTION +aspiración I-EVOLUTION +e I-EVOLUTION +introducir I-EVOLUTION +nutrición I-EVOLUTION +oral I-EVOLUTION +con I-EVOLUTION +ayuda I-EVOLUTION +de I-EVOLUTION +procinéticos I-EVOLUTION +y I-EVOLUTION +medidas I-EVOLUTION +higiénico-dietéticas I-EVOLUTION +favorecedoras I-EVOLUTION +del I-EVOLUTION +peristaltismo. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +14 I-EVOLUTION +semanas I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +peso I-EVOLUTION +de I-EVOLUTION +79 I-EVOLUTION +Kg I-EVOLUTION +(IMC I-EVOLUTION +21, I-EVOLUTION +9 I-EVOLUTION +Kg/m2). I-EVOLUTION + I-EVOLUTION +Tres I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +ingresar I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +Cirugía I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +deshidratación I-EVOLUTION +hiponatrémica I-EVOLUTION +severa I-EVOLUTION +debido I-EVOLUTION +al I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +débito I-EVOLUTION +por I-EVOLUTION +ileostomía I-EVOLUTION +de I-EVOLUTION +unos I-EVOLUTION +3-4 I-EVOLUTION +litros/día I-EVOLUTION +e I-EVOLUTION +intolerancia I-EVOLUTION +oral I-EVOLUTION +de I-EVOLUTION +varios I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución; I-EVOLUTION +episodio I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +relacionado I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +suboclusivo I-EVOLUTION +según I-EVOLUTION +los I-EVOLUTION +resultados I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +pruebas I-EVOLUTION +complementarias I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +hicieron. I-EVOLUTION +Se I-EVOLUTION +le I-EVOLUTION +corrigieron I-EVOLUTION +las I-EVOLUTION +alteraciones I-EVOLUTION +hidroelectolíticas I-EVOLUTION +que I-EVOLUTION +presentaba, I-EVOLUTION +y I-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +intolerancia I-EVOLUTION +oral, I-EVOLUTION +se I-EVOLUTION +comenzó I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +la I-EVOLUTION +NPT I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +siguientes. I-EVOLUTION + I-EVOLUTION +En B-TREATMENT +el I-TREATMENT +cuarto I-TREATMENT +mes I-TREATMENT +del I-TREATMENT +segundo I-TREATMENT +ingreso, I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +enterolisis I-TREATMENT +de I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +paquete I-TREATMENT +intestinal, I-TREATMENT +se I-TREATMENT +desmontó I-TREATMENT +la I-TREATMENT +gastroenteroanastomosis I-TREATMENT +previa, I-TREATMENT +se I-TREATMENT +resecó I-TREATMENT +el I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +a I-TREATMENT +unos I-TREATMENT +40-50 I-TREATMENT +cm I-TREATMENT +del I-TREATMENT +ángulo I-TREATMENT +de I-TREATMENT +Treiz I-TREATMENT +y I-TREATMENT +se I-TREATMENT +extirparon I-TREATMENT +80 I-TREATMENT +y I-TREATMENT +130 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +íleon I-TREATMENT +de I-TREATMENT +sendos I-TREATMENT +extremos, I-TREATMENT +se I-TREATMENT +liberó I-TREATMENT +el I-TREATMENT +colon I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +anastomosis I-TREATMENT +íleo-cólica I-TREATMENT +latero-lateral I-TREATMENT +mecánica. I-TREATMENT +Dos I-TREATMENT +meses I-TREATMENT +después, I-TREATMENT +tuvo I-TREATMENT +que I-TREATMENT +ser I-TREATMENT +reintervenido I-TREATMENT +por I-TREATMENT +mal I-TREATMENT +paso I-TREATMENT +en I-TREATMENT +anastomosis, I-TREATMENT +se I-TREATMENT +resecó I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +anastomótica I-TREATMENT +anterior I-TREATMENT +con I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +íleon I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +anastomosis I-TREATMENT +íleo-cólica I-TREATMENT +termino-lateral I-TREATMENT +manual. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +boca I-EXPLORATION +de I-EXPLORATION +ileostomía I-EXPLORATION +y I-EXPLORATION +colostomía I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +hiperganglionosis I-EXPLORATION +en I-EXPLORATION +plexos I-EXPLORATION +parasimpáticos, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +ganglios I-EXPLORATION +inmaduros I-EXPLORATION +bcl2+ I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +intraepiteliales, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +intersticiales I-EXPLORATION +de I-EXPLORATION +Cajal, I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +DNIB. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +malabsorción I-EVOLUTION +y I-EVOLUTION +esteatorrea I-EVOLUTION +crónica I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +intervenciones I-EVOLUTION +previas, I-EVOLUTION +se I-EVOLUTION +pautaron I-EVOLUTION +medidas I-EVOLUTION +dietéticas I-EVOLUTION +y I-EVOLUTION +enzimas I-EVOLUTION +pancreáticos I-EVOLUTION +en I-EVOLUTION +cada I-EVOLUTION +ingesta, I-EVOLUTION +junto I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +antidiarreico I-EVOLUTION +y I-EVOLUTION +resíncolestiramina I-EVOLUTION +a I-EVOLUTION +demanda. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +revisión I-EVOLUTION +con I-EVOLUTION +excelente I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +hace I-EVOLUTION +vida I-EVOLUTION +normal, I-EVOLUTION +sigue I-EVOLUTION +los I-EVOLUTION +consejos I-EVOLUTION +dietéticos I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +indicaron, I-EVOLUTION +hace I-EVOLUTION +2-3 I-EVOLUTION +deposiciones I-EVOLUTION +diarias I-EVOLUTION +no I-EVOLUTION +esteatorreicas, I-EVOLUTION +toma I-EVOLUTION +4-6 I-EVOLUTION +comprimidos I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +suplementos I-EVOLUTION +enzimáticos I-EVOLUTION +(Kreon®10000) I-EVOLUTION +y I-EVOLUTION +su I-EVOLUTION +peso I-EVOLUTION +es I-EVOLUTION +90, I-EVOLUTION +5 I-EVOLUTION +kilos I-EVOLUTION +(IMC I-EVOLUTION +25, I-EVOLUTION +1 I-EVOLUTION +Kg/m2). I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +vascular I-PAST_MEDICAL_HISTORY +(hipertensión I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dislipemia). I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destacaban: I-PAST_MEDICAL_HISTORY +diverticulosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colon I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +adenomatosos I-PAST_MEDICAL_HISTORY +tubulares. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +amígdalas, I-PAST_MEDICAL_HISTORY +apéndice I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +eventración I-PAST_MEDICAL_HISTORY +abdominal. I-PAST_MEDICAL_HISTORY +Como B-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +destacaba I-FAMILY_HISTORY +su I-FAMILY_HISTORY +hija I-FAMILY_HISTORY +fallecida I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +52 I-FAMILY_HISTORY +años I-FAMILY_HISTORY +de I-FAMILY_HISTORY +cáncer I-FAMILY_HISTORY +gástrico. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Acudió B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +persistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hemiabdomen I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +periumbilical I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +predominio I-PRESENT_ILLNESS +postprandial, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nauseas I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +ritmo I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tendencia I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +estreñimiento I-PRESENT_ILLNESS +exacerbado I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +dicho I-PRESENT_ILLNESS +periodo. I-PRESENT_ILLNESS +Presentaba I-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +ponderal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7kg. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Estaba B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con: I-PAST_MEDICAL_HISTORY +artilog I-PAST_MEDICAL_HISTORY +200 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +0-1-0, I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +1-0-0, I-PAST_MEDICAL_HISTORY +nerdipina I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +1-0-1, I-PAST_MEDICAL_HISTORY +pantoprazol I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +1-0-0, I-PAST_MEDICAL_HISTORY +simvastatina I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +0-0-1, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +venlafaxina I-PAST_MEDICAL_HISTORY +75 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +0-0-1. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presentaba: I-EXPLORATION +tensión I-EXPLORATION +arterial: I-EXPLORATION +120/80; I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca: I-EXPLORATION +81 I-EXPLORATION +latidos/min. I-EXPLORATION +Afebril. I-EXPLORATION +Regular I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +Bien I-EXPLORATION +hidratada I-EXPLORATION +y I-EXPLORATION +ligera I-EXPLORATION +palidez I-EXPLORATION +mucocutánea. I-EXPLORATION +Nódulo I-EXPLORATION +supraclavicular I-EXPLORATION +izquierdo, I-EXPLORATION +duro I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +móvil, I-EXPLORATION +no I-EXPLORATION +doloroso. I-EXPLORATION +Auscultación I-EXPLORATION +cardiaca I-EXPLORATION +normal. I-EXPLORATION +Auscultación I-EXPLORATION +pulmonar I-EXPLORATION +sin I-EXPLORATION +hallazgos. I-EXPLORATION +Abdomen I-EXPLORATION +blando, I-EXPLORATION +depresible, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +superior I-EXPLORATION +y I-EXPLORATION +periumbilical, I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +ni I-EXPLORATION +megalias, I-EXPLORATION +peristaltismo I-EXPLORATION +disminuido. I-EXPLORATION +Extremidades I-EXPLORATION +inferiores I-EXPLORATION +sin I-EXPLORATION +edemas I-EXPLORATION +ni I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +venosa I-EXPLORATION +profunda. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +exploraciones I-EXPLORATION +complementarias: I-EXPLORATION +radiología I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +nódulo I-EXPLORATION +pulmonar I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +LSD. I-EXPLORATION +ECG: I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +a I-EXPLORATION +86 I-EXPLORATION +latidos/min. I-EXPLORATION +Analítica I-EXPLORATION +de I-EXPLORATION +sangre: I-EXPLORATION +anemia I-EXPLORATION +microcítica I-EXPLORATION +(Hb: I-EXPLORATION +10 I-EXPLORATION +g/dl I-EXPLORATION +(11,9-16,5), I-EXPLORATION +VCM: I-EXPLORATION +77, I-EXPLORATION +4 I-EXPLORATION +(80,2-99,4). I-EXPLORATION +Leucocitosis I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(20.000 I-EXPLORATION +leucocitos/ml I-EXPLORATION +(3,5-10,5) I-EXPLORATION +con I-EXPLORATION +84% I-EXPLORATION +de I-EXPLORATION +neutrófilos I-EXPLORATION +(37-73). I-EXPLORATION +VSG I-EXPLORATION +67 I-EXPLORATION +mm/h I-EXPLORATION +(2-10). I-EXPLORATION +PCR I-EXPLORATION +150 I-EXPLORATION +mg/l I-EXPLORATION +(0-10). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +analítico I-EXPLORATION +con I-EXPLORATION +perfil I-EXPLORATION +férrico I-EXPLORATION +completo: I-EXPLORATION +hierro I-EXPLORATION +sérico I-EXPLORATION +14 I-EXPLORATION +µg/dl I-EXPLORATION +(37-145 I-EXPLORATION +µg/dl), I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +transferrina I-EXPLORATION +15% I-EXPLORATION +(20-50%) I-EXPLORATION +y I-EXPLORATION +ferritina I-EXPLORATION +463 I-EXPLORATION +ng/ml I-EXPLORATION +(valores<30ng/ml I-EXPLORATION +implica I-EXPLORATION +ferropenia). I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +determinó I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario I-EXPLORATION +(CEA) I-EXPLORATION +pensando I-EXPLORATION +en I-EXPLORATION +neoplasias I-EXPLORATION +malignas I-EXPLORATION +gastrointestinales I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +anti-transglutaminasa I-EXPLORATION +siendo I-EXPLORATION +sus I-EXPLORATION +valores I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +del I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +requería I-EXPLORATION +de I-EXPLORATION +opiáceos I-EXPLORATION +intravenosos I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +adenopatías I-EXPLORATION +mesentéricas I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +patológico, I-EXPLORATION +completándose I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +tomografia I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +abdomino-pélvica. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +dicha I-EXPLORATION +TAC I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +mural I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +4, I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +acompañaba I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +adenopatías I-EXPLORATION +mesentéricas I-EXPLORATION +con I-EXPLORATION +centro I-EXPLORATION +hipodenso. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +enteroscopia I-EXPLORATION +anterógrada I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +ángulo I-EXPLORATION +de I-EXPLORATION +Treitz, I-EXPLORATION +formación I-EXPLORATION +polipoidea I-EXPLORATION +con I-EXPLORATION +ulceración I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +15 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +biopsias. I-EXPLORATION +Se I-EXPLORATION +introdujo I-EXPLORATION +el I-EXPLORATION +endoscopio I-EXPLORATION +hasta I-EXPLORATION +yeyuno I-EXPLORATION +proximal I-EXPLORATION +(50-60 I-EXPLORATION +cm I-EXPLORATION +distales I-EXPLORATION +a I-EXPLORATION +píloro) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +neoformación I-EXPLORATION +ulcerada, I-EXPLORATION +rígida I-EXPLORATION +y I-EXPLORATION +friable, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +mitad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +circunferencia, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +impidió I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio. I-EXPLORATION +A I-EXPLORATION +unos I-EXPLORATION +30 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +píloro I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +otra I-EXPLORATION +zona I-EXPLORATION +ulcerada, I-EXPLORATION +rígida, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +2 I-EXPLORATION +cms I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +biopsió I-EXPLORATION +(C).. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +histológico I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +yeyunales I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +pobremente I-EXPLORATION +diferenciado. I-EXPLORATION +Tanto I-EXPLORATION +la I-EXPLORATION +morfología I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +inmunofenotipo I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes I-EXPLORATION +de I-EXPLORATION +pulmón. I-EXPLORATION + I-EXPLORATION +Inmunofenotipo: I-EXPLORATION +citoqueratinas I-EXPLORATION +AE1-AE3: I-EXPLORATION +(+); I-EXPLORATION +S100, I-EXPLORATION +HMB I-EXPLORATION +45: I-EXPLORATION +(-); I-EXPLORATION +citoqueratina I-EXPLORATION +20: I-EXPLORATION +(-), I-EXPLORATION +citoqueratina I-EXPLORATION +7: I-EXPLORATION +(+); I-EXPLORATION +TTF1: I-EXPLORATION +(-); I-EXPLORATION +napsina: I-EXPLORATION +(-); I-EXPLORATION +vimentina: I-EXPLORATION +(+); I-EXPLORATION +p63: I-EXPLORATION +(+); I-EXPLORATION +cd10: I-EXPLORATION +(-); I-EXPLORATION +WT1: I-EXPLORATION +(-) I-EXPLORATION +; I-EXPLORATION +GCDFP I-EXPLORATION +15: I-EXPLORATION +(-); I-EXPLORATION +citoqueratina I-EXPLORATION +19: I-EXPLORATION +(+); I-EXPLORATION +citoqueratina I-EXPLORATION +5-6: I-EXPLORATION +(-), I-EXPLORATION +citoqueratina I-EXPLORATION +34 I-EXPLORATION +beta I-EXPLORATION +12; I-EXPLORATION +CDX2: I-EXPLORATION +(-). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +torácico I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +pulmonar I-EXPLORATION +sólido I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +espiculado I-EXPLORATION +en I-EXPLORATION +apex I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +contacto I-EXPLORATION +pleural; I-EXPLORATION +adenopatías I-EXPLORATION +mediastínicas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +compartimento I-EXPLORATION +paratraqueal I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +pretraqueales, I-EXPLORATION +hiliares I-EXPLORATION +derechas I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bifurcación I-EXPLORATION +bronquial. I-EXPLORATION +Adenopatías I-EXPLORATION +supraclaviculares I-EXPLORATION +bilaterales. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +edad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +el I-TREATMENT +estadio I-TREATMENT +avanzado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +y I-TREATMENT +la I-TREATMENT +presentación I-TREATMENT +un I-TREATMENT +ECOG I-TREATMENT +3 I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +paliativo, I-TREATMENT +falleciendo I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +a I-TREATMENT +los I-TREATMENT +22 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +su I-TREATMENT +alta I-TREATMENT +hospitalaria. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +incapacitante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +calma I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +analgésicos. I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +traumático. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cartílagos I-EXPLORATION +costales I-EXPLORATION +es I-EXPLORATION +dolorosa, I-EXPLORATION +refiriendo I-EXPLORATION +como I-EXPLORATION +punto I-EXPLORATION +más I-EXPLORATION +doloroso I-EXPLORATION +la I-EXPLORATION +7a I-EXPLORATION +unión I-EXPLORATION +costoesternal I-EXPLORATION +derecha, I-EXPLORATION +sin I-EXPLORATION +apreciarse I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contorno I-EXPLORATION +ni I-EXPLORATION +signos I-EXPLORATION +inflamatorios I-EXPLORATION +cutáneos. I-EXPLORATION +La I-EXPLORATION +maniobra I-EXPLORATION +del I-EXPLORATION +gancho, I-EXPLORATION +que I-EXPLORATION +consiste I-EXPLORATION +en I-EXPLORATION +producir I-EXPLORATION +una I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cartílagos I-EXPLORATION +costales I-EXPLORATION +inferiores I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +introducción I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dedos I-EXPLORATION +del I-EXPLORATION +explorador I-EXPLORATION +por I-EXPLORATION +debajo I-EXPLORATION +del I-EXPLORATION +último I-EXPLORATION +arco I-EXPLORATION +costal I-EXPLORATION +y I-EXPLORATION +traccionando I-EXPLORATION +de I-EXPLORATION +él I-EXPLORATION +en I-EXPLORATION +sentido I-EXPLORATION +craneal, I-EXPLORATION +es I-EXPLORATION +muy I-EXPLORATION +dolorosa. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +exploración I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +exploración I-TREATMENT +tan I-TREATMENT +característica, I-TREATMENT +se I-TREATMENT +pensó I-TREATMENT +en I-TREATMENT +el I-TREATMENT +SCD I-TREATMENT +y I-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +conservador I-TREATMENT +con I-TREATMENT +antiinflamatorios I-TREATMENT +orales. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +sin I-TREATMENT +mejoría, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +propuso I-TREATMENT +bloqueo I-TREATMENT +anestésico I-TREATMENT +intercostal I-TREATMENT +o I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +definitivo. I-TREATMENT +Dado I-TREATMENT +que I-TREATMENT +el I-TREATMENT +dolor I-TREATMENT +de I-TREATMENT +la I-TREATMENT +niña I-TREATMENT +cada I-TREATMENT +vez I-TREATMENT +es I-TREATMENT +más I-TREATMENT +limitante I-TREATMENT +y I-TREATMENT +que I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +opción I-TREATMENT +aportaría I-TREATMENT +un I-TREATMENT +alivio I-TREATMENT +temporal, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica. I-TREATMENT +Al I-TREATMENT +año I-TREATMENT +del I-TREATMENT +diagnóstico, I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +y I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +transversa I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +cm I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +arco I-TREATMENT +costal I-TREATMENT +afectado, I-TREATMENT +extirpamos I-TREATMENT +el I-TREATMENT +7o, I-TREATMENT +8o I-TREATMENT +y I-TREATMENT +9o I-TREATMENT +cartílagos I-TREATMENT +costales, I-TREATMENT +preservando I-TREATMENT +el I-TREATMENT +pericondrio. I-TREATMENT + I-TREATMENT +Transcurrido B-EVOLUTION +un I-EVOLUTION +año, I-EVOLUTION +el I-EVOLUTION +resultado I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +satisfactorio. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +81 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +(por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +anticoagulante) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +próstata I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +libre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +precordial I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mínimos I-PRESENT_ILLNESS +esfuerzos. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +la I-EXPLORATION +sintomatología I-EXPLORATION +había I-EXPLORATION +disminuido. I-EXPLORATION +Inicialmente I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +síndrome I-EXPLORATION +coronario I-EXPLORATION +agudo I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +tratamiento I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +enzimas I-EXPLORATION +de I-EXPLORATION +daño I-EXPLORATION +miocárdico I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +electrocardiograma I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +presentaban I-EXPLORATION +anomalías. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +refería I-EXPLORATION +astenia I-EXPLORATION +y I-EXPLORATION +molestias I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +evolución, I-EXPLORATION +pero I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +dolor I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +era I-EXPLORATION +anodina I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +tras I-EXPLORATION +ser I-EXPLORATION +valorado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +Cardiología I-EXPLORATION +se I-EXPLORATION +dio I-EXPLORATION +de I-EXPLORATION +alta. I-EXPLORATION + I-EXPLORATION +Seis B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +acudió I-EVOLUTION +al I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +Urgencias I-EVOLUTION +por I-EVOLUTION +persistencia I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +derecho I-EVOLUTION +acompañado I-EVOLUTION +de I-EVOLUTION +naúseas I-EVOLUTION +e I-EVOLUTION +hiporexia. I-EVOLUTION +No B-EXPLORATION +presentaba I-EXPLORATION +fiebre I-EXPLORATION +ni I-EXPLORATION +otra I-EXPLORATION +clínica I-EXPLORATION +acompañante. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +distendido, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +y I-EXPLORATION +flanco I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +defensa I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +Blumberg I-EXPLORATION +y I-EXPLORATION +Murphy I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +32, I-EXPLORATION +6%, I-EXPLORATION +leucocitos I-EXPLORATION +14.000 I-EXPLORATION +con I-EXPLORATION +74% I-EXPLORATION +de I-EXPLORATION +neutrófilos, I-EXPLORATION +INR I-EXPLORATION +2, I-EXPLORATION +95 I-EXPLORATION +y I-EXPLORATION +fibrinógeno I-EXPLORATION +816 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +con I-EXPLORATION +paredes I-EXPLORATION +mal I-EXPLORATION +definidas I-EXPLORATION +y I-EXPLORATION +colelitiasis, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +hipoecoica I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +perivesicular I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +interpretó I-EXPLORATION +como I-EXPLORATION +colecistitis I-EXPLORATION +aguda I-EXPLORATION +perforada I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +completar I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC). I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +vesícula I-EXPLORATION +con I-EXPLORATION +paredes I-EXPLORATION +mal I-EXPLORATION +definidas I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +7x3 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +alteraba I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +circundante I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +colecistitis I-EXPLORATION +aguda I-EXPLORATION +perforada. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +estable I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +planta I-EXPLORATION +de I-EXPLORATION +Cirugía I-EXPLORATION +para I-EXPLORATION +tratamiento I-EXPLORATION +conservador. I-EXPLORATION +Se B-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +analgésico I-TREATMENT +y I-TREATMENT +antibiótico I-TREATMENT +(Piperacilina-Tazobactan). I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +continuaba I-EVOLUTION +con I-EVOLUTION +molestias I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +derecho I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +análisis I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +persistía I-EVOLUTION +la I-EVOLUTION +leucocitosis I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +realizar I-EVOLUTION +una I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +prueba I-EVOLUTION +de I-EVOLUTION +imagen I-EVOLUTION +se I-EVOLUTION +confirmó I-EVOLUTION +la I-EVOLUTION +mala I-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +proceso I-EVOLUTION +con I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +líquido I-EVOLUTION +libre I-EVOLUTION +intraabdominal. I-EVOLUTION +Con B-TREATMENT +estos I-TREATMENT +hallazgos I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +urgente. I-TREATMENT + I-TREATMENT +Fue I-TREATMENT +intervenido I-TREATMENT +mediante I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +subcostal I-TREATMENT +derecha I-TREATMENT +por I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +accedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +peritoneal. I-TREATMENT +Se I-TREATMENT +localizó I-TREATMENT +un I-TREATMENT +plastrón I-TREATMENT +de I-TREATMENT +epiplón I-TREATMENT +que I-TREATMENT +cubría I-TREATMENT +la I-TREATMENT +vesícula, I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +tumoral, I-TREATMENT +con I-TREATMENT +sufusión I-TREATMENT +hemorrágica I-TREATMENT +en I-TREATMENT +espacio I-TREATMENT +subfrénico I-TREATMENT +y I-TREATMENT +perirrenal, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +un I-TREATMENT +hemoperitoneo I-TREATMENT +de I-TREATMENT +2, I-TREATMENT +7 I-TREATMENT +litros I-TREATMENT +sin I-TREATMENT +apreciarse I-TREATMENT +punto I-TREATMENT +de I-TREATMENT +hemorragia. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +colecistectomía I-TREATMENT +subtotal I-TREATMENT +por I-TREATMENT +invasión I-TREATMENT +tumoral I-TREATMENT +del I-TREATMENT +parénquima I-TREATMENT +hepático I-TREATMENT +y I-TREATMENT +se I-TREATMENT +extirpó I-TREATMENT +la I-TREATMENT +mayor I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +epiplón I-TREATMENT +quedando I-TREATMENT +residuo I-TREATMENT +tumoral I-TREATMENT +macroscópico. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +6o I-EVOLUTION +día I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +del I-EVOLUTION +alta, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +reingresó I-EVOLUTION +por I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +derecho I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +astenia I-EVOLUTION +y I-EVOLUTION +anorexia. I-EVOLUTION +En B-EXPLORATION +los I-EXPLORATION +análisis I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +5 I-EXPLORATION +g/dL, I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +22, I-EXPLORATION +7% I-EXPLORATION +y I-EXPLORATION +32.500 I-EXPLORATION +leucocitos I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +izquierda. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +mesogastrio I-EXPLORATION +e I-EXPLORATION +hipocondrio I-EXPLORATION +derecho. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +4x4 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lecho I-EXPLORATION +quirúrgico. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +estableció I-TREATMENT +tratamiento I-TREATMENT +sintomático I-TREATMENT +pero I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +presentó I-TREATMENT +un I-TREATMENT +deterioro I-TREATMENT +progresivo I-TREATMENT +durante I-TREATMENT +los I-TREATMENT +días I-TREATMENT +siguientes I-TREATMENT +marcado I-TREATMENT +por I-TREATMENT +disnea, I-TREATMENT +dolor I-TREATMENT +abdominal I-TREATMENT +en I-TREATMENT +aumento, I-TREATMENT +melenas I-TREATMENT +y I-TREATMENT +una I-TREATMENT +anemización I-TREATMENT +progresiva I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +hipotensión I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +transfusiones I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +finalmente I-TREATMENT +falleció I-TREATMENT +a I-TREATMENT +los I-TREATMENT +20 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +ser I-TREATMENT +intervenido. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +remitidas I-EXPLORATION +a I-EXPLORATION +anatomía I-EXPLORATION +patológica. I-EXPLORATION +En I-EXPLORATION +ellas I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +áreas I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +en I-EXPLORATION +células I-EXPLORATION +entremezclado I-EXPLORATION +con I-EXPLORATION +focos I-EXPLORATION +hemorrágicos I-EXPLORATION +y I-EXPLORATION +zonas I-EXPLORATION +en I-EXPLORATION +donde I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +se I-EXPLORATION +disponen I-EXPLORATION +formando I-EXPLORATION +canales I-EXPLORATION +vasculares. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +análisis I-EXPLORATION +inmunohistoquímico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +queratina I-EXPLORATION +7 I-EXPLORATION +positivo I-EXPLORATION +intenso, I-EXPLORATION +D2.40, I-EXPLORATION +CD-31 I-EXPLORATION +y I-EXPLORATION +vimentina I-EXPLORATION +intensamente I-EXPLORATION +positivo. I-EXPLORATION +Todo I-EXPLORATION +ello I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +angiosarcoma I-EXPLORATION +epitelioide I-EXPLORATION +primario I-EXPLORATION +de I-EXPLORATION +vesícula I-EXPLORATION +biliar. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +rectorragia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +mes I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +cólico I-PAST_MEDICAL_HISTORY +recidivante. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +alteraciones I-PAST_MEDICAL_HISTORY +analíticas I-PAST_MEDICAL_HISTORY +relevantes. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +distendido, I-EXPLORATION +timpanizado, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +peritonismo. I-EXPLORATION +El I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +mostró I-EXPLORATION +restos I-EXPLORATION +hemáticos. I-EXPLORATION +La I-EXPLORATION +colonoscopia I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +friable I-EXPLORATION +y I-EXPLORATION +violácea, I-EXPLORATION +en I-EXPLORATION +válvula I-EXPLORATION +ileocecal, I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +rotación I-EXPLORATION +o I-EXPLORATION +invaginación. I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +invaginación I-EXPLORATION +ileo-cólica I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +con I-EXPLORATION +sus I-EXPLORATION +paredes I-EXPLORATION +engrosadas I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +obstrucción I-EXPLORATION +intestinal. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +quirúrgico, I-TREATMENT +objetivando I-TREATMENT +la I-TREATMENT +invaginación I-TREATMENT +ileocecal I-TREATMENT +y I-TREATMENT +un I-TREATMENT +pequeño I-TREATMENT +deserosamiento I-TREATMENT +de I-TREATMENT +ciego. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +ampliada I-TREATMENT +de I-TREATMENT +ciego I-TREATMENT +con I-TREATMENT +anastomosis I-TREATMENT +ileocólica I-TREATMENT +mecánica. I-TREATMENT +El B-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +invaginación I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +polipoide I-EXPLORATION +formada I-EXPLORATION +por I-EXPLORATION +adipocitos I-EXPLORATION +maduros I-EXPLORATION +sin I-EXPLORATION +lipoblastos, I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +invaginada. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +postoperatoria. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ulcus I-PAST_MEDICAL_HISTORY +bulbar I-PAST_MEDICAL_HISTORY +(Helicobacter I-PAST_MEDICAL_HISTORY +pylori I-PAST_MEDICAL_HISTORY +positivo, I-PAST_MEDICAL_HISTORY +erradicada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2005), I-PAST_MEDICAL_HISTORY +tromboembolismo I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2012 I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +inguinal I-PAST_MEDICAL_HISTORY +derecha. I-PAST_MEDICAL_HISTORY +Fumador, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +acumulado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +paquetes/año. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inestabilidad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +lateropulsión I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +bradipsiquia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +disnomia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +craneal I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +en I-EXPLORATION +hemisferio I-EXPLORATION +cerebeloso I-EXPLORATION +derecho. I-EXPLORATION +Tras I-EXPLORATION +completar I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +toraco-abdominal, I-EXPLORATION +RM I-EXPLORATION +craneal, I-EXPLORATION +broncoscopia I-EXPLORATION +y I-EXPLORATION +PET I-EXPLORATION +fue I-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cerebral I-EXPLORATION +sugestiva I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +posible I-EXPLORATION +neoplasia I-EXPLORATION +pulmonar I-EXPLORATION +localizada. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +metastasectomía I-TREATMENT +cerebral I-TREATMENT +diagnóstico-terapéutica. I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +microcítico I-EXPLORATION +de I-EXPLORATION +pulmón. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +CPCP I-EXPLORATION +T1N0M1b, I-EXPLORATION +estadio I-EXPLORATION +IV. I-EXPLORATION +Se B-TREATMENT +administró I-TREATMENT +tratamiento I-TREATMENT +adyuvante I-TREATMENT +con I-TREATMENT +radioterapia I-TREATMENT +holocraneal I-TREATMENT +hasta I-TREATMENT +alcanzar I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +de I-TREATMENT +37.5 I-TREATMENT +Gys I-TREATMENT +que I-TREATMENT +finalizó I-TREATMENT +en I-TREATMENT +julio I-TREATMENT +de I-TREATMENT +2011 I-TREATMENT +tras I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +cisplatino I-TREATMENT +-VP16. I-TREATMENT + I-TREATMENT +Precisó I-TREATMENT +cambio I-TREATMENT +a I-TREATMENT +carboplatino I-TREATMENT +por I-TREATMENT +emesis I-TREATMENT +e I-TREATMENT +insuficiencia I-TREATMENT +renal I-TREATMENT +recibiendo I-TREATMENT +en I-TREATMENT +total I-TREATMENT +4 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +mala I-TREATMENT +tolerancia I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +hematológica I-TREATMENT +finalizando I-TREATMENT +en I-TREATMENT +octubre I-TREATMENT +de I-TREATMENT +2011. I-TREATMENT +Posteriormente, I-TREATMENT +en I-TREATMENT +diciembre I-TREATMENT +de I-TREATMENT +2011, I-TREATMENT +recibió I-TREATMENT +radioterapia I-TREATMENT +torácica I-TREATMENT +de I-TREATMENT +consolidación, I-TREATMENT +45 I-TREATMENT +Gys I-TREATMENT +en I-TREATMENT +15 I-TREATMENT +fracciones I-TREATMENT +siguiendo I-TREATMENT +las I-TREATMENT +recomendaciones I-TREATMENT +RTOG I-TREATMENT +09372, I-TREATMENT +consiguiendo I-TREATMENT +mantener I-TREATMENT +la I-TREATMENT +estabilidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +en I-TREATMENT +los I-TREATMENT +siguientes I-TREATMENT +controles. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +julio I-EVOLUTION +de I-EVOLUTION +2012 I-EVOLUTION +ingresó I-EVOLUTION +procedente I-EVOLUTION +del I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +Urgencias I-EVOLUTION +por I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +fuerza I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +inferior I-EVOLUTION +izquierda I-EVOLUTION +de I-EVOLUTION +varios I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución. I-EVOLUTION +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +RM I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +metástasis I-EXPLORATION +leptomeníngeas I-EXPLORATION +con I-EXPLORATION +implante I-EXPLORATION +dorsal I-EXPLORATION +(D2-D3) I-EXPLORATION +que I-EXPLORATION +provocaba I-EXPLORATION +una I-EXPLORATION +compresión I-EXPLORATION +medular I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +radioterapia I-TREATMENT +sobre I-TREATMENT +niveles I-TREATMENT +D1-D4 I-TREATMENT +administrándose I-TREATMENT +20 I-TREATMENT +Gy I-TREATMENT +en I-TREATMENT +5 I-TREATMENT +fracciones I-TREATMENT +con I-TREATMENT +excelente I-TREATMENT +respuesta I-TREATMENT +clínica. I-TREATMENT + I-TREATMENT +Asimismo B-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +toracoabdominal I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +adenopatía I-EXPLORATION +hiliar I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +nueva I-EXPLORATION +aparición I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +carboplatino-etopósido, I-TREATMENT +con I-TREATMENT +respuesta I-TREATMENT +parcial I-TREATMENT +tras I-TREATMENT +3 I-TREATMENT +ciclos I-TREATMENT +y I-TREATMENT +estabilización I-TREATMENT +tras I-TREATMENT +el I-TREATMENT +6o I-TREATMENT +ciclo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +en I-TREATMENT +diciembre I-TREATMENT +de I-TREATMENT +2012. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +en I-EXPLORATION +junio I-EXPLORATION +de I-EXPLORATION +2013 I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +captación I-EXPLORATION +puntiformes I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +diseminación I-EXPLORATION +leptomeníngea I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +del I-EXPLORATION +raquis, I-EXPLORATION +tanto I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +dorsal I-EXPLORATION +como I-EXPLORATION +lumbar, I-EXPLORATION +encontrándose I-EXPLORATION +los I-EXPLORATION +implantes I-EXPLORATION +más I-EXPLORATION +destacables I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +lumbar I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +planificó I-EXPLORATION +RT I-EXPLORATION +a I-EXPLORATION +ese I-EXPLORATION +nivel I-EXPLORATION +(L1-L5). I-EXPLORATION +Se B-TREATMENT +administraron I-TREATMENT +20 I-TREATMENT +Gys I-TREATMENT +en I-TREATMENT +5 I-TREATMENT +fracciones I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +junio I-TREATMENT +de I-TREATMENT +2013. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mediante I-EXPLORATION +TAC I-EXPLORATION +toracoabdominal I-EXPLORATION +en I-EXPLORATION +junio I-EXPLORATION +de I-EXPLORATION +ese I-EXPLORATION +año I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +adenopatía I-EXPLORATION +hiliar I-EXPLORATION +derecha I-EXPLORATION +había I-EXPLORATION +aumentado I-EXPLORATION +ligeramente I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +TAC I-EXPLORATION +previo I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +administrar I-TREATMENT +radioterapia I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +hiliar I-TREATMENT +con I-TREATMENT +un I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +Gy I-TREATMENT +en I-TREATMENT +15 I-TREATMENT +fracciones, I-TREATMENT +finalizando I-TREATMENT +tratamiento I-TREATMENT +en I-TREATMENT +noviembre I-TREATMENT +2013. I-TREATMENT + I-TREATMENT +Desde B-EVOLUTION +entonces I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +revisiones, I-EVOLUTION +con I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +vida I-EVOLUTION +activa I-EVOLUTION +e I-EVOLUTION +independiente I-EVOLUTION +para I-EVOLUTION +las I-EVOLUTION +actividades I-EVOLUTION +básicas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +vida I-EVOLUTION +diaria. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +estudios I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +no I-EVOLUTION +hay I-EVOLUTION +datos I-EVOLUTION +de I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION +No B-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +realces I-EXPLORATION +patológicos I-EXPLORATION +leptomeníngeos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +última I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +comprobado I-EXPLORATION +por I-EXPLORATION +TAC I-EXPLORATION +la I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +adenopatía I-EXPLORATION +hiliar I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +estos I-EXPLORATION +momentos I-EXPLORATION +es I-EXPLORATION +infracentimétrica. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +varón, I-PRESENT_ILLNESS +fruto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +gestación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +El B-EXPLORATION +embarazo I-EXPLORATION +había I-EXPLORATION +transcurrido I-EXPLORATION +sin I-EXPLORATION +incidencias, I-EXPLORATION +con I-EXPLORATION +cribado I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +trimestre I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +riesgo. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +serológicos I-EXPLORATION +habituales I-EXPLORATION +estaban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +antenatal I-EXPLORATION +se I-EXPLORATION +detecta I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +37 I-EXPLORATION +semanas I-EXPLORATION +de I-EXPLORATION +edad I-EXPLORATION +gestacional I-EXPLORATION +la I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +lateral I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +anomalías I-EXPLORATION +morfológicas I-EXPLORATION +a I-EXPLORATION +destacar. I-EXPLORATION + I-EXPLORATION +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +nació I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +39+3 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +gestacional, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +vaginal I-PAST_MEDICAL_HISTORY +instrumentado. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +presentación I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +cefálica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +puntuación I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +test I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +9-9-10. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +parto I-EXPLORATION +mostraba I-EXPLORATION +buen I-EXPLORATION +tono I-EXPLORATION +y I-EXPLORATION +vitalidad; I-EXPLORATION +fontanela I-EXPLORATION +anterior I-EXPLORATION +normotensa, I-EXPLORATION +sin I-EXPLORATION +anomalías I-EXPLORATION +morfológicas I-EXPLORATION +a I-EXPLORATION +destacar I-EXPLORATION +ni I-EXPLORATION +disrafismos. I-EXPLORATION +Reflejos I-EXPLORATION +arcaicos I-EXPLORATION +presentes. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +analíticos, I-EXPLORATION +serológicos, I-EXPLORATION +el I-EXPLORATION +cribado I-EXPLORATION +de I-EXPLORATION +metabolopatías I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +sordera I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +normal I-EXPLORATION +El I-EXPLORATION +ecocardiograma I-EXPLORATION +demostró I-EXPLORATION +comunicación I-EXPLORATION +interauricular I-EXPLORATION +sin I-EXPLORATION +repercusión I-EXPLORATION +hemodinámica. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +transfontanelar I-EXPLORATION +demostró I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +lateral I-EXPLORATION +derecho, I-EXPLORATION +en I-EXPLORATION +probable I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +obstrucción I-EXPLORATION +del I-EXPLORATION +foramen I-EXPLORATION +de I-EXPLORATION +Monro I-EXPLORATION +derecho. I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +momento I-EXPLORATION +el I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +resistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pericallosa I-EXPLORATION +se I-EXPLORATION +situaba I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad, I-EXPLORATION +sin I-EXPLORATION +aumentar I-EXPLORATION +tras I-EXPLORATION +ejercer I-EXPLORATION +presión I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fontanela I-EXPLORATION +anterior. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +semana I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +nacimiento I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +cerebral I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +dilatación I-EXPLORATION +ventricular I-EXPLORATION +con I-EXPLORATION +calibre I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +mm I-EXPLORATION +del I-EXPLORATION +asta I-EXPLORATION +frontal, I-EXPLORATION +32 I-EXPLORATION +mm I-EXPLORATION +del I-EXPLORATION +asta I-EXPLORATION +occipital I-EXPLORATION +y I-EXPLORATION +14 I-EXPLORATION +mm I-EXPLORATION +del I-EXPLORATION +asta I-EXPLORATION +temporal. I-EXPLORATION +Se I-EXPLORATION +asociaba I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +desplazamiento I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media, I-EXPLORATION +sin I-EXPLORATION +observarse I-EXPLORATION +masas I-EXPLORATION +ni I-EXPLORATION +tabiques I-EXPLORATION +intraventriculares. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +ventricular I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +hipertensión I-EXPLORATION +intracraneal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +seguimiento I-EXPLORATION +inicial I-EXPLORATION +clínico I-EXPLORATION +y I-EXPLORATION +radiológico I-EXPLORATION +mediante I-EXPLORATION +ecografías I-EXPLORATION +seriadas. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +las I-EXPLORATION +10 I-EXPLORATION +semanas I-EXPLORATION +de I-EXPLORATION +edad, I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +transfontanelar I-EXPLORATION +demostró I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +dilatación I-EXPLORATION +(asta I-EXPLORATION +frontal I-EXPLORATION +11 I-EXPLORATION +mm, I-EXPLORATION +occipital I-EXPLORATION +27 I-EXPLORATION +mm I-EXPLORATION +y I-EXPLORATION +temporal I-EXPLORATION +19 I-EXPLORATION +mm), I-EXPLORATION +desplazamiento I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +resistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pericallosa I-EXPLORATION +incrementado, I-EXPLORATION +aumentando I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +significativa I-EXPLORATION +tras I-EXPLORATION +presión I-EXPLORATION +ligera I-EXPLORATION +sobre I-EXPLORATION +fontanela I-EXPLORATION +anterior, I-EXPLORATION +hallazgo I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +hidrocefalia I-EXPLORATION +a I-EXPLORATION +tensión. I-EXPLORATION +Ante B-TREATMENT +estos I-TREATMENT +hallazgos, I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +presentaba I-TREATMENT +perímetro I-TREATMENT +cefálico I-TREATMENT +normal I-TREATMENT +y I-TREATMENT +exploración I-TREATMENT +clínica I-TREATMENT +normal, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hidrocefalia. I-TREATMENT + I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +intervenido I-TREATMENT +a I-TREATMENT +los I-TREATMENT +3 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +edad. I-TREATMENT +Se I-TREATMENT +empleó I-TREATMENT +un I-TREATMENT +ventriculoscopio I-TREATMENT +rígido I-TREATMENT +a I-TREATMENT +0o I-TREATMENT +(Kart I-TREATMENT +Storz I-TREATMENT +®, I-TREATMENT +Tuttlingen, I-TREATMENT +Alemania). I-TREATMENT +Bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +en I-TREATMENT +decúbito I-TREATMENT +supino, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +cabeza I-TREATMENT +neutra I-TREATMENT +elevada I-TREATMENT +unos I-TREATMENT +20o. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +agujero I-TREATMENT +de I-TREATMENT +trépano I-TREATMENT +derecho, I-TREATMENT +justo I-TREATMENT +anterior I-TREATMENT +a I-TREATMENT +la I-TREATMENT +sutura I-TREATMENT +coronal I-TREATMENT +y I-TREATMENT +3 I-TREATMENT +cm I-TREATMENT +lateral I-TREATMENT +a I-TREATMENT +la I-TREATMENT +línea I-TREATMENT +media. I-TREATMENT +El I-TREATMENT +acceso I-TREATMENT +al I-TREATMENT +ventrículo I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +siguiendo I-TREATMENT +las I-TREATMENT +referencias I-TREATMENT +anatómicas I-TREATMENT +habituales, I-TREATMENT +dirigiendo I-TREATMENT +el I-TREATMENT +endoscopio I-TREATMENT +hacia I-TREATMENT +el I-TREATMENT +canto I-TREATMENT +interno I-TREATMENT +del I-TREATMENT +ojo I-TREATMENT +ipsilateral I-TREATMENT +en I-TREATMENT +el I-TREATMENT +plano I-TREATMENT +coronal I-TREATMENT +y I-TREATMENT +hacia I-TREATMENT +el I-TREATMENT +conducto I-TREATMENT +auditivo I-TREATMENT +externo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +plano I-TREATMENT +sagital. I-TREATMENT +Tras I-TREATMENT +acceder I-TREATMENT +al I-TREATMENT +asta I-TREATMENT +frontal I-TREATMENT +derecha, I-TREATMENT +se I-TREATMENT +identificó I-TREATMENT +la I-TREATMENT +anatomía I-TREATMENT +ventricular I-TREATMENT +y I-TREATMENT +se I-TREATMENT +localizó I-TREATMENT +la I-TREATMENT +ubicación I-TREATMENT +teórica I-TREATMENT +del I-TREATMENT +foramen I-TREATMENT +de I-TREATMENT +Monro I-TREATMENT +siguiendo I-TREATMENT +las I-TREATMENT +venas I-TREATMENT +talamoestriada I-TREATMENT +y I-TREATMENT +septal I-TREATMENT +anterior I-TREATMENT +y I-TREATMENT +el I-TREATMENT +plexo I-TREATMENT +coroideo. I-TREATMENT +Se I-TREATMENT +identificó I-TREATMENT +una I-TREATMENT +membrana I-TREATMENT +avascular I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +intuía I-TREATMENT +por I-TREATMENT +transparencia I-TREATMENT +el I-TREATMENT +foramen I-TREATMENT +de I-TREATMENT +Monro. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +coagulación I-TREATMENT +y I-TREATMENT +posterior I-TREATMENT +apertura I-TREATMENT +de I-TREATMENT +esta I-TREATMENT +membrana I-TREATMENT +empleando I-TREATMENT +la I-TREATMENT +punta I-TREATMENT +bipolar I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +dilató I-TREATMENT +con I-TREATMENT +un I-TREATMENT +balón I-TREATMENT +de I-TREATMENT +Fogarty I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +French. I-TREATMENT +A I-TREATMENT +través I-TREATMENT +del I-TREATMENT +nuevo I-TREATMENT +foramen I-TREATMENT +creado, I-TREATMENT +se I-TREATMENT +introdujo I-TREATMENT +el I-TREATMENT +endoscopio I-TREATMENT +hasta I-TREATMENT +visualizar I-TREATMENT +el I-TREATMENT +tercer I-TREATMENT +ventrículo. I-TREATMENT +Tras I-TREATMENT +crear I-TREATMENT +una I-TREATMENT +adecuada I-TREATMENT +comunicación I-TREATMENT +del I-TREATMENT +asta I-TREATMENT +frontal I-TREATMENT +derecha I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tercer I-TREATMENT +ventrículo, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +fenestración I-TREATMENT +en I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +anterior I-TREATMENT +del I-TREATMENT +septo I-TREATMENT +pellucidum, I-TREATMENT +para I-TREATMENT +asegurar I-TREATMENT +otra I-TREATMENT +vía I-TREATMENT +de I-TREATMENT +comunicación I-TREATMENT +entre I-TREATMENT +las I-TREATMENT +astas I-TREATMENT +frontales I-TREATMENT +de I-TREATMENT +los I-TREATMENT +ventrículos I-TREATMENT +laterales. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +cursó I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +perímetro I-EVOLUTION +craneal I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +exploración I-EVOLUTION +física I-EVOLUTION +y I-EVOLUTION +neurológica I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +fueron I-EVOLUTION +normales. I-EVOLUTION +Las I-EVOLUTION +ecografias I-EVOLUTION +transfontanelares I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +mostraron I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +dilatación I-EVOLUTION +del I-EVOLUTION +ventrículo I-EVOLUTION +lateral I-EVOLUTION +derecho, I-EVOLUTION +con I-EVOLUTION +índice I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +arteria I-EVOLUTION +pericallosa I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad. I-EVOLUTION +La I-EVOLUTION +RM I-EVOLUTION +realizada I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +9 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +edad I-EVOLUTION +confirmó I-EVOLUTION +estos I-EVOLUTION +hallazgos I-EVOLUTION +de I-EVOLUTION +ecografía. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +ingresado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cuidados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Intensivos I-PRESENT_ILLNESS +(UCI) I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +situación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +daño I-PRESENT_ILLNESS +cerebral I-PRESENT_ILLNESS +catastrófico I-PRESENT_ILLNESS +secundario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +cerebrovascular I-PRESENT_ILLNESS +isquémico I-PRESENT_ILLNESS +establecido I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +territorio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +arteria I-PRESENT_ILLNESS +cerebral I-PRESENT_ILLNESS +media I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +transformación I-PRESENT_ILLNESS +hemorrágica. I-PRESENT_ILLNESS +Tras B-EXPLORATION +cuatro I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +UCI I-EXPLORATION +y I-EXPLORATION +ante I-EXPLORATION +el I-EXPLORATION +infausto I-EXPLORATION +pronóstico I-EXPLORATION +neurológico, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +aplicar I-EXPLORATION +LTSV I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +consensuada I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +de I-EXPLORATION +UCI I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +familia. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +establecida I-EXPLORATION +la I-EXPLORATION +LTSV, I-EXPLORATION +y I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +pudiera I-EXPLORATION +ser I-EXPLORATION +donante I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +en I-EXPLORATION +asistolia I-EXPLORATION +controlada, I-EXPLORATION +el I-EXPLORATION +coordinador I-EXPLORATION +de I-EXPLORATION +trasplantes I-EXPLORATION +se I-EXPLORATION +entrevistó I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +familiares I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +su I-EXPLORATION +deseo I-EXPLORATION +de I-EXPLORATION +donación I-EXPLORATION +y I-EXPLORATION +firmaron I-EXPLORATION +el I-EXPLORATION +consiguiente I-EXPLORATION +consentimiento I-EXPLORATION +informado I-EXPLORATION +(que I-EXPLORATION +incluye I-EXPLORATION +canulación I-EXPLORATION +y I-EXPLORATION +heparinización I-EXPLORATION +premortem). I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +clínicas I-EXPLORATION +y I-EXPLORATION +analíticas I-EXPLORATION +necesarias, I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +canulación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +femorales I-EXPLORATION +derechas I-EXPLORATION +(necesarias I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +NECMO), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +femoral I-EXPLORATION +contralateral I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +colocación I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +catéter I-EXPLORATION +de I-EXPLORATION +oclusión I-EXPLORATION +aórtico I-EXPLORATION +tipo I-EXPLORATION +Fogarty. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +confirmada I-EXPLORATION +la I-EXPLORATION +adecuada I-EXPLORATION +colocación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cánulas I-EXPLORATION +de I-EXPLORATION +NECMO I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +catéter I-EXPLORATION +Fogarty, I-EXPLORATION +el I-EXPLORATION +enfermo I-EXPLORATION +fue I-EXPLORATION +trasladado I-EXPLORATION +a I-EXPLORATION +quirófano I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +LTSV I-EXPLORATION +acordada. I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +retirada I-EXPLORATION +de I-EXPLORATION +soporte I-EXPLORATION +vital I-EXPLORATION +se I-EXPLORATION +administraron I-EXPLORATION +300 I-EXPLORATION +UI/Kg I-EXPLORATION +de I-EXPLORATION +heparina I-EXPLORATION +sódica I-EXPLORATION +i.v., I-EXPLORATION +y I-EXPLORATION +12 I-EXPLORATION +minutos I-EXPLORATION +más I-EXPLORATION +tarde I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +comenzó I-EXPLORATION +con I-EXPLORATION +hipoperfusión I-EXPLORATION +verdadera I-EXPLORATION +(tensión I-EXPLORATION +arterial I-EXPLORATION +sistólica I-EXPLORATION +(TAS) I-EXPLORATION +menor I-EXPLORATION +de I-EXPLORATION +60 I-EXPLORATION +mmHg), I-EXPLORATION +presentando I-EXPLORATION +asistolia I-EXPLORATION +cinco I-EXPLORATION +minutos I-EXPLORATION +después I-EXPLORATION +y I-EXPLORATION +confirmando I-EXPLORATION +el I-EXPLORATION +fallecimiento I-EXPLORATION +otros I-EXPLORATION +cinco I-EXPLORATION +minutos I-EXPLORATION +más I-EXPLORATION +tarde. I-EXPLORATION +Así, I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +isquemia I-EXPLORATION +caliente I-EXPLORATION +total I-EXPLORATION +(TICT, I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +retirada I-EXPLORATION +de I-EXPLORATION +soporte I-EXPLORATION +vital I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +perfusión I-EXPLORATION +fría I-EXPLORATION +o I-EXPLORATION +NECMO) I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +22 I-EXPLORATION +minutos I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +isquemia I-EXPLORATION +caliente I-EXPLORATION +funcional I-EXPLORATION +(TICF, I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +comienzo I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +hipoperfusión I-EXPLORATION +significativa I-EXPLORATION +-TAS<60 I-EXPLORATION +mmHg- I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +perfusión I-EXPLORATION +fría I-EXPLORATION +o I-EXPLORATION +NECMO) I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +minutos. I-EXPLORATION +Se I-EXPLORATION +puede I-EXPLORATION +ver I-EXPLORATION +la I-EXPLORATION +evolución I-EXPLORATION +del I-EXPLORATION +potencial I-EXPLORATION +donante I-EXPLORATION +durante I-EXPLORATION +este I-EXPLORATION +período I-EXPLORATION +de I-EXPLORATION +observación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Tabla I-EXPLORATION +1. I-EXPLORATION + I-EXPLORATION +LTSV: I-EXPLORATION +limitación I-EXPLORATION +del I-EXPLORATION +tratamiento I-EXPLORATION +de I-EXPLORATION +soporte I-EXPLORATION +vital; I-EXPLORATION +min: I-EXPLORATION +minutos; I-EXPLORATION +TAS: I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +sistólica; I-EXPLORATION +TAD: I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +diastólica; I-EXPLORATION +FC: I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca; I-EXPLORATION +FR: I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria; I-EXPLORATION +Sat. I-EXPLORATION +O2: I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +oxígeno; I-EXPLORATION +lpm: I-EXPLORATION +latidos/minuto; I-EXPLORATION +rpm: I-EXPLORATION +respiraciones/minuto; I-EXPLORATION +ml: I-EXPLORATION +mililitros I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +muerte, I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +la I-EXPLORATION +NECMO I-EXPLORATION +(previo I-EXPLORATION +hinchado I-EXPLORATION +del I-EXPLORATION +balón I-EXPLORATION +de I-EXPLORATION +Fogarty I-EXPLORATION +contralateral) I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +intubado I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +iniciar I-EXPLORATION +ventilación I-EXPLORATION +(tubo I-EXPLORATION +al I-EXPLORATION +aire). I-EXPLORATION +Seguidamente, I-EXPLORATION +el I-EXPLORATION +cirujano I-EXPLORATION +torácico I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +esternotomía I-EXPLORATION +rápida I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +7-8 I-EXPLORATION +minutos, I-EXPLORATION +revisó I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +torácica I-EXPLORATION +y I-EXPLORATION +clampó I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +torácica I-EXPLORATION +justo I-EXPLORATION +por I-EXPLORATION +encima I-EXPLORATION +del I-EXPLORATION +catéter I-EXPLORATION +de I-EXPLORATION +Fogarty. I-EXPLORATION +Inmediatamente I-EXPLORATION +después I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +ventilación I-EXPLORATION +mecánica I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fracción I-EXPLORATION +inspirada I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +(FiO2) I-EXPLORATION +del I-EXPLORATION +100%, I-EXPLORATION +presión I-EXPLORATION +positiva I-EXPLORATION +al I-EXPLORATION +final I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +espiración I-EXPLORATION +(PEEP) I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +y I-EXPLORATION +12 I-EXPLORATION +respiraciones/minuto. I-EXPLORATION +El I-EXPLORATION +cirujano I-EXPLORATION +canuló I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +perfundieron I-EXPLORATION +los I-EXPLORATION +pulmones I-EXPLORATION +con I-EXPLORATION +Perfadex I-EXPLORATION +(solución I-EXPLORATION +de I-EXPLORATION +preservación I-EXPLORATION +de I-EXPLORATION +órganos) I-EXPLORATION +hasta I-EXPLORATION +alcanzar I-EXPLORATION +la I-EXPLORATION +limpieza I-EXPLORATION +del I-EXPLORATION +circuito I-EXPLORATION +pulmonar, I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +extracción I-EXPLORATION +reglada, I-EXPLORATION +realizando I-EXPLORATION +maniobras I-EXPLORATION +de I-EXPLORATION +Valsalva I-EXPLORATION +(o I-EXPLORATION +suspiros) I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +distensibilidad I-EXPLORATION +del I-EXPLORATION +pulmón. I-EXPLORATION +Simultáneamente, I-EXPLORATION +la I-EXPLORATION +NECMO I-EXPLORATION +siguió I-EXPLORATION +funcionando I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cirujano I-EXPLORATION +hepático I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +media I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +viabilidad I-EXPLORATION +y I-EXPLORATION +confirmar I-EXPLORATION +la I-EXPLORATION +adecuada I-EXPLORATION +perfusión I-EXPLORATION +hepática. I-EXPLORATION +Preventivamente I-EXPLORATION +se I-EXPLORATION +infundieron I-EXPLORATION +dos I-EXPLORATION +concentrados I-EXPLORATION +de I-EXPLORATION +hematíes I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +litro I-EXPLORATION +de I-EXPLORATION +suero I-EXPLORATION +salino I-EXPLORATION +0, I-EXPLORATION +9%, I-EXPLORATION +para I-EXPLORATION +así I-EXPLORATION +aumentar I-EXPLORATION +el I-EXPLORATION +circuito I-EXPLORATION +de I-EXPLORATION +ECMO I-EXPLORATION +previo I-EXPLORATION +al I-EXPLORATION +clampaje I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +cirujano I-EXPLORATION +torácico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +iba I-EXPLORATION +a I-EXPLORATION +ligar I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +desembocadura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha, I-EXPLORATION +ambos I-EXPLORATION +cirujanos I-EXPLORATION +movilizaron I-EXPLORATION +conjuntamente I-EXPLORATION +la I-EXPLORATION +cánula I-EXPLORATION +venosa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ECMO I-EXPLORATION +para I-EXPLORATION +bajarla I-EXPLORATION +varios I-EXPLORATION +centímetros I-EXPLORATION +y I-EXPLORATION +dejar I-EXPLORATION +el I-EXPLORATION +extremo I-EXPLORATION +distal I-EXPLORATION +por I-EXPLORATION +debajo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +recolocada I-EXPLORATION +la I-EXPLORATION +cánula I-EXPLORATION +venosa I-EXPLORATION +y I-EXPLORATION +clampada I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior, I-EXPLORATION +los I-EXPLORATION +flujos I-EXPLORATION +de I-EXPLORATION +ECMO I-EXPLORATION +bajaron I-EXPLORATION +ligeramente I-EXPLORATION +requiriendo I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +dos I-EXPLORATION +hemoconcentrados I-EXPLORATION +y I-EXPLORATION +500 I-EXPLORATION +ml I-EXPLORATION +de I-EXPLORATION +suero I-EXPLORATION +salino I-EXPLORATION +0, I-EXPLORATION +9%. I-EXPLORATION +En I-EXPLORATION +esta I-EXPLORATION +fase I-EXPLORATION +ya I-EXPLORATION +estaban I-EXPLORATION +separados I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +con I-EXPLORATION +ligadura I-EXPLORATION +previa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +cava, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +extracción I-EXPLORATION +reglada I-EXPLORATION +pulmonar I-EXPLORATION +mientras I-EXPLORATION +se I-EXPLORATION +continuaba I-EXPLORATION +con I-EXPLORATION +NECMO. I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +extraídos I-EXPLORATION +los I-EXPLORATION +pulmones I-EXPLORATION +se I-EXPLORATION +mantuvo I-EXPLORATION +la I-EXPLORATION +NECMO I-EXPLORATION +16 I-EXPLORATION +minutos I-EXPLORATION +más I-EXPLORATION +(tiempo I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +NECMO I-EXPLORATION +de I-EXPLORATION +84 I-EXPLORATION +minutos), I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +la I-EXPLORATION +perfusión I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +Celsior I-EXPLORATION +(solución I-EXPLORATION +de I-EXPLORATION +preservación I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +abdominales) I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cánula I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +ECMO I-EXPLORATION +y I-EXPLORATION +finalmente I-EXPLORATION +se I-EXPLORATION +extrajeron I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +reglada I-EXPLORATION +el I-EXPLORATION +hígado I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +riñones. I-EXPLORATION + I-EXPLORATION +Durante I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +proceso I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +determinaciones I-EXPLORATION +seriadas I-EXPLORATION +cada I-EXPLORATION +20 I-EXPLORATION +minutos I-EXPLORATION +del I-EXPLORATION +equilibrio I-EXPLORATION +ácido-base I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +iónico, I-EXPLORATION +hematología I-EXPLORATION +y I-EXPLORATION +bioquímica I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +renal. I-EXPLORATION + I-EXPLORATION +PaO2: I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +(mmHg); I-EXPLORATION +PaCO2: I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +dióxido I-EXPLORATION +de I-EXPLORATION +carbono I-EXPLORATION +(mmHg); I-EXPLORATION +HCO3-: I-EXPLORATION +bicarbonato I-EXPLORATION +(mmol/L); I-EXPLORATION +Lact.: I-EXPLORATION +lactato I-EXPLORATION +(mg/dL); I-EXPLORATION +Bil.: I-EXPLORATION +bilirrubina I-EXPLORATION +(mg/dL); I-EXPLORATION +Hto.: I-EXPLORATION +hematocrito I-EXPLORATION +(%); I-EXPLORATION +Hb.: I-EXPLORATION +hemoglobina I-EXPLORATION +(g/dL); I-EXPLORATION +Gluc.: I-EXPLORATION +glucemia I-EXPLORATION +(mg/dL); I-EXPLORATION +Na+: I-EXPLORATION +ión I-EXPLORATION +sodio I-EXPLORATION +(mmol/L); I-EXPLORATION +K+: I-EXPLORATION +ión I-EXPLORATION +potasio I-EXPLORATION +(mmol/L); I-EXPLORATION +min: I-EXPLORATION +minutos I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +cuanto I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +receptores I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +injertos I-EVOLUTION +extraídos, I-EVOLUTION +todos I-EVOLUTION +han I-EVOLUTION +presentado I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable I-EVOLUTION +postrasplante. I-EVOLUTION +El I-EVOLUTION +receptor I-EVOLUTION +pulmonar I-EVOLUTION +recibió I-EVOLUTION +un I-EVOLUTION +trasplante I-EVOLUTION +bipulmonar I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +durante I-EVOLUTION +su I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +en I-EVOLUTION +UCI I-EVOLUTION +y I-EVOLUTION +posterior I-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +planta I-EVOLUTION +de I-EVOLUTION +hospitalización. I-EVOLUTION + I-EVOLUTION + +Paciente, B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +atendida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Postgrado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Rehabilitación I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Prótesis I-PRESENT_ILLNESS +Maxilofacial I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Universidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Barcelona, I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +sustituir I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +prótesis I-PRESENT_ILLNESS +óculo-palpebral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +portadora. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Tras B-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +minucioso I-EXPLORATION +del I-EXPLORATION +defecto I-EXPLORATION +facial, I-EXPLORATION +se I-EXPLORATION +evaluaron I-EXPLORATION +las I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +soporte I-EXPLORATION +para I-EXPLORATION +ver I-EXPLORATION +las I-EXPLORATION +posibilidades I-EXPLORATION +de I-EXPLORATION +obtención I-EXPLORATION +de I-EXPLORATION +estabilidad, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +retención I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +prótesis4.. I-EXPLORATION +Éste I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +superficie I-EXPLORATION +cubierta I-EXPLORATION +totalmente I-EXPLORATION +de I-EXPLORATION +piel, I-EXPLORATION +firme, I-EXPLORATION +estable, I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +concavidad I-EXPLORATION +comunicada I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +temporal I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +agujero I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +resultado I-EXPLORATION +del I-EXPLORATION +fracaso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +osteointegración I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +implante. I-EXPLORATION + I-EXPLORATION +Para B-TREATMENT +la I-TREATMENT +elaboración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +óculo-palpebral I-TREATMENT +flexible I-TREATMENT +se I-TREATMENT +debe I-TREATMENT +obtener I-TREATMENT +una I-TREATMENT +impresión I-TREATMENT +que I-TREATMENT +reproduzca I-TREATMENT +fielmente I-TREATMENT +los I-TREATMENT +tejidos I-TREATMENT +remanentes. I-TREATMENT +Para I-TREATMENT +ello I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +delimitación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +extensión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +sus I-TREATMENT +márgenes I-TREATMENT +deben I-TREATMENT +estar I-TREATMENT +apoyados I-TREATMENT +en I-TREATMENT +superficies I-TREATMENT +estables. I-TREATMENT +La I-TREATMENT +finalidad I-TREATMENT +es I-TREATMENT +obtener I-TREATMENT +un I-TREATMENT +modelo I-TREATMENT +de I-TREATMENT +trabajo I-TREATMENT +y I-TREATMENT +de I-TREATMENT +estudio I-TREATMENT +en I-TREATMENT +yeso I-TREATMENT +piedra I-TREATMENT +o I-TREATMENT +yeso I-TREATMENT +extraduro. I-TREATMENT +Se I-TREATMENT +individualizaron I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +facial I-TREATMENT +y I-TREATMENT +temporal I-TREATMENT +a I-TREATMENT +impresionar I-TREATMENT +tapando I-TREATMENT +el I-TREATMENT +orificio I-TREATMENT +creado I-TREATMENT +por I-TREATMENT +la I-TREATMENT +perdida I-TREATMENT +del I-TREATMENT +implante I-TREATMENT +con I-TREATMENT +cera I-TREATMENT +«Utility», I-TREATMENT +para I-TREATMENT +que I-TREATMENT +en I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +impresión I-TREATMENT +éste I-TREATMENT +no I-TREATMENT +bloquease I-TREATMENT +su I-TREATMENT +retirada. I-TREATMENT +Se I-TREATMENT +aplicó I-TREATMENT +vaselina I-TREATMENT +en I-TREATMENT +las I-TREATMENT +regiones I-TREATMENT +que I-TREATMENT +puedan I-TREATMENT +retener I-TREATMENT +el I-TREATMENT +material I-TREATMENT +de I-TREATMENT +impresión I-TREATMENT +como I-TREATMENT +las I-TREATMENT +cejas I-TREATMENT +o I-TREATMENT +cabello, I-TREATMENT +además I-TREATMENT +también I-TREATMENT +se I-TREATMENT +puede I-TREATMENT +utilizar I-TREATMENT +como I-TREATMENT +material I-TREATMENT +de I-TREATMENT +impresión I-TREATMENT +siliconas I-TREATMENT +fluidas, I-TREATMENT +agár, I-TREATMENT +materiales I-TREATMENT +de I-TREATMENT +poliéter I-TREATMENT +o I-TREATMENT +alginato2, I-TREATMENT +5*, I-TREATMENT +6, I-TREATMENT +8*. I-TREATMENT +En I-TREATMENT +este I-TREATMENT +caso I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +alginato, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +debe I-TREATMENT +ser I-TREATMENT +muy I-TREATMENT +fluido I-TREATMENT +para I-TREATMENT +no I-TREATMENT +deformar I-TREATMENT +los I-TREATMENT +tegumentos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +comienza I-TREATMENT +a I-TREATMENT +colocar I-TREATMENT +en I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +más I-TREATMENT +profundas I-TREATMENT +del I-TREATMENT +defecto, I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +la I-TREATMENT +formación I-TREATMENT +de I-TREATMENT +burbujas. I-TREATMENT + I-TREATMENT +Después I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +una I-TREATMENT +gasa I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +alginato I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +su I-TREATMENT +escurrimiento I-TREATMENT +y I-TREATMENT +que I-TREATMENT +además I-TREATMENT +sirvió I-TREATMENT +de I-TREATMENT +unión I-TREATMENT +a I-TREATMENT +la I-TREATMENT +capa I-TREATMENT +de I-TREATMENT +yeso I-TREATMENT +de I-TREATMENT +fraguado I-TREATMENT +rápido I-TREATMENT +que I-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +material I-TREATMENT +de I-TREATMENT +impresión2, I-TREATMENT +6. I-TREATMENT + I-TREATMENT +Es I-TREATMENT +importante I-TREATMENT +mantener I-TREATMENT +libres I-TREATMENT +las I-TREATMENT +vías I-TREATMENT +respiratorias I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +diciéndole I-TREATMENT +que I-TREATMENT +respire I-TREATMENT +por I-TREATMENT +la I-TREATMENT +boca I-TREATMENT +y I-TREATMENT +conversando I-TREATMENT +con I-TREATMENT +ella I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +procedimiento, I-TREATMENT +para I-TREATMENT +tranquilizarla I-TREATMENT +e I-TREATMENT +informarla2. I-TREATMENT + I-TREATMENT +La I-TREATMENT +confección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +ocular I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +a I-TREATMENT +continuación, I-TREATMENT +imitando I-TREATMENT +el I-TREATMENT +ojo I-TREATMENT +remanente. I-TREATMENT +Por I-TREATMENT +las I-TREATMENT +características I-TREATMENT +individuales I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +algunos I-TREATMENT +autores I-TREATMENT +la I-TREATMENT +denominan I-TREATMENT +«almendra»3*. I-TREATMENT +Su I-TREATMENT +tamaño I-TREATMENT +corresponderá I-TREATMENT +al I-TREATMENT +ancho I-TREATMENT +entre I-TREATMENT +el I-TREATMENT +canto I-TREATMENT +interno I-TREATMENT +y I-TREATMENT +externo I-TREATMENT +del I-TREATMENT +ojo I-TREATMENT +sano. I-TREATMENT +La I-TREATMENT +cara I-TREATMENT +externa I-TREATMENT +es I-TREATMENT +totalmente I-TREATMENT +convexa I-TREATMENT +y I-TREATMENT +recubierta I-TREATMENT +de I-TREATMENT +acrílico I-TREATMENT +transparente I-TREATMENT +para I-TREATMENT +obtener I-TREATMENT +mejor I-TREATMENT +resultado I-TREATMENT +estético. I-TREATMENT +Su I-TREATMENT +cara I-TREATMENT +interna I-TREATMENT +será I-TREATMENT +plana I-TREATMENT +y I-TREATMENT +se I-TREATMENT +apoyará I-TREATMENT +en I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +posterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +óculo-palpebral3*. I-TREATMENT + I-TREATMENT +Para I-TREATMENT +esta I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +un I-TREATMENT +molde I-TREATMENT +de I-TREATMENT +silicona, I-TREATMENT +que I-TREATMENT +había I-TREATMENT +sido I-TREATMENT +confeccionado I-TREATMENT +de I-TREATMENT +unas I-TREATMENT +impresiones I-TREATMENT +de I-TREATMENT +otra I-TREATMENT +paciente. I-TREATMENT +Se I-TREATMENT +pueden I-TREATMENT +utilizar I-TREATMENT +numerosas I-TREATMENT +ceras, I-TREATMENT +que I-TREATMENT +sean I-TREATMENT +duras I-TREATMENT +y I-TREATMENT +que I-TREATMENT +pesen I-TREATMENT +poco. I-TREATMENT +Aquí I-TREATMENT +que I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +cera I-TREATMENT +color I-TREATMENT +marfil I-TREATMENT +de I-TREATMENT +una I-TREATMENT +consistencia I-TREATMENT +dura. I-TREATMENT + I-TREATMENT +El I-TREATMENT +iris I-TREATMENT +debe I-TREATMENT +ser I-TREATMENT +caracterizado I-TREATMENT +previamente, I-TREATMENT +para I-TREATMENT +esto I-TREATMENT +se I-TREATMENT +han I-TREATMENT +descrito I-TREATMENT +muchas I-TREATMENT +técnicas4. I-TREATMENT +En I-TREATMENT +este I-TREATMENT +caso I-TREATMENT +se I-TREATMENT +utilizaron I-TREATMENT +discos I-TREATMENT +de I-TREATMENT +grafito I-TREATMENT +por I-TREATMENT +ser I-TREATMENT +muy I-TREATMENT +resistentes, I-TREATMENT +retienen I-TREATMENT +mejor I-TREATMENT +la I-TREATMENT +pintura I-TREATMENT +y I-TREATMENT +los I-TREATMENT +hay I-TREATMENT +de I-TREATMENT +varios I-TREATMENT +tamaños. I-TREATMENT +El I-TREATMENT +disco I-TREATMENT +de I-TREATMENT +grafito I-TREATMENT +se I-TREATMENT +selecciona I-TREATMENT +según I-TREATMENT +el I-TREATMENT +tamaño I-TREATMENT +del I-TREATMENT +iris I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +El I-TREATMENT +diámetro I-TREATMENT +del I-TREATMENT +iris I-TREATMENT +varía I-TREATMENT +entre I-TREATMENT +11, I-TREATMENT +5-12 I-TREATMENT +mm, I-TREATMENT +y I-TREATMENT +el I-TREATMENT +diámetro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pupila I-TREATMENT +varia I-TREATMENT +entre I-TREATMENT +2, I-TREATMENT +5-3 I-TREATMENT +mm5. I-TREATMENT +Dicha I-TREATMENT +caracterización I-TREATMENT +precisa I-TREATMENT +de I-TREATMENT +una I-TREATMENT +mezcla I-TREATMENT +de I-TREATMENT +monómero I-TREATMENT +(líquido) I-TREATMENT +con I-TREATMENT +polímero I-TREATMENT +(polvo I-TREATMENT +de I-TREATMENT +acrílico) I-TREATMENT +y I-TREATMENT +óleo, I-TREATMENT +haciéndola I-TREATMENT +lo I-TREATMENT +más I-TREATMENT +suave I-TREATMENT +posible5*. I-TREATMENT +Se I-TREATMENT +colocaron I-TREATMENT +los I-TREATMENT +colores I-TREATMENT +base I-TREATMENT +en I-TREATMENT +una I-TREATMENT +paleta7. I-TREATMENT +La I-TREATMENT +fijación I-TREATMENT +del I-TREATMENT +disco I-TREATMENT +a I-TREATMENT +un I-TREATMENT +puntero I-TREATMENT +facilita I-TREATMENT +su I-TREATMENT +pintura I-TREATMENT +de I-TREATMENT +una I-TREATMENT +forma I-TREATMENT +radial4, I-TREATMENT +5*. I-TREATMENT +Existen I-TREATMENT +varias I-TREATMENT +técnicas I-TREATMENT +para I-TREATMENT +la I-TREATMENT +mejor I-TREATMENT +disposición I-TREATMENT +de I-TREATMENT +colores. I-TREATMENT +La I-TREATMENT +que I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +fue I-TREATMENT +la I-TREATMENT +que I-TREATMENT +empieza I-TREATMENT +con I-TREATMENT +colores I-TREATMENT +más I-TREATMENT +claros I-TREATMENT +y I-TREATMENT +sigue I-TREATMENT +subiendo I-TREATMENT +las I-TREATMENT +tonalidades, I-TREATMENT +pintando I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +centro I-TREATMENT +hacia I-TREATMENT +la I-TREATMENT +periferia. I-TREATMENT +Se I-TREATMENT +consigue I-TREATMENT +así I-TREATMENT +una I-TREATMENT +mejor I-TREATMENT +perspectiva I-TREATMENT +de I-TREATMENT +profundidad. I-TREATMENT +Este I-TREATMENT +paso I-TREATMENT +depende I-TREATMENT +un I-TREATMENT +50% I-TREATMENT +de I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +y I-TREATMENT +otro I-TREATMENT +50% I-TREATMENT +del I-TREATMENT +arte3*, I-TREATMENT +5*, I-TREATMENT +8. I-TREATMENT + I-TREATMENT +El I-TREATMENT +color I-TREATMENT +de I-TREATMENT +un I-TREATMENT +objeto, I-TREATMENT +no I-TREATMENT +es I-TREATMENT +otra I-TREATMENT +cosa I-TREATMENT +que I-TREATMENT +la I-TREATMENT +propiedad I-TREATMENT +que I-TREATMENT +él I-TREATMENT +mismo I-TREATMENT +tiene I-TREATMENT +de I-TREATMENT +absorber I-TREATMENT +una I-TREATMENT +determinada I-TREATMENT +cantidad I-TREATMENT +de I-TREATMENT +radiación I-TREATMENT +de I-TREATMENT +luz I-TREATMENT +y I-TREATMENT +emitir I-TREATMENT +otras. I-TREATMENT +Por I-TREATMENT +eso I-TREATMENT +es I-TREATMENT +importante I-TREATMENT +utilizar I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +tipo I-TREATMENT +de I-TREATMENT +luz I-TREATMENT +a I-TREATMENT +la I-TREATMENT +hora I-TREATMENT +de I-TREATMENT +examinar I-TREATMENT +el I-TREATMENT +color I-TREATMENT +del I-TREATMENT +iris. I-TREATMENT +Es I-TREATMENT +aconsejable I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +una I-TREATMENT +mejor I-TREATMENT +reproducción I-TREATMENT +de I-TREATMENT +los I-TREATMENT +colores I-TREATMENT +del I-TREATMENT +ojo I-TREATMENT +sano3*, I-TREATMENT +5*, I-TREATMENT +8. I-TREATMENT + I-TREATMENT +Existen I-TREATMENT +varias I-TREATMENT +maneras I-TREATMENT +de I-TREATMENT +hacer I-TREATMENT +la I-TREATMENT +pupila. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +pueden I-TREATMENT +adquirir I-TREATMENT +conformadores I-TREATMENT +de I-TREATMENT +córnea I-TREATMENT +preformados I-TREATMENT +que I-TREATMENT +la I-TREATMENT +incorporan, I-TREATMENT +para I-TREATMENT +ser I-TREATMENT +adheridos I-TREATMENT +al I-TREATMENT +disco I-TREATMENT +donde I-TREATMENT +está I-TREATMENT +pintado I-TREATMENT +el I-TREATMENT +iris4. I-TREATMENT +Estos I-TREATMENT +conformadores I-TREATMENT +permiten I-TREATMENT +comprobar I-TREATMENT +en I-TREATMENT +cera I-TREATMENT +el I-TREATMENT +centrado I-TREATMENT +del I-TREATMENT +ojo I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +adaptar I-TREATMENT +el I-TREATMENT +conjunto I-TREATMENT +iris-pupila I-TREATMENT +al I-TREATMENT +modelo I-TREATMENT +en I-TREATMENT +cera, I-TREATMENT +se I-TREATMENT +construyó I-TREATMENT +una I-TREATMENT +mufla I-TREATMENT +para I-TREATMENT +obtener I-TREATMENT +el I-TREATMENT +ojo I-TREATMENT +protésico I-TREATMENT +en I-TREATMENT +acrílico. I-TREATMENT +Se I-TREATMENT +cargó I-TREATMENT +la I-TREATMENT +mufla I-TREATMENT +con I-TREATMENT +resina I-TREATMENT +blanca, I-TREATMENT +incluyendo I-TREATMENT +pigmentos I-TREATMENT +que I-TREATMENT +se I-TREATMENT +asemejen I-TREATMENT +lo I-TREATMENT +más I-TREATMENT +posible I-TREATMENT +a I-TREATMENT +la I-TREATMENT +esclerótica I-TREATMENT +y I-TREATMENT +se I-TREATMENT +polimerizó I-TREATMENT +en I-TREATMENT +agua I-TREATMENT +hirviendo I-TREATMENT +durante I-TREATMENT +30 I-TREATMENT +minutos. I-TREATMENT +Tras I-TREATMENT +el I-TREATMENT +enfriamiento I-TREATMENT +se I-TREATMENT +desgastó I-TREATMENT +el I-TREATMENT +exceso I-TREATMENT +de I-TREATMENT +resina I-TREATMENT +existente I-TREATMENT +en I-TREATMENT +la I-TREATMENT +superficie I-TREATMENT +del I-TREATMENT +iris, I-TREATMENT +dejándola I-TREATMENT +inclusive I-TREATMENT +cóncava, I-TREATMENT +para I-TREATMENT +dar I-TREATMENT +una I-TREATMENT +mayor I-TREATMENT +apariencia I-TREATMENT +de I-TREATMENT +profundidad; I-TREATMENT +lo I-TREATMENT +mismo I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +con I-TREATMENT +el I-TREATMENT +espacio I-TREATMENT +correspondiente I-TREATMENT +a I-TREATMENT +la I-TREATMENT +esclerótica. I-TREATMENT + I-TREATMENT +La I-TREATMENT +caracterización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +esclerótica I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +imitando I-TREATMENT +los I-TREATMENT +vasos I-TREATMENT +sanguíneos I-TREATMENT +con I-TREATMENT +hilos I-TREATMENT +de I-TREATMENT +lana I-TREATMENT +o I-TREATMENT +seda I-TREATMENT +cortados I-TREATMENT +y I-TREATMENT +pegados I-TREATMENT +en I-TREATMENT +la I-TREATMENT +esclerótica I-TREATMENT +en I-TREATMENT +sentido I-TREATMENT +longitudinal, I-TREATMENT +partiendo I-TREATMENT +de I-TREATMENT +los I-TREATMENT +ángulos I-TREATMENT +donde I-TREATMENT +hay I-TREATMENT +mas I-TREATMENT +concentración I-TREATMENT +y I-TREATMENT +disminuyendo I-TREATMENT +de I-TREATMENT +intensidad I-TREATMENT +cuando I-TREATMENT +se I-TREATMENT +aproximan I-TREATMENT +al I-TREATMENT +iris3*, I-TREATMENT +5*, I-TREATMENT +8*, I-TREATMENT +9. I-TREATMENT +Se I-TREATMENT +utilizan I-TREATMENT +las I-TREATMENT +mismas I-TREATMENT +pinturas I-TREATMENT +usadas I-TREATMENT +para I-TREATMENT +el I-TREATMENT +iris. I-TREATMENT + I-TREATMENT +Terminada I-TREATMENT +la I-TREATMENT +pigmentación I-TREATMENT +externa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +esta I-TREATMENT +se I-TREATMENT +reubicó I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mufla I-TREATMENT +y I-TREATMENT +se I-TREATMENT +carga I-TREATMENT +con I-TREATMENT +una I-TREATMENT +capa I-TREATMENT +de I-TREATMENT +acrílico I-TREATMENT +transparente I-TREATMENT +que I-TREATMENT +tiene I-TREATMENT +la I-TREATMENT +función I-TREATMENT +de I-TREATMENT +proteger I-TREATMENT +y I-TREATMENT +dar I-TREATMENT +translucidez I-TREATMENT +a I-TREATMENT +la I-TREATMENT +prótesis4, I-TREATMENT +5. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +el I-TREATMENT +pulido I-TREATMENT +las I-TREATMENT +dos I-TREATMENT +resinas I-TREATMENT +tienen I-TREATMENT +que I-TREATMENT +quedar I-TREATMENT +perfectamente I-TREATMENT +unidas, I-TREATMENT +sin I-TREATMENT +irregularidades. I-TREATMENT +Para I-TREATMENT +eso, I-TREATMENT +se I-TREATMENT +puede I-TREATMENT +utilizar I-TREATMENT +fresas I-TREATMENT +de I-TREATMENT +diamante, I-TREATMENT +conos I-TREATMENT +de I-TREATMENT +silicona, I-TREATMENT +papel I-TREATMENT +de I-TREATMENT +lija, I-TREATMENT +y I-TREATMENT +siempre I-TREATMENT +a I-TREATMENT +baja I-TREATMENT +velocidad. I-TREATMENT +El I-TREATMENT +pulido I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +con I-TREATMENT +agua, I-TREATMENT +polvo I-TREATMENT +de I-TREATMENT +piedra-pómez I-TREATMENT +y I-TREATMENT +algodón5, I-TREATMENT +10. I-TREATMENT + I-TREATMENT +El I-TREATMENT +encerado I-TREATMENT +del I-TREATMENT +globo I-TREATMENT +ocular I-TREATMENT +empieza I-TREATMENT +a I-TREATMENT +partir I-TREATMENT +de I-TREATMENT +una I-TREATMENT +hoja I-TREATMENT +de I-TREATMENT +cera I-TREATMENT +rosa I-TREATMENT +bien I-TREATMENT +adaptada I-TREATMENT +al I-TREATMENT +modelo I-TREATMENT +de I-TREATMENT +trabajo, I-TREATMENT +rellenando I-TREATMENT +los I-TREATMENT +espacios I-TREATMENT +y I-TREATMENT +esculpiendo I-TREATMENT +los I-TREATMENT +límites I-TREATMENT +y I-TREATMENT +los I-TREATMENT +salientes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis, I-TREATMENT +los I-TREATMENT +cuales I-TREATMENT +tienen I-TREATMENT +que I-TREATMENT +estar I-TREATMENT +perfectamente I-TREATMENT +definidos I-TREATMENT +y I-TREATMENT +adaptados2, I-TREATMENT +6, I-TREATMENT +10, I-TREATMENT +11. I-TREATMENT + I-TREATMENT +La I-TREATMENT +ubicación I-TREATMENT +del I-TREATMENT +ojo I-TREATMENT +protésico I-TREATMENT +constituye I-TREATMENT +un I-TREATMENT +paso I-TREATMENT +extremadamente I-TREATMENT +crítico I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +recomienda I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +del I-TREATMENT +paciente8*, I-TREATMENT +11. I-TREATMENT +Se I-TREATMENT +debe I-TREATMENT +conseguir I-TREATMENT +que I-TREATMENT +la I-TREATMENT +«almendra» I-TREATMENT +ocupe I-TREATMENT +la I-TREATMENT +posición I-TREATMENT +correcta I-TREATMENT +en I-TREATMENT +los I-TREATMENT +tres I-TREATMENT +planos I-TREATMENT +del I-TREATMENT +espacio12. I-TREATMENT +Se I-TREATMENT +usan I-TREATMENT +diferentes I-TREATMENT +técnicas I-TREATMENT +de I-TREATMENT +alineación; I-TREATMENT +todas I-TREATMENT +ellas I-TREATMENT +tienen I-TREATMENT +la I-TREATMENT +finalidad I-TREATMENT +de I-TREATMENT +lograr I-TREATMENT +la I-TREATMENT +posición I-TREATMENT +correcta I-TREATMENT +en I-TREATMENT +la I-TREATMENT +lámina I-TREATMENT +de I-TREATMENT +cera. I-TREATMENT +Aparatos I-TREATMENT +como I-TREATMENT +la I-TREATMENT +regla I-TREATMENT +de I-TREATMENT +Vernier I-TREATMENT +y I-TREATMENT +pupilómetros, I-TREATMENT +se I-TREATMENT +usan I-TREATMENT +para I-TREATMENT +ayudar I-TREATMENT +a I-TREATMENT +conseguir I-TREATMENT +la I-TREATMENT +ubicación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +ocular I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +órbita. I-TREATMENT +La I-TREATMENT +regla I-TREATMENT +de I-TREATMENT +Vernier I-TREATMENT +mide I-TREATMENT +la I-TREATMENT +distancia I-TREATMENT +interpupilar I-TREATMENT +que I-TREATMENT +normalmente I-TREATMENT +es I-TREATMENT +de I-TREATMENT +60 I-TREATMENT +mm, I-TREATMENT +aproximadamente2, I-TREATMENT +3*, I-TREATMENT +10. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +ubicada I-TREATMENT +la I-TREATMENT +«almendra» I-TREATMENT +se I-TREATMENT +comienza I-TREATMENT +la I-TREATMENT +escultura., I-TREATMENT +confeccionando I-TREATMENT +un I-TREATMENT +ojo I-TREATMENT +con I-TREATMENT +un I-TREATMENT +tamaño I-TREATMENT +mayor I-TREATMENT +que I-TREATMENT +permite I-TREATMENT +una I-TREATMENT +mayor I-TREATMENT +adaptación I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cavidad. I-TREATMENT + I-TREATMENT +La I-TREATMENT +escultura I-TREATMENT +intenta I-TREATMENT +copiar I-TREATMENT +todas I-TREATMENT +las I-TREATMENT +líneas I-TREATMENT +de I-TREATMENT +expresión I-TREATMENT +e I-TREATMENT +irregularidades I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cera. I-TREATMENT +Se I-TREATMENT +crean I-TREATMENT +los I-TREATMENT +párpados I-TREATMENT +y I-TREATMENT +la I-TREATMENT +abertura I-TREATMENT +palpebral, I-TREATMENT +siempre I-TREATMENT +comparándolos I-TREATMENT +con I-TREATMENT +el I-TREATMENT +ojo I-TREATMENT +sano I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +Las I-TREATMENT +marcas I-TREATMENT +en I-TREATMENT +el I-TREATMENT +yeso I-TREATMENT +que I-TREATMENT +se I-TREATMENT +aprecian I-TREATMENT +en I-TREATMENT +la I-TREATMENT +foto, I-TREATMENT +corresponden I-TREATMENT +a I-TREATMENT +la I-TREATMENT +línea I-TREATMENT +media I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +y I-TREATMENT +a I-TREATMENT +la I-TREATMENT +línea I-TREATMENT +bipupilar. I-TREATMENT +Los I-TREATMENT +límites I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +deben I-TREATMENT +quedar I-TREATMENT +disimulados I-TREATMENT +con I-TREATMENT +las I-TREATMENT +arrugas I-TREATMENT +y I-TREATMENT +salientes I-TREATMENT +naturales I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +intención I-TREATMENT +de I-TREATMENT +conseguir I-TREATMENT +la I-TREATMENT +correcta I-TREATMENT +expresión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +del I-TREATMENT +paciente8. I-TREATMENT +La I-TREATMENT +prueba I-TREATMENT +de I-TREATMENT +la I-TREATMENT +épitesis I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +permite I-TREATMENT +verificar I-TREATMENT +la I-TREATMENT +alineación I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +ojos. I-TREATMENT +Se I-TREATMENT +pide I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +que I-TREATMENT +imite I-TREATMENT +la I-TREATMENT +acción I-TREATMENT +de I-TREATMENT +leer I-TREATMENT +un I-TREATMENT +periódico. I-TREATMENT + I-TREATMENT +Cuando I-TREATMENT +todo I-TREATMENT +es I-TREATMENT +correcto I-TREATMENT +se I-TREATMENT +incluye I-TREATMENT +el I-TREATMENT +encerado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +épitesis I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mufla, I-TREATMENT +donde I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +interna I-TREATMENT +de I-TREATMENT +la I-TREATMENT +escultura I-TREATMENT +corresponde I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +del I-TREATMENT +defecto. I-TREATMENT +Este I-TREATMENT +tipo I-TREATMENT +de I-TREATMENT +prótesis I-TREATMENT +es I-TREATMENT +la I-TREATMENT +única I-TREATMENT +que I-TREATMENT +permite I-TREATMENT +reproducir I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +retentivas I-TREATMENT +del I-TREATMENT +fondo I-TREATMENT +cavitario. I-TREATMENT +Las I-TREATMENT +muflas I-TREATMENT +deben I-TREATMENT +tener I-TREATMENT +guías I-TREATMENT +que I-TREATMENT +nos I-TREATMENT +aseguren I-TREATMENT +la I-TREATMENT +correcta I-TREATMENT +colocación I-TREATMENT +y I-TREATMENT +por I-TREATMENT +ello I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +retención I-TREATMENT +en I-TREATMENT +el I-TREATMENT +ojo I-TREATMENT +que I-TREATMENT +permite I-TREATMENT +su I-TREATMENT +ubicación I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mufla. I-TREATMENT +Es I-TREATMENT +muy I-TREATMENT +importante I-TREATMENT +que I-TREATMENT +los I-TREATMENT +márgenes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cera I-TREATMENT +estén I-TREATMENT +en I-TREATMENT +una I-TREATMENT +base I-TREATMENT +pulida I-TREATMENT +de I-TREATMENT +yeso I-TREATMENT +para I-TREATMENT +que I-TREATMENT +queden I-TREATMENT +bien I-TREATMENT +definidos. I-TREATMENT +La I-TREATMENT +silicona I-TREATMENT +fue I-TREATMENT +el I-TREATMENT +material I-TREATMENT +de I-TREATMENT +elección I-TREATMENT +para I-TREATMENT +confeccionar I-TREATMENT +la I-TREATMENT +épitesis. I-TREATMENT +Viene I-TREATMENT +con I-TREATMENT +una I-TREATMENT +presentación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +endurecedor I-TREATMENT +o I-TREATMENT +«crosslinker», I-TREATMENT +un I-TREATMENT +catalizador I-TREATMENT +y I-TREATMENT +una I-TREATMENT +base I-TREATMENT +de I-TREATMENT +coloración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +en I-TREATMENT +diferentes I-TREATMENT +tonalidades, I-TREATMENT +para I-TREATMENT +facilitar I-TREATMENT +la I-TREATMENT +mezcla I-TREATMENT +y I-TREATMENT +poder I-TREATMENT +encontrar I-TREATMENT +los I-TREATMENT +colores I-TREATMENT +adecuados I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +caso. I-TREATMENT +En I-TREATMENT +éste I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +una I-TREATMENT +silicona I-TREATMENT +catalizada I-TREATMENT +con I-TREATMENT +platina I-TREATMENT +(Episyl, I-TREATMENT +de I-TREATMENT +la I-TREATMENT +casa I-TREATMENT +Dreve), I-TREATMENT +que I-TREATMENT +ya I-TREATMENT +viene I-TREATMENT +pre-coloreada. I-TREATMENT +Algunos I-TREATMENT +profesionales I-TREATMENT +prefieren I-TREATMENT +siliconas I-TREATMENT +transparentes I-TREATMENT +de I-TREATMENT +otras I-TREATMENT +casas I-TREATMENT +comerciales. I-TREATMENT +Si I-TREATMENT +se I-TREATMENT +utiliza I-TREATMENT +una I-TREATMENT +u I-TREATMENT +otra I-TREATMENT +silicona, I-TREATMENT +es I-TREATMENT +necesario I-TREATMENT +añadir I-TREATMENT +pigmentos, I-TREATMENT +que I-TREATMENT +pueden I-TREATMENT +ser I-TREATMENT +minerales I-TREATMENT +u I-TREATMENT +orgánicos13. I-TREATMENT +Aquí I-TREATMENT +se I-TREATMENT +utilizaron I-TREATMENT +pigmentos I-TREATMENT +orgánicos, I-TREATMENT +que I-TREATMENT +ya I-TREATMENT +vienen I-TREATMENT +mezclados I-TREATMENT +con I-TREATMENT +aceite I-TREATMENT +de I-TREATMENT +silicona. I-TREATMENT + I-TREATMENT +Por I-TREATMENT +otro I-TREATMENT +lado I-TREATMENT +la I-TREATMENT +iluminación I-TREATMENT +del I-TREATMENT +local I-TREATMENT +debe I-TREATMENT +ser I-TREATMENT +natural, I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +errores. I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +debe I-TREATMENT +estar I-TREATMENT +presente I-TREATMENT +en I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +caracterización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +silicona. I-TREATMENT +Primero I-TREATMENT +se I-TREATMENT +determina I-TREATMENT +el I-TREATMENT +color I-TREATMENT +base I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +mezclando I-TREATMENT +las I-TREATMENT +siliconas I-TREATMENT +de I-TREATMENT +vulcanización I-TREATMENT +a I-TREATMENT +frío I-TREATMENT +y I-TREATMENT +haciendo I-TREATMENT +presión. I-TREATMENT +Después I-TREATMENT +de I-TREATMENT +presionar I-TREATMENT +con I-TREATMENT +el I-TREATMENT +dedo I-TREATMENT +durante I-TREATMENT +unos I-TREATMENT +segundos I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +ésta I-TREATMENT +presenta I-TREATMENT +un I-TREATMENT +color I-TREATMENT +sin I-TREATMENT +afluencia I-TREATMENT +sanguínea. I-TREATMENT +Es I-TREATMENT +este I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +en I-TREATMENT +que I-TREATMENT +se I-TREATMENT +debe I-TREATMENT +comparar I-TREATMENT +el I-TREATMENT +color. I-TREATMENT +En I-TREATMENT +seguida I-TREATMENT +se I-TREATMENT +intenta I-TREATMENT +llegar I-TREATMENT +al I-TREATMENT +color I-TREATMENT +exterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel. I-TREATMENT +Se I-TREATMENT +separa I-TREATMENT +los I-TREATMENT +diferentes I-TREATMENT +colores I-TREATMENT +y I-TREATMENT +se I-TREATMENT +van I-TREATMENT +mezclando I-TREATMENT +los I-TREATMENT +pigmentos I-TREATMENT +hasta I-TREATMENT +conseguir I-TREATMENT +imitar I-TREATMENT +las I-TREATMENT +regiones I-TREATMENT +de I-TREATMENT +los I-TREATMENT +párpados I-TREATMENT +superior I-TREATMENT +e I-TREATMENT +inferior I-TREATMENT +y I-TREATMENT +de I-TREATMENT +las I-TREATMENT +zonas I-TREATMENT +aledañas5. I-TREATMENT +Se I-TREATMENT +pueden I-TREATMENT +ir I-TREATMENT +agregando I-TREATMENT +con I-TREATMENT +un I-TREATMENT +pincel I-TREATMENT +diferentes I-TREATMENT +colores I-TREATMENT +directamente I-TREATMENT +en I-TREATMENT +las I-TREATMENT +distintas I-TREATMENT +áreas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mufla. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +colocado I-TREATMENT +el I-TREATMENT +ojo I-TREATMENT +en I-TREATMENT +la I-TREATMENT +mufla, I-TREATMENT +se I-TREATMENT +cargó I-TREATMENT +con I-TREATMENT +la I-TREATMENT +silicona I-TREATMENT +correspondiente I-TREATMENT +al I-TREATMENT +color I-TREATMENT +base I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel. I-TREATMENT +Cargada I-TREATMENT +la I-TREATMENT +mufla, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +su I-TREATMENT +prensado, I-TREATMENT +hasta I-TREATMENT +que I-TREATMENT +los I-TREATMENT +bordes I-TREATMENT +metálicos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mufla I-TREATMENT +contactaron. I-TREATMENT +Hecho I-TREATMENT +esto, I-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +en I-TREATMENT +agua I-TREATMENT +y I-TREATMENT +se I-TREATMENT +hace I-TREATMENT +hervir I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +horas I-TREATMENT +hasta I-TREATMENT +que I-TREATMENT +el I-TREATMENT +material I-TREATMENT +polimerice I-TREATMENT +o I-TREATMENT +se I-TREATMENT +sigue I-TREATMENT +las I-TREATMENT +instrucciones I-TREATMENT +del I-TREATMENT +fabricante. I-TREATMENT +Luego I-TREATMENT +que I-TREATMENT +se I-TREATMENT +comprueba I-TREATMENT +la I-TREATMENT +vulcanización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +silicona, I-TREATMENT +se I-TREATMENT +abre I-TREATMENT +la I-TREATMENT +mufla I-TREATMENT +con I-TREATMENT +cuidado I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +la I-TREATMENT +silicona I-TREATMENT +puede I-TREATMENT +rasgarse I-TREATMENT +en I-TREATMENT +los I-TREATMENT +bordes I-TREATMENT +y I-TREATMENT +estropear I-TREATMENT +el I-TREATMENT +trabajo. I-TREATMENT + I-TREATMENT +Con I-TREATMENT +la I-TREATMENT +epítesis I-TREATMENT +en I-TREATMENT +mano, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +recortar I-TREATMENT +los I-TREATMENT +márgenes. I-TREATMENT +Se I-TREATMENT +limpian I-TREATMENT +los I-TREATMENT +restos I-TREATMENT +de I-TREATMENT +yeso I-TREATMENT +que I-TREATMENT +pueden I-TREATMENT +haber I-TREATMENT +quedado. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +retira I-TREATMENT +el I-TREATMENT +ojo I-TREATMENT +para I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +pulido I-TREATMENT +y I-TREATMENT +se I-TREATMENT +rellena I-TREATMENT +el I-TREATMENT +agujero I-TREATMENT +efectuado, I-TREATMENT +para I-TREATMENT +colocar I-TREATMENT +el I-TREATMENT +ojo. I-TREATMENT +Con I-TREATMENT +una I-TREATMENT +aguja I-TREATMENT +hipodérmica, I-TREATMENT +se I-TREATMENT +cose I-TREATMENT +con I-TREATMENT +cabello I-TREATMENT +las I-TREATMENT +cejas I-TREATMENT +y I-TREATMENT +las I-TREATMENT +pestañas. I-TREATMENT +El I-TREATMENT +color I-TREATMENT +debe I-TREATMENT +ser I-TREATMENT +lo I-TREATMENT +más I-TREATMENT +parecido I-TREATMENT +posible I-TREATMENT +a I-TREATMENT +las I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +es I-TREATMENT +ideal I-TREATMENT +utilizar I-TREATMENT +los I-TREATMENT +propios I-TREATMENT +cabellos I-TREATMENT +del I-TREATMENT +paciente3*. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +coloca I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +y I-TREATMENT +se I-TREATMENT +verifican I-TREATMENT +los I-TREATMENT +márgenes. I-TREATMENT +La I-TREATMENT +utilización I-TREATMENT +de I-TREATMENT +gafas I-TREATMENT +es I-TREATMENT +recomendable I-TREATMENT +porque I-TREATMENT +ayuda I-TREATMENT +a I-TREATMENT +la I-TREATMENT +protección I-TREATMENT +del I-TREATMENT +ojo I-TREATMENT +natural I-TREATMENT +y I-TREATMENT +disimula I-TREATMENT +la I-TREATMENT +prótesis14. I-TREATMENT + I-TREATMENT +Es I-TREATMENT +imprescindible I-TREATMENT +explicar I-TREATMENT +a I-TREATMENT +cada I-TREATMENT +paciente I-TREATMENT +la I-TREATMENT +adecuada I-TREATMENT +manipulación I-TREATMENT +de I-TREATMENT +su I-TREATMENT +epítesis I-TREATMENT +óculo-palpebral, I-TREATMENT +su I-TREATMENT +colocación, I-TREATMENT +limpieza I-TREATMENT +y I-TREATMENT +adhesivo I-TREATMENT +médico I-TREATMENT +más I-TREATMENT +adecuado8*. I-TREATMENT +Los I-TREATMENT +adhesivos I-TREATMENT +utilizados I-TREATMENT +son I-TREATMENT +a I-TREATMENT +base I-TREATMENT +de I-TREATMENT +silicona I-TREATMENT +médica I-TREATMENT +(siliconas I-TREATMENT +externas I-TREATMENT +sin I-TREATMENT +plomo). I-TREATMENT +Normalmente I-TREATMENT +el I-TREATMENT +tiempo I-TREATMENT +de I-TREATMENT +efectividad I-TREATMENT +de I-TREATMENT +los I-TREATMENT +adhesivos I-TREATMENT +cutáneos I-TREATMENT +es I-TREATMENT +de I-TREATMENT +48 I-TREATMENT +horas, I-TREATMENT +pero I-TREATMENT +depende I-TREATMENT +del I-TREATMENT +clima. I-TREATMENT +Pasado I-TREATMENT +ese I-TREATMENT +tiempo, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +deberá I-TREATMENT +retirar I-TREATMENT +la I-TREATMENT +prótesis, I-TREATMENT +limpiarla I-TREATMENT +correctamente, I-TREATMENT +limpiando I-TREATMENT +también I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +donde I-TREATMENT +ésta I-TREATMENT +se I-TREATMENT +asienta. I-TREATMENT +Esta I-TREATMENT +tarea I-TREATMENT +casi I-TREATMENT +diaria I-TREATMENT +debe I-TREATMENT +ser I-TREATMENT +muy I-TREATMENT +cuidadosa I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +los I-TREATMENT +bordes I-TREATMENT +finos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +no I-TREATMENT +deben I-TREATMENT +recibir I-TREATMENT +el I-TREATMENT +adhesivo, I-TREATMENT +evitando I-TREATMENT +así I-TREATMENT +el I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +los I-TREATMENT +mismos3*. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +debe I-TREATMENT +advertir I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +proteger I-TREATMENT +su I-TREATMENT +prótesis I-TREATMENT +de I-TREATMENT +los I-TREATMENT +limpiadores I-TREATMENT +abrasivos, I-TREATMENT +solventes I-TREATMENT +o I-TREATMENT +volátiles, I-TREATMENT +perfumes, I-TREATMENT +colonias I-TREATMENT +y I-TREATMENT +sprays. I-TREATMENT +Solamente I-TREATMENT +se I-TREATMENT +deberá I-TREATMENT +usar I-TREATMENT +agua I-TREATMENT +tibia, I-TREATMENT +jabón I-TREATMENT +suave I-TREATMENT +o I-TREATMENT +detergente I-TREATMENT +para I-TREATMENT +limpiar I-TREATMENT +la I-TREATMENT +prótesis. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +gingival I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tiene I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +infancia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sangrado I-PRESENT_ILLNESS +ocasional I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +dolor. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +intraoral I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +encía I-EXPLORATION +vestibular I-EXPLORATION +superior, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +interincisal I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +rojiza, I-EXPLORATION +blanda I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión, I-EXPLORATION +similar I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +granuloma I-EXPLORATION +telangiectásico, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +algunas I-EXPLORATION +pequeñas I-EXPLORATION +vesículas I-EXPLORATION +rojizas I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +superficie. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +papila I-EXPLORATION +que I-EXPLORATION +separa I-EXPLORATION +el I-EXPLORATION +12 I-EXPLORATION +del I-EXPLORATION +13 I-EXPLORATION +se I-EXPLORATION +manifiesta I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +rojiza I-EXPLORATION +con I-EXPLORATION +pequeñas I-EXPLORATION +proyecciones I-EXPLORATION +papilares I-EXPLORATION +sobreelevadas, I-EXPLORATION +del I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +alfiler I-EXPLORATION +y I-EXPLORATION +entre I-EXPLORATION +ambas I-EXPLORATION +lesiones I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +pequeñas I-EXPLORATION +zonas I-EXPLORATION +puntiformes I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +rojiza. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +de I-EXPLORATION +encía I-EXPLORATION +insertada I-EXPLORATION +en I-EXPLORATION +palatino, I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +12 I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +13 I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +rojiza I-EXPLORATION +con I-EXPLORATION +elevaciones I-EXPLORATION +papilares I-EXPLORATION +similares I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +descritas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +vestibular. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +toma I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +vestibular I-EXPLORATION +del I-EXPLORATION +12 I-EXPLORATION +al I-EXPLORATION +13 I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +hemolinfangioma. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +salvo I-PAST_MEDICAL_HISTORY +estar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +fase I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +hormonal I-PAST_MEDICAL_HISTORY +sustitutiva, I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +referida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +odontología I-DERIVED_FROM/TO +general I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +periodoncia I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +iniciar I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +multidisciplinario. I-DERIVED_FROM/TO +El B-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +corregir I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +frente I-PRESENT_ILLNESS +estético, I-PRESENT_ILLNESS +solucionar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +movilidad I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +reposición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +molares I-PRESENT_ILLNESS +inferiores. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +anamnesis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +dental I-PAST_MEDICAL_HISTORY +constaba I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +fumadora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +diarios I-PAST_MEDICAL_HISTORY +y B-FAMILY_HISTORY +tenía I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +maternos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +enfermedad I-FAMILY_HISTORY +periodontal. I-FAMILY_HISTORY + I-FAMILY_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +dental, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba: I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +18/28/35/ I-EXPLORATION +36/38/45/46 I-EXPLORATION +y I-EXPLORATION +obturaciones I-EXPLORATION +en I-EXPLORATION +diversas I-EXPLORATION +piezas. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +periodontal I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +placa I-EXPLORATION +bacteriana I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +gingival, I-EXPLORATION +profundidad I-EXPLORATION +de I-EXPLORATION +sondaje I-EXPLORATION +entre I-EXPLORATION +4 I-EXPLORATION +y I-EXPLORATION +7 I-EXPLORATION +mm, I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +soporte I-EXPLORATION +generalizado; I-EXPLORATION +furca I-EXPLORATION +vestibular I-EXPLORATION +grado I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +lingual I-EXPLORATION +grado I-EXPLORATION +2 I-EXPLORATION +en I-EXPLORATION +37; I-EXPLORATION +furca I-EXPLORATION +vestibular I-EXPLORATION +grado I-EXPLORATION +2 I-EXPLORATION +en I-EXPLORATION +47; I-EXPLORATION +abundantes I-EXPLORATION +recesiones; I-EXPLORATION +movilidad I-EXPLORATION ++1 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +sextante I-EXPLORATION +anterosuperior I-EXPLORATION +y I-EXPLORATION ++2 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +grupo I-EXPLORATION +anteroinferior; I-EXPLORATION +mesialización I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +47 I-EXPLORATION +y I-EXPLORATION +48, I-EXPLORATION +y I-EXPLORATION +diastemas I-EXPLORATION +en I-EXPLORATION +frente I-EXPLORATION +anterosuperior. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +ortodóncica I-EXPLORATION +mostró I-EXPLORATION +clase I-EXPLORATION +III I-EXPLORATION +esquelética I-EXPLORATION +y I-EXPLORATION +dentaria, I-EXPLORATION +mordida I-EXPLORATION +cruzada I-EXPLORATION +anterior I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +céntrica, I-EXPLORATION +un I-EXPLORATION +contacto I-EXPLORATION +prematuro, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +sobrecarga I-EXPLORATION +funcional I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dientes I-EXPLORATION +anteriores. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ortopantomografía I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +dientes, I-EXPLORATION +buena I-EXPLORATION +relación I-EXPLORATION +corono I-EXPLORATION +radicular, I-EXPLORATION +pérdida I-EXPLORATION +ósea I-EXPLORATION +generalizada I-EXPLORATION +y I-EXPLORATION +horizontal I-EXPLORATION +de I-EXPLORATION +más I-EXPLORATION +del I-EXPLORATION +50%, I-EXPLORATION +espacio I-EXPLORATION +periodontal I-EXPLORATION +ensanchado I-EXPLORATION +en I-EXPLORATION +12, I-EXPLORATION +defecto I-EXPLORATION +angular I-EXPLORATION +en I-EXPLORATION +22 I-EXPLORATION +y I-EXPLORATION +37, I-EXPLORATION +defecto I-EXPLORATION +en I-EXPLORATION +furca I-EXPLORATION +de I-EXPLORATION +37 I-EXPLORATION +y I-EXPLORATION +47 I-EXPLORATION +y I-EXPLORATION +cortical I-EXPLORATION +ósea I-EXPLORATION +reforzada I-EXPLORATION +en I-EXPLORATION +grupo I-EXPLORATION +anteroinferior. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +cefalométrico I-EXPLORATION +reveló I-EXPLORATION +clase I-EXPLORATION +III I-EXPLORATION +esquelética, I-EXPLORATION +protrusión I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +incisivos I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +altura I-EXPLORATION +facial I-EXPLORATION +aumentada. I-EXPLORATION +Exploración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +temporo-mandibular: I-EXPLORATION +sin I-EXPLORATION +interés. I-EXPLORATION +A I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +previamente I-EXPLORATION +expuestos, I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +el I-EXPLORATION +siguiente I-EXPLORATION +diagnóstico: I-EXPLORATION +enfermedad I-EXPLORATION +periodontal I-EXPLORATION +generalizada I-EXPLORATION +y I-EXPLORATION +avanzada; I-EXPLORATION +clase I-EXPLORATION +III I-EXPLORATION +esquelética I-EXPLORATION +y I-EXPLORATION +dentaria. I-EXPLORATION + I-EXPLORATION +Exposición B-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT + I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +planificó I-TREATMENT +en I-TREATMENT +cuatro I-TREATMENT +fases: I-TREATMENT +regeneración I-TREATMENT +periodontal, I-TREATMENT +nivelación I-TREATMENT +de I-TREATMENT +arcadas I-TREATMENT +mediante I-TREATMENT +ortodoncia, I-TREATMENT +reposición I-TREATMENT +de I-TREATMENT +dientes I-TREATMENT +mediante I-TREATMENT +prótesis I-TREATMENT +implantosoportada I-TREATMENT +y I-TREATMENT +terapia I-TREATMENT +periodontal I-TREATMENT +de I-TREATMENT +soporte. I-TREATMENT + I-TREATMENT +Primera I-TREATMENT +fase: I-TREATMENT +comenzamos I-TREATMENT +por I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +periodontal. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +había I-TREATMENT +sido I-TREATMENT +ya I-TREATMENT +motivada I-TREATMENT +e I-TREATMENT +instruida I-TREATMENT +en I-TREATMENT +normas I-TREATMENT +y I-TREATMENT +hábitos I-TREATMENT +de I-TREATMENT +higiene I-TREATMENT +oral I-TREATMENT +por I-TREATMENT +su I-TREATMENT +dentista, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +permitió I-TREATMENT +pasar I-TREATMENT +directamente I-TREATMENT +al I-TREATMENT +debridamiento I-TREATMENT +de I-TREATMENT +las I-TREATMENT +superficies I-TREATMENT +radiculares, I-TREATMENT +efectuando I-TREATMENT +raspajes, I-TREATMENT +alisados I-TREATMENT +y I-TREATMENT +pulido I-TREATMENT +de I-TREATMENT +superficies I-TREATMENT +contaminadas. I-TREATMENT +Dado I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +era I-TREATMENT +muy I-TREATMENT +fumadora, I-TREATMENT +esta I-TREATMENT +fase I-TREATMENT +resultó I-TREATMENT +algo I-TREATMENT +laboriosa. I-TREATMENT +Completamos I-TREATMENT +esta I-TREATMENT +fase I-TREATMENT +con I-TREATMENT +cirugía I-TREATMENT +periodontal I-TREATMENT +de I-TREATMENT +bolsas I-TREATMENT +residuales, I-TREATMENT +es I-TREATMENT +decir, I-TREATMENT +las I-TREATMENT +que I-TREATMENT +presentaban I-TREATMENT +hemorragia I-TREATMENT +al I-TREATMENT +sondaje I-TREATMENT +cuatro I-TREATMENT +semanas I-TREATMENT +después I-TREATMENT +de I-TREATMENT +concluida I-TREATMENT +la I-TREATMENT +fase I-TREATMENT +básica. I-TREATMENT +A I-TREATMENT +la I-TREATMENT +vez, I-TREATMENT +procedimos I-TREATMENT +a I-TREATMENT +tratar I-TREATMENT +los I-TREATMENT +defectos I-TREATMENT +óseos I-TREATMENT +angulares I-TREATMENT +y I-TREATMENT +de I-TREATMENT +furcas I-TREATMENT +de I-TREATMENT +12, I-TREATMENT +22, I-TREATMENT +37 I-TREATMENT +y I-TREATMENT +47 I-TREATMENT +y I-TREATMENT +efectuamos I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +ellos I-TREATMENT +un I-TREATMENT +pequeño I-TREATMENT +colgajo I-TREATMENT +para I-TREATMENT +regenerar I-TREATMENT +los I-TREATMENT +tejidos I-TREATMENT +periodontales I-TREATMENT +con I-TREATMENT +Emdogain®. I-TREATMENT +El I-TREATMENT +plazo I-TREATMENT +de I-TREATMENT +tiempo I-TREATMENT +transcurrido I-TREATMENT +en I-TREATMENT +los I-TREATMENT +pasos I-TREATMENT +previos I-TREATMENT +sirvió I-TREATMENT +para I-TREATMENT +reforzar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +hábitos I-TREATMENT +de I-TREATMENT +higiene I-TREATMENT +interdental I-TREATMENT +y I-TREATMENT +para I-TREATMENT +animarle I-TREATMENT +a I-TREATMENT +que I-TREATMENT +suprimiera I-TREATMENT +el I-TREATMENT +hábito I-TREATMENT +del I-TREATMENT +tabaquismo, I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +consiguió. I-TREATMENT +Hubo I-TREATMENT +que I-TREATMENT +preparar I-TREATMENT +una I-TREATMENT +férula I-TREATMENT +de I-TREATMENT +relajación I-TREATMENT +porque I-TREATMENT +la I-TREATMENT +supresión I-TREATMENT +del I-TREATMENT +tabaco I-TREATMENT +le I-TREATMENT +provocaba I-TREATMENT +mucha I-TREATMENT +ansiedad, I-TREATMENT +sensibilidad I-TREATMENT +y I-TREATMENT +dolor I-TREATMENT +dental. I-TREATMENT +Además I-TREATMENT +se I-TREATMENT +le I-TREATMENT +propuso I-TREATMENT +revisión I-TREATMENT +de I-TREATMENT +mantenimiento I-TREATMENT +cada I-TREATMENT +cuatro I-TREATMENT +meses I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +finalizadas I-TREATMENT +las I-TREATMENT +restantes I-TREATMENT +fases I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +si I-TREATMENT +la I-TREATMENT +situación I-TREATMENT +periodontal I-TREATMENT +y I-TREATMENT +de I-TREATMENT +los I-TREATMENT +implantes I-TREATMENT +no I-TREATMENT +variaba. I-TREATMENT + I-TREATMENT +Segunda B-DERIVED_FROM/TO +fase. I-DERIVED_FROM/TO +Doce I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +después I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +regeneración I-DERIVED_FROM/TO +periodontal I-DERIVED_FROM/TO +guiada, I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +referida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +ortodoncista I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +continuar I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +tratamiento. I-DERIVED_FROM/TO +Esta B-TREATMENT +fase I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +con I-TREATMENT +ortodoncia I-TREATMENT +fija, I-TREATMENT +nivelando I-TREATMENT +la I-TREATMENT +arcada I-TREATMENT +maxilar I-TREATMENT +con I-TREATMENT +un I-TREATMENT +levante I-TREATMENT +de I-TREATMENT +mordida I-TREATMENT +mandibular. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +resuelta I-TREATMENT +la I-TREATMENT +mordida I-TREATMENT +anterior, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +nivelar I-TREATMENT +la I-TREATMENT +arcada I-TREATMENT +mandibular, I-TREATMENT +preparando I-TREATMENT +los I-TREATMENT +espacios I-TREATMENT +que I-TREATMENT +más I-TREATMENT +adelante I-TREATMENT +servirían I-TREATMENT +para I-TREATMENT +colocar I-TREATMENT +implantes, I-TREATMENT +si I-TREATMENT +el I-TREATMENT +ancho I-TREATMENT +de I-TREATMENT +hueso I-TREATMENT +lo I-TREATMENT +permitía. I-TREATMENT +Para I-TREATMENT +conseguir I-TREATMENT +esos I-TREATMENT +espacios I-TREATMENT +se I-TREATMENT +nivelaron I-TREATMENT +los I-TREATMENT +molares I-TREATMENT +posteriores I-TREATMENT +mandibulares, I-TREATMENT +empleando I-TREATMENT +arcos I-TREATMENT +con I-TREATMENT +escalones I-TREATMENT +para I-TREATMENT +no I-TREATMENT +interferir I-TREATMENT +la I-TREATMENT +masticación. I-TREATMENT +Aunque I-TREATMENT +se I-TREATMENT +trataba I-TREATMENT +de I-TREATMENT +una I-TREATMENT +clase I-TREATMENT +III, I-TREATMENT +fue I-TREATMENT +preciso I-TREATMENT +empujar I-TREATMENT +hacia I-TREATMENT +mesial I-TREATMENT +el I-TREATMENT +tercer I-TREATMENT +cuadrante I-TREATMENT +que I-TREATMENT +estaba I-TREATMENT +en I-TREATMENT +clase I-TREATMENT +II I-TREATMENT +dentaria I-TREATMENT +sin I-TREATMENT +sobrecargar I-TREATMENT +los I-TREATMENT +incisivos I-TREATMENT +superiores, I-TREATMENT +por I-TREATMENT +eso I-TREATMENT +evitamos I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +elásticos I-TREATMENT +para I-TREATMENT +corregir I-TREATMENT +la I-TREATMENT +Clase I-TREATMENT +II I-TREATMENT +en I-TREATMENT +el I-TREATMENT +lado I-TREATMENT +izquierdo I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +22 I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +34. I-TREATMENT +Para I-TREATMENT +mesializar I-TREATMENT +el I-TREATMENT +tercer I-TREATMENT +cuadrante I-TREATMENT +se I-TREATMENT +recurrió I-TREATMENT +a I-TREATMENT +un I-TREATMENT +anclaje I-TREATMENT +óseo I-TREATMENT +mediante I-TREATMENT +un I-TREATMENT +microtornillo I-TREATMENT +y I-TREATMENT +un I-TREATMENT +resorte I-TREATMENT +de I-TREATMENT +19 I-TREATMENT +x I-TREATMENT +25 I-TREATMENT +de I-TREATMENT +TMA®, I-TREATMENT +donde I-TREATMENT +podemos I-TREATMENT +observar I-TREATMENT +el I-TREATMENT +canino I-TREATMENT +en I-TREATMENT +clase I-TREATMENT +I I-TREATMENT +de I-TREATMENT +Angle. I-TREATMENT +Los I-TREATMENT +registros I-TREATMENT +finales I-TREATMENT +pueden I-TREATMENT +verse I-TREATMENT +en I-TREATMENT +la I-TREATMENT +figura I-TREATMENT +9. I-TREATMENT +Para I-TREATMENT +finalizar, I-TREATMENT +el I-TREATMENT +ortodoncista I-TREATMENT +hizo I-TREATMENT +una I-TREATMENT +retención I-TREATMENT +intracoronaria, I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +deberá I-TREATMENT +llevar I-TREATMENT +de I-TREATMENT +por I-TREATMENT +vida. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +tercera I-EXPLORATION +fase, I-EXPLORATION +o I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +reposición I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +molares I-EXPLORATION +ausentes, I-EXPLORATION +requirió I-EXPLORATION +inicialmente I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +zonas I-EXPLORATION +desdentadas I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +colocar I-EXPLORATION +implantes. I-EXPLORATION +Gracias I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +obtenidas I-EXPLORATION +en I-EXPLORATION +diversos I-EXPLORATION +cortes, I-EXPLORATION +posteriormente I-EXPLORATION +manipuladas I-EXPLORATION +con I-EXPLORATION +programas I-EXPLORATION +de I-EXPLORATION +simulación I-EXPLORATION +para I-EXPLORATION +implantes, I-EXPLORATION +se I-EXPLORATION +concluyó I-EXPLORATION +que I-EXPLORATION +era I-EXPLORATION +viable I-EXPLORATION +colocar I-EXPLORATION +fijaciones I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +x I-EXPLORATION +9 I-EXPLORATION +mm I-EXPLORATION +(Astra®) I-EXPLORATION +a I-EXPLORATION +cada I-EXPLORATION +lado I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tramos I-EXPLORATION +desdentados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mandíbula. I-EXPLORATION +Estas B-TREATMENT +fijaciones I-TREATMENT +fueron I-TREATMENT +guiadas I-TREATMENT +e I-TREATMENT +instaladas I-TREATMENT +por I-TREATMENT +una I-TREATMENT +férula I-TREATMENT +diagnóstico-quirúrgica, I-TREATMENT +previamente I-TREATMENT +confeccionada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +prostodoncista, I-TREATMENT +en I-TREATMENT +los I-TREATMENT +lugares I-TREATMENT +correspondientes I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dientes I-TREATMENT +35, I-TREATMENT +36, I-TREATMENT +45, I-TREATMENT +46. I-TREATMENT + I-TREATMENT +Como I-TREATMENT +es I-TREATMENT +habitual I-TREATMENT +en I-TREATMENT +estos I-TREATMENT +tratamientos I-TREATMENT +quirúrgicos, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +presentó I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +días I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía, I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +el I-TREATMENT +presupuesto I-TREATMENT +y I-TREATMENT +plan I-TREATMENT +de I-TREATMENT +tratamiento, I-TREATMENT +el I-TREATMENT +formulario I-TREATMENT +del I-TREATMENT +Colegio I-TREATMENT +de I-TREATMENT +Odontólogos I-TREATMENT +y I-TREATMENT +Estomatólogos I-TREATMENT +de I-TREATMENT +Aragón I-TREATMENT +para I-TREATMENT +informarle I-TREATMENT +de I-TREATMENT +los I-TREATMENT +posibles I-TREATMENT +riesgos I-TREATMENT +que I-TREATMENT +pudieran I-TREATMENT +surgir I-TREATMENT +a I-TREATMENT +consecuencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención. I-TREATMENT +Tras I-TREATMENT +meditada I-TREATMENT +lectura, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +firmar I-TREATMENT +el I-TREATMENT +preceptivo I-TREATMENT +consentimiento I-TREATMENT +informado. I-TREATMENT +Por I-TREATMENT +otra I-TREATMENT +parte, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +siguió I-TREATMENT +llevando I-TREATMENT +la I-TREATMENT +férula I-TREATMENT +de I-TREATMENT +relajación I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +periodo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +integración, I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +comodidad I-TREATMENT +que I-TREATMENT +le I-TREATMENT +proporcionaba. I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +cuarta I-TREATMENT +fase, I-TREATMENT +el I-TREATMENT +prostodoncista I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +implanto-soportada I-TREATMENT +en I-TREATMENT +metal I-TREATMENT +cerámica I-TREATMENT +y I-TREATMENT +la I-TREATMENT +cementó I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +el I-TREATMENT +generalista I-TREATMENT +en I-TREATMENT +aquel I-TREATMENT +momento I-TREATMENT +no I-TREATMENT +colocaba I-TREATMENT +implantes I-TREATMENT +ni I-TREATMENT +hacía I-TREATMENT +prótesis I-TREATMENT +implanto-soportadas. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +figura I-TREATMENT +11 I-TREATMENT +vemos I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +un I-TREATMENT +año I-TREATMENT +después I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +ortodóncico I-TREATMENT +con I-TREATMENT +la I-TREATMENT +boca I-TREATMENT +rehabilitada. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +tercer I-EVOLUTION +control I-EVOLUTION +radiológico I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +colocación I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +fijaciones I-EVOLUTION +se I-EVOLUTION +apreció I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +hueso I-EVOLUTION +en I-EVOLUTION +varias I-EVOLUTION +espiras I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +fijaciones I-EVOLUTION +correspondientes I-EVOLUTION +al I-EVOLUTION +35' I-EVOLUTION +y I-EVOLUTION +45'. I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +mantener I-TREATMENT +esa I-TREATMENT +mucosa I-TREATMENT +bajo I-TREATMENT +un I-TREATMENT +régimen I-TREATMENT +de I-TREATMENT +higiene I-TREATMENT +oral I-TREATMENT +muy I-TREATMENT +estricto, I-TREATMENT +efectuando I-TREATMENT +controles I-TREATMENT +quincenales I-TREATMENT +de I-TREATMENT +placa, I-TREATMENT +pulido I-TREATMENT +de I-TREATMENT +la I-TREATMENT +superficie I-TREATMENT +de I-TREATMENT +piezas I-TREATMENT +e I-TREATMENT +implantes I-TREATMENT +con I-TREATMENT +taza I-TREATMENT +de I-TREATMENT +goma I-TREATMENT +y I-TREATMENT +enjuagues I-TREATMENT +con I-TREATMENT +clorhexidina I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +20% I-TREATMENT +cada I-TREATMENT +doce I-TREATMENT +horas, I-TREATMENT +hasta I-TREATMENT +conseguir I-TREATMENT +que I-TREATMENT +los I-TREATMENT +tejidos I-TREATMENT +periimplantarios I-TREATMENT +no I-TREATMENT +presentaran I-TREATMENT +hemorragia I-TREATMENT +al I-TREATMENT +sondaje. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +continua I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +en I-EVOLUTION +tratamiento I-EVOLUTION +de I-EVOLUTION +mantenimiento I-EVOLUTION +periodontal, I-EVOLUTION +con I-EVOLUTION +revisiones I-EVOLUTION +trimestrales I-EVOLUTION +para I-EVOLUTION +comprobar I-EVOLUTION +la I-EVOLUTION +estabilidad I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +piezas, I-EVOLUTION +implantes I-EVOLUTION +y I-EVOLUTION +prótesis. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +al B-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +DP I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +sustitutivo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +IRCT I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +consecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +severa I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hiperuricemia. I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +siguiente I-PAST_MEDICAL_HISTORY +perfil I-PAST_MEDICAL_HISTORY +respeto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +situación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +acidosis. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Dado I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +general I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +bueno I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +mantenía I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +diuresis I-PAST_MEDICAL_HISTORY +residual I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +(2000 I-PAST_MEDICAL_HISTORY +ml/d, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +decidió I-PAST_MEDICAL_HISTORY +iniciar I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +depurador I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +intercambios I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2l, I-PAST_MEDICAL_HISTORY +(4 I-PAST_MEDICAL_HISTORY +l I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +1’26% I-PAST_MEDICAL_HISTORY ++ I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +l I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Icodextrina I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +recambio I-PAST_MEDICAL_HISTORY +nocturno). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +iniciada I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +DP I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +incluido I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +multicéntrico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +evaluaba I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +líquido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diálisis I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +bicarbonato, I-PRESENT_ILLNESS +Physioneal®. I-PRESENT_ILLNESS +Las B-EXPLORATION +características I-EXPLORATION +dialíticas I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +reflejan I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +2. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +poco I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +utilizar I-EXPLORATION +esta I-EXPLORATION +solución I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +refiere I-EXPLORATION +algunas I-EXPLORATION +molestias I-EXPLORATION +como: I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sensación I-EXPLORATION +de I-EXPLORATION +sed I-EXPLORATION +y I-EXPLORATION +discreta I-EXPLORATION +distensión I-EXPLORATION +abdominal I-EXPLORATION +los I-EXPLORATION +primeros I-EXPLORATION +días. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Manifiesta I-EXPLORATION +que I-EXPLORATION +ocasionalmente I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +finalizar I-EXPLORATION +los I-EXPLORATION +drenajes I-EXPLORATION +siente I-EXPLORATION +dolor, I-EXPLORATION +que I-EXPLORATION +atribuye I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +posición I-EXPLORATION +del I-EXPLORATION +catéter. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Aparición I-EXPLORATION +de I-EXPLORATION +coágulos I-EXPLORATION +de I-EXPLORATION +fibrina I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +líquido I-EXPLORATION +drenado. I-EXPLORATION + I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +da I-EXPLORATION +importancia I-EXPLORATION +a I-EXPLORATION +estas I-EXPLORATION +manifestaciones I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +atribuyen, I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +parte I-EXPLORATION +al I-EXPLORATION +incumplimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +dieta I-EXPLORATION +por I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +paciente, I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +tenía I-EXPLORATION +un I-EXPLORATION +sodio I-EXPLORATION +alto I-EXPLORATION +(141mEq/L), I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +otra, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +incomodidad I-EXPLORATION +que I-EXPLORATION +ocasionalmente I-EXPLORATION +provoca I-EXPLORATION +el I-EXPLORATION +líquido I-EXPLORATION +IP I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +adaptación I-EXPLORATION +al I-EXPLORATION +tratamiento. I-EXPLORATION +Para B-TREATMENT +evitar I-TREATMENT +la I-TREATMENT +formación I-TREATMENT +de I-TREATMENT +coágulos I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +15 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +heparina I-TREATMENT +sódica I-TREATMENT +en I-TREATMENT +el I-TREATMENT +líquido I-TREATMENT +de I-TREATMENT +diálisis. I-TREATMENT +Esta B-EVOLUTION +sintomatología I-EVOLUTION +remitió I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +era I-EVOLUTION +satisfactorio. I-EVOLUTION +El I-EVOLUTION +estudio I-EVOLUTION +tuvo I-EVOLUTION +una I-EVOLUTION +duración I-EVOLUTION +de I-EVOLUTION +tres I-EVOLUTION +meses; I-EVOLUTION +al I-EVOLUTION +final I-EVOLUTION +del I-EVOLUTION +mismo I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +analíticos I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +y I-EVOLUTION +características I-EVOLUTION +dialíticas I-EVOLUTION +se I-EVOLUTION +reflejan I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +tabla I-EVOLUTION +3. I-EVOLUTION + I-EVOLUTION +Se B-TREATMENT +reinicia I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +habitual I-TREATMENT +con I-TREATMENT +4 I-TREATMENT +l I-TREATMENT +de I-TREATMENT +con I-TREATMENT +glucosa I-TREATMENT +al I-TREATMENT +1’5%, I-TREATMENT +Ca I-TREATMENT +normal I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +l I-TREATMENT +de I-TREATMENT +solución I-TREATMENT +con I-TREATMENT +Icodextrina I-TREATMENT +para I-TREATMENT +el I-TREATMENT +recambio I-TREATMENT +nocturno. I-TREATMENT +Tras B-EVOLUTION +estos I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +solución I-EVOLUTION +de I-EVOLUTION +bicarbonato, I-EVOLUTION +la I-EVOLUTION +situación I-EVOLUTION +clínica I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +era I-EVOLUTION +buena I-EVOLUTION +(aunque I-EVOLUTION +había I-EVOLUTION +manifestado I-EVOLUTION +alguna I-EVOLUTION +molestia) I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +analíticos I-EVOLUTION +aceptables, I-EVOLUTION +pero I-EVOLUTION +se I-EVOLUTION +hade I-EVOLUTION +destacar I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +periodo I-EVOLUTION +corto I-EVOLUTION +de I-EVOLUTION +tiempo, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +había I-EVOLUTION +pasado I-EVOLUTION +de I-EVOLUTION +ser I-EVOLUTION +"Medio I-EVOLUTION +alto I-EVOLUTION +transportador" I-EVOLUTION +a I-EVOLUTION +"Alto I-EVOLUTION +transportador", I-EVOLUTION +disminuyendo I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +de I-EVOLUTION +Kt/V. I-EVOLUTION + I-EVOLUTION +Cinco B-TREATMENT +meses I-TREATMENT +más I-TREATMENT +tarde, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +reiniciar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +bicarbonato. I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +desea I-TREATMENT +volver I-TREATMENT +a I-TREATMENT +utilizar I-TREATMENT +la I-TREATMENT +nueva I-TREATMENT +solución I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +le I-TREATMENT +parecía I-TREATMENT +que I-TREATMENT +con I-TREATMENT +ella"se I-TREATMENT +encontraba I-TREATMENT +mejor" I-TREATMENT +(menos I-TREATMENT +astenia I-TREATMENT +y I-TREATMENT +mejor I-TREATMENT +estado I-TREATMENT +de I-TREATMENT +ánimo). I-TREATMENT +Aunque I-TREATMENT +el I-TREATMENT +Kt/V I-TREATMENT +era I-TREATMENT +ligeramente I-TREATMENT +inferior I-TREATMENT +a I-TREATMENT +los I-TREATMENT +valores I-TREATMENT +recomendados, I-TREATMENT +al I-TREATMENT +mantener I-TREATMENT +diuresis, I-TREATMENT +buen I-TREATMENT +aclaramiento I-TREATMENT +de I-TREATMENT +creatinina I-TREATMENT +y I-TREATMENT +buen I-TREATMENT +estado I-TREATMENT +general, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +no I-TREATMENT +aumentar I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +diálisis. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +considero I-TREATMENT +importante I-TREATMENT +el I-TREATMENT +que I-TREATMENT +hubieran I-TREATMENT +aumentado I-TREATMENT +ligeramente I-TREATMENT +los I-TREATMENT +valores I-TREATMENT +del I-TREATMENT +HCO3. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +control I-EVOLUTION +realizado I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +reiniciar I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +solución I-EVOLUTION +de I-EVOLUTION +bicarbonato I-EVOLUTION +se I-EVOLUTION +obtuvieron I-EVOLUTION +los I-EVOLUTION +resultados I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +observan I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +tabla I-EVOLUTION +5. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +presentaba I-EVOLUTION +muy I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +incluso I-EVOLUTION +deseaba I-EVOLUTION +irse I-EVOLUTION +de I-EVOLUTION +vacaciones I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +continuar I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +pauta I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION + I-EVOLUTION +Tres I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +y I-EVOLUTION +coincidiendo I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +siguiente I-EVOLUTION +control, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +sintiéndose I-EVOLUTION +bien I-EVOLUTION +y I-EVOLUTION +ha I-EVOLUTION +decidido I-EVOLUTION +irse I-EVOLUTION +de I-EVOLUTION +vacaciones. I-EVOLUTION +No I-EVOLUTION +obstante, I-EVOLUTION +su I-EVOLUTION +diuresis I-EVOLUTION +y I-EVOLUTION +Kt/V I-EVOLUTION +han I-EVOLUTION +disminuido I-EVOLUTION +y I-EVOLUTION +está I-EVOLUTION +hipertenso. I-EVOLUTION +Se B-TREATMENT +le I-TREATMENT +prescribe I-TREATMENT +mayor I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +hipotensores I-TREATMENT +y I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +aumentar I-TREATMENT +el I-TREATMENT +flujo I-TREATMENT +peritoneal I-TREATMENT +a I-TREATMENT +cuatro I-TREATMENT +recambios I-TREATMENT +/día: I-TREATMENT +6 I-TREATMENT +l I-TREATMENT +al I-TREATMENT +1.36% I-TREATMENT +y I-TREATMENT +Icodextrina I-TREATMENT +2 I-TREATMENT +l, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +recambio I-TREATMENT +nocturno. I-TREATMENT + I-TREATMENT +Un B-EVOLUTION +mes I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +acude I-EVOLUTION +al I-EVOLUTION +hospital I-EVOLUTION +con I-EVOLUTION +carácter I-EVOLUTION +urgente, I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +líquido I-EVOLUTION +turbio I-EVOLUTION +con I-EVOLUTION +cultivo I-EVOLUTION +negativo I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +abdominal, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +cree I-EVOLUTION +es I-EVOLUTION +consecuencia I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +irritación I-EVOLUTION +peritoneal I-EVOLUTION +producida I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +excesiva I-EVOLUTION +UF I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +Icodextrina, I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +infusión I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +l I-EVOLUTION +drena I-EVOLUTION +(3'8 I-EVOLUTION +l. I-EVOLUTION +Se B-TREATMENT +le I-TREATMENT +administran I-TREATMENT +antibióticos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +reduce I-TREATMENT +el I-TREATMENT +volumen I-TREATMENT +de I-TREATMENT +la I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +Icodextrina I-TREATMENT +a I-TREATMENT +1’5 I-TREATMENT +l. I-TREATMENT +El B-EVOLUTION +cuadro I-EVOLUTION +se I-EVOLUTION +soluciona I-EVOLUTION +favorablemente. I-EVOLUTION + I-EVOLUTION +Quince I-EVOLUTION +días I-EVOLUTION +más I-EVOLUTION +tarde, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +acude I-EVOLUTION +al I-EVOLUTION +hospital I-EVOLUTION +presentando I-EVOLUTION +una I-EVOLUTION +alteración I-EVOLUTION +importante I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +infección, I-EVOLUTION +destacando: B-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Descenso I-EXPLORATION +brusco I-EXPLORATION +del I-EXPLORATION +Hto I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Hipertensión I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Hiperhidratación I-EXPLORATION +(aumento I-EXPLORATION +de I-EXPLORATION +peso I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +edemas I-EXPLORATION +maleolares) I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Disnea I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Desorientación I-EXPLORATION +importante I-EXPLORATION +en I-EXPLORATION +espacio-tiempo I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Elevación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +diafragmas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +RX I-EXPLORATION +tórax, I-EXPLORATION +con I-EXPLORATION +reducción I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +campos I-EXPLORATION +pulmonares I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +analíticos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +reflejan I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +6 I-EXPLORATION +demuestran I-EXPLORATION +una I-EXPLORATION +ALCALOSIS I-EXPLORATION +METABÓLICA. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +esta I-TREATMENT +situación, I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +la I-TREATMENT +infusión I-TREATMENT +del I-TREATMENT +líquido I-TREATMENT +con I-TREATMENT +bicarbonato I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +la I-TREATMENT +DP I-TREATMENT +con I-TREATMENT +líquido I-TREATMENT +con I-TREATMENT +lactato I-TREATMENT +PD1, I-TREATMENT +aumentando I-TREATMENT +la I-TREATMENT +frecuencia I-TREATMENT +de I-TREATMENT +los I-TREATMENT +recambios I-TREATMENT +a10 I-TREATMENT +l/día. I-TREATMENT +Para I-TREATMENT +optimizar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +utiliza I-TREATMENT +runa I-TREATMENT +cicladora, I-TREATMENT +para I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +instruye I-TREATMENT +a I-TREATMENT +la I-TREATMENT +esposa I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +el I-TREATMENT +estado I-TREATMENT +de I-TREATMENT +conciencia I-TREATMENT +de I-TREATMENT +éste I-TREATMENT +no I-TREATMENT +permite I-TREATMENT +entrenarlo. I-TREATMENT +A B-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +iniciar I-EVOLUTION +del I-EVOLUTION +nuevo I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +cicladora I-EVOLUTION +hospitalaria, I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +mejorado, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +la I-EVOLUTION +situación I-EVOLUTION +de I-EVOLUTION +acidosis. I-EVOLUTION +Es I-EVOLUTION +capaz, I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +apoyo I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +esposa, I-EVOLUTION +de I-EVOLUTION +iniciar I-EVOLUTION +la I-EVOLUTION +diálisis I-EVOLUTION +peritoneal I-EVOLUTION +automatizada I-EVOLUTION +(DPA) I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +casa. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +iniciada I-EVOLUTION +la I-EVOLUTION +diálisis I-EVOLUTION +peritoneal I-EVOLUTION +con I-EVOLUTION +cicladora I-EVOLUTION +se I-EVOLUTION +normalizaron I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +analíticos I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +tensión I-EVOLUTION +arterial, I-EVOLUTION +siendo I-EVOLUTION +su I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +bueno. I-EVOLUTION +Los I-EVOLUTION +parámetros I-EVOLUTION +más I-EVOLUTION +destacables I-EVOLUTION +se I-EVOLUTION +reflejan I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +tabla I-EVOLUTION +8. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +(30 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +DP), I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +ninguna I-EVOLUTION +complicación, I-EVOLUTION +ningún I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +líquido I-EVOLUTION +turbio I-EVOLUTION +y I-EVOLUTION +su I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +es I-EVOLUTION +correcto, I-EVOLUTION +con I-EVOLUTION +tendencia I-EVOLUTION +al I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +sin I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +edemas. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +obesidad, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +controlada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dieta I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tabaquismo, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +glomerulonefritis I-PRESENT_ILLNESS +rápidamente I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +anticuerpos I-PRESENT_ILLNESS +antimembrana I-PRESENT_ILLNESS +basal I-PRESENT_ILLNESS +glomerular. I-PRESENT_ILLNESS +Por B-TREATMENT +este I-TREATMENT +motivo, I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +inmunosupresor I-TREATMENT +con I-TREATMENT +esteroides, I-TREATMENT +ciclofosfamida I-TREATMENT +y I-TREATMENT +también I-TREATMENT +plasmaféresis, I-TREATMENT +todo I-TREATMENT +ello, I-TREATMENT +sin I-TREATMENT +resultado I-TREATMENT +satisfactorio I-TREATMENT +para I-TREATMENT +su I-TREATMENT +función I-TREATMENT +renal. I-TREATMENT + I-TREATMENT +Inicialmente I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +renal I-TREATMENT +sustitutivo I-TREATMENT +mediante I-TREATMENT +HD I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +pasó I-TREATMENT +a I-TREATMENT +DP. I-TREATMENT +Durante B-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +en I-EVOLUTION +esta I-EVOLUTION +técnica, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +desarrolló I-EVOLUTION +10 I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +peritonitis, I-EVOLUTION +9 I-EVOLUTION +de I-EVOLUTION +ellos I-EVOLUTION +por I-EVOLUTION +Staphilococcus I-EVOLUTION +(8 I-EVOLUTION +epidermidis I-EVOLUTION +y I-EVOLUTION +1 I-EVOLUTION +capitis). I-EVOLUTION +El I-EVOLUTION +último I-EVOLUTION +de I-EVOLUTION +ellos I-EVOLUTION +por I-EVOLUTION +Candida I-EVOLUTION +albicans, I-EVOLUTION +que I-EVOLUTION +motivó I-EVOLUTION +la I-EVOLUTION +retirada I-EVOLUTION +del I-EVOLUTION +catéter I-EVOLUTION +de I-EVOLUTION +DP I-EVOLUTION +y I-EVOLUTION +su I-EVOLUTION +transferencia I-EVOLUTION +a I-EVOLUTION +HD. I-EVOLUTION +Durante I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +DP I-EVOLUTION +se I-EVOLUTION +transformó I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +"alto I-EVOLUTION +transportador". I-EVOLUTION + I-EVOLUTION +Seis I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +cambio I-EVOLUTION +de I-EVOLUTION +modalidad I-EVOLUTION +terapéutica, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +sufre I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +con I-EVOLUTION +vómitos, I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +peso, I-EVOLUTION +distensión I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +efecto I-EVOLUTION +masa I-EVOLUTION +en I-EVOLUTION +hipogastrio. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +apreciándose I-EXPLORATION +marcada I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +estómago I-EXPLORATION +y I-EXPLORATION +asa I-EXPLORATION +proximal I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +delgado, I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +pared I-EXPLORATION +moderadamente I-EXPLORATION +engrosada; I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +septos I-EXPLORATION +en I-EXPLORATION +hipogastrio. I-EXPLORATION + I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computorizada I-EXPLORATION +(TAC) I-EXPLORATION +abdominal, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +perihepático I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +periesplénico, I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +peritoneal, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +pélvica I-EXPLORATION +con I-EXPLORATION +septos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +que I-EXPLORATION +engloba I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado, I-EXPLORATION +condicionando I-EXPLORATION +gran I-EXPLORATION +dilatación I-EXPLORATION +gástrica, I-EXPLORATION +duodenal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +yeyuno, I-EXPLORATION +con I-EXPLORATION +niveles I-EXPLORATION +hidroaéreos, I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +condujo I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +esclerosis I-EXPLORATION +peritoneal. I-EXPLORATION + I-EXPLORATION +Por B-TREATMENT +otra I-TREATMENT +parte, I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +le I-TREATMENT +propuso I-TREATMENT +tratamiento I-TREATMENT +quirúrgico, I-TREATMENT +que I-TREATMENT +desestimó. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +tórpida, I-EVOLUTION +con I-EVOLUTION +varios I-EVOLUTION +ingresos I-EVOLUTION +por I-EVOLUTION +cuadros I-EVOLUTION +de I-EVOLUTION +oclusión I-EVOLUTION +intestinal, I-EVOLUTION +precisando I-EVOLUTION +alimentación I-EVOLUTION +parenteral, I-EVOLUTION +administración I-EVOLUTION +sin I-EVOLUTION +éxito I-EVOLUTION +de I-EVOLUTION +esteroides I-EVOLUTION +y I-EVOLUTION +progresivo I-EVOLUTION +deterioro I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +estado, I-EVOLUTION +con I-EVOLUTION +ascitis I-EVOLUTION +y I-EVOLUTION +desnutrición I-EVOLUTION +que I-EVOLUTION +motivaron I-EVOLUTION +su I-EVOLUTION +fallecimiento I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico. I-EVOLUTION + I-EVOLUTION +Resultados B-EXPLORATION +y I-EXPLORATION +descripción I-EXPLORATION + I-EXPLORATION +Tenemos I-EXPLORATION +una I-EXPLORATION +serie I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +predictivos I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +entidad, I-EXPLORATION +como I-EXPLORATION +son I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +en I-EXPLORATION +DP, I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +sea I-EXPLORATION +alto I-EXPLORATION +transportador, I-EXPLORATION +y I-EXPLORATION +factores I-EXPLORATION +predisponentes I-EXPLORATION +como I-EXPLORATION +son, I-EXPLORATION +el I-EXPLORATION +hiperparatiroidismo I-EXPLORATION +grave I-EXPLORATION +(primer I-EXPLORATION +caso) I-EXPLORATION +o I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +peritonitis I-EXPLORATION +de I-EXPLORATION +repetición I-EXPLORATION +(en I-EXPLORATION +el I-EXPLORATION +segundo). I-EXPLORATION +Hay I-EXPLORATION +que I-EXPLORATION +tener I-EXPLORATION +en I-EXPLORATION +cuenta, I-EXPLORATION +que I-EXPLORATION +más I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mitad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +casos, I-EXPLORATION +se I-EXPLORATION +producen I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +abandono I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +DP. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +se I-EXPLORATION +efectúa I-EXPLORATION +mediante I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen: I-EXPLORATION +Rx I-EXPLORATION +simple, I-EXPLORATION +ecografía I-EXPLORATION +o I-EXPLORATION +TAC I-EXPLORATION +abdominal, I-EXPLORATION +aunque I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +obtener I-EXPLORATION +mediante I-EXPLORATION +biopsia I-EXPLORATION +peritoneal, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +apreciar, I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +fibroblastos, I-EXPLORATION +depósito I-EXPLORATION +de I-EXPLORATION +fibrina, I-EXPLORATION +angiogénesis I-EXPLORATION +capilar, I-EXPLORATION +sangrado I-EXPLORATION +perivascular I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +mononucleares. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +tratamiento I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +grave I-EXPLORATION +cuadro, I-EXPLORATION +dependerá I-EXPLORATION +del I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +peritoneal. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +estadios I-EXPLORATION +iniciales I-EXPLORATION +podría I-EXPLORATION +ser I-EXPLORATION +suficiente I-EXPLORATION +el I-EXPLORATION +reposo I-EXPLORATION +peritoneal; I-EXPLORATION +con I-EXPLORATION +lavados I-EXPLORATION +peritoneales I-EXPLORATION +y I-EXPLORATION +esteroides. I-EXPLORATION +En I-EXPLORATION +casos I-EXPLORATION +más I-EXPLORATION +avanzados I-EXPLORATION +se I-EXPLORATION +necesitará I-EXPLORATION +tratamiento I-EXPLORATION +inmunosupresor I-EXPLORATION +(ciclofosfamida, I-EXPLORATION +azatioprina, I-EXPLORATION +ciclosporina) I-EXPLORATION +e I-EXPLORATION +incluso I-EXPLORATION +tamoxifeno. I-EXPLORATION +En I-EXPLORATION +casos I-EXPLORATION +extremos I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +visceral, I-EXPLORATION +puede I-EXPLORATION +ser I-EXPLORATION +necesario I-EXPLORATION +recurrir I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cirugía, I-EXPLORATION +realizando I-EXPLORATION +enterolisis, I-EXPLORATION +técnica I-EXPLORATION +que I-EXPLORATION +tiene I-EXPLORATION +una I-EXPLORATION +mortalidad I-EXPLORATION +entre I-EXPLORATION +40-80%. I-EXPLORATION + I-EXPLORATION +Entre I-EXPLORATION +las I-EXPLORATION +medidas I-EXPLORATION +de I-EXPLORATION +prevención I-EXPLORATION +del I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +peritonitis I-EXPLORATION +esclerosante, I-EXPLORATION +cabe I-EXPLORATION +destacar I-EXPLORATION +la I-EXPLORATION +importancia I-EXPLORATION +del I-EXPLORATION +papel I-EXPLORATION +de I-EXPLORATION +enfermería I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +entrenamiento I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +para I-EXPLORATION +reducir I-EXPLORATION +al I-EXPLORATION +máximo I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +peritonitis I-EXPLORATION +y I-EXPLORATION +tratarlos I-EXPLORATION +adecuadamente I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +precoz; I-EXPLORATION +además I-EXPLORATION +debemos I-EXPLORATION +utilizar I-EXPLORATION +soluciones I-EXPLORATION +lo I-EXPLORATION +más I-EXPLORATION +biocompatibles I-EXPLORATION +posible, I-EXPLORATION +evitando I-EXPLORATION +de I-EXPLORATION +ese I-EXPLORATION +modo I-EXPLORATION +altas I-EXPLORATION +concentraciones I-EXPLORATION +de I-EXPLORATION +glucosa. I-EXPLORATION +Así I-EXPLORATION +mismo, I-EXPLORATION +es I-EXPLORATION +muy I-EXPLORATION +importante I-EXPLORATION +el I-EXPLORATION +control I-EXPLORATION +del I-EXPLORATION +hiperparatiroidismo I-EXPLORATION +secundario I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +pacientes I-EXPLORATION +urémicos. I-EXPLORATION + I-EXPLORATION +Finalmente, I-EXPLORATION +debemos I-EXPLORATION +estar I-EXPLORATION +alerta I-EXPLORATION +en I-EXPLORATION +aquellos I-EXPLORATION +pacientes I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +convierten I-EXPLORATION +en I-EXPLORATION +altos I-EXPLORATION +transportadores I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +tiempo I-EXPLORATION +en I-EXPLORATION +DP. I-EXPLORATION +Por I-EXPLORATION +tanto, I-EXPLORATION +es I-EXPLORATION +conveniente I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +PET I-EXPLORATION +(test I-EXPLORATION +de I-EXPLORATION +equilibrio I-EXPLORATION +peritoneal), I-EXPLORATION +al I-EXPLORATION +menos I-EXPLORATION +una I-EXPLORATION +vez I-EXPLORATION +al I-EXPLORATION +año I-EXPLORATION +y I-EXPLORATION +tras I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +peritonitis. I-EXPLORATION + I-EXPLORATION + +Lactante B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +fruto B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +término, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +adecuado I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +gestacional. I-PAST_MEDICAL_HISTORY +Embarazo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +controlado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +antecedente B-FAMILY_HISTORY +de I-FAMILY_HISTORY +lupus I-FAMILY_HISTORY +eritematoso I-FAMILY_HISTORY +sistémico I-FAMILY_HISTORY +(LES) I-FAMILY_HISTORY +materno I-FAMILY_HISTORY +en I-FAMILY_HISTORY +tratamiento I-FAMILY_HISTORY +con I-FAMILY_HISTORY +cloroquina, I-FAMILY_HISTORY +siendo I-FAMILY_HISTORY +negativos I-FAMILY_HISTORY +los I-FAMILY_HISTORY +marcadores I-FAMILY_HISTORY +maternos I-FAMILY_HISTORY +para I-FAMILY_HISTORY +LES I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +momento I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +concepción; I-FAMILY_HISTORY +exámenes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rutina I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +lactante I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +ocasiones, I-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +estaba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +lactancia I-PRESENT_ILLNESS +mixta, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +41.º I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +motivo, I-PRESENT_ILLNESS +realizándose B-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +presentó I-EXPLORATION +9.220 I-EXPLORATION +leucocitos I-EXPLORATION +con I-EXPLORATION +11, I-EXPLORATION +9% I-EXPLORATION +de I-EXPLORATION +eosinófilos, I-EXPLORATION +hemograma, I-EXPLORATION +sedimento I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +urocultivo I-EXPLORATION +negativos. I-EXPLORATION +Ante B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +presencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +eosinofilia I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +analítica I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vómitos I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +diagnostica I-DERIVED_FROM/TO +intolerancia I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +proteínas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +leche I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vaca, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +especialista I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Alergología. I-DERIVED_FROM/TO +Con B-EVOLUTION +46 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +consulta I-EVOLUTION +con I-EVOLUTION +máculas I-EVOLUTION +anulares, I-EVOLUTION +policíclicas, I-EVOLUTION +localizadas I-EVOLUTION +en I-EVOLUTION +cabeza I-EVOLUTION +y I-EVOLUTION +zona I-EVOLUTION +anterior I-EVOLUTION +del I-EVOLUTION +tronco I-EVOLUTION +y I-EVOLUTION +pubis. I-EVOLUTION +Ante B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +duda I-DERIVED_FROM/TO +diagnóstica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +afectación I-DERIVED_FROM/TO +lúpica I-DERIVED_FROM/TO +o I-DERIVED_FROM/TO +bien I-DERIVED_FROM/TO +posible I-DERIVED_FROM/TO +reacción I-DERIVED_FROM/TO +adversa I-DERIVED_FROM/TO +medicamentosa I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +cloroquina, I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +LES I-DERIVED_FROM/TO +materno, I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +referencia I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +cita I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +biopsia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +analítica. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +La B-EXPLORATION +biopsia I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +suprapúbica, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +analíticos I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +anti-La I-EXPLORATION +y I-EXPLORATION +anti-Ro I-EXPLORATION +positivos I-EXPLORATION +confirman I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +caso. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +ECG I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +descartándose I-EXPLORATION +la I-EXPLORATION +afectación I-EXPLORATION +cardíaca. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +ferropénica, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fórmula I-EXPLORATION +leucocitaria I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +neutropenia. I-EXPLORATION + I-EXPLORATION +Al B-TREATMENT +momento I-TREATMENT +del I-TREATMENT +diagnóstico I-TREATMENT +se I-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +fotoprotección; I-TREATMENT +metilprednisolona I-TREATMENT +oral, I-TREATMENT +con I-TREATMENT +protección I-TREATMENT +gástrica I-TREATMENT +por I-TREATMENT +el I-TREATMENT +antecedente I-TREATMENT +de I-TREATMENT +vómitos; I-TREATMENT +y I-TREATMENT +sulfato I-TREATMENT +ferroso I-TREATMENT +para I-TREATMENT +corregir I-TREATMENT +su I-TREATMENT +anemia. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +habían I-EVOLUTION +remitido, I-EVOLUTION +suspendiéndose B-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +corticoideo I-TREATMENT +a I-TREATMENT +los I-TREATMENT +3 I-TREATMENT +meses I-TREATMENT +y I-TREATMENT +medio. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +meses I-EVOLUTION +se I-EVOLUTION +habían I-EVOLUTION +negativizado I-EVOLUTION +los I-EVOLUTION +anticuerpos I-EVOLUTION +lúpicos I-EVOLUTION +maternos I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +niño I-EVOLUTION +y I-EVOLUTION +había I-EVOLUTION +desaparecido I-EVOLUTION +la I-EVOLUTION +neutropenia, I-EVOLUTION +persistiendo I-EVOLUTION +la I-EVOLUTION +anemia. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Desde B-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +recurrentes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +elevada I-PRESENT_ILLNESS +(cada I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +semanas), I-PRESENT_ILLNESS +adenopatías I-PRESENT_ILLNESS +laterocervicales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +faringitis. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Los I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +cursan I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +(39-40 I-PRESENT_ILLNESS +oC) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3-4 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +escasa I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +antitérmicos. I-PRESENT_ILLNESS +La B-EXPLORATION +niña I-EXPLORATION +está I-EXPLORATION +asintomática I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +y I-EXPLORATION +tiene I-EXPLORATION +un I-EXPLORATION +desarrollo I-EXPLORATION +normal I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +edad. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +aparecen I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +moderada, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR). I-EXPLORATION +En I-EXPLORATION +varias I-EXPLORATION +ocasiones I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +frotis I-EXPLORATION +faríngeos I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Los B-TREATMENT +primeros I-TREATMENT +episodios I-TREATMENT +se I-TREATMENT +trataron I-TREATMENT +con I-TREATMENT +antibiótico. I-TREATMENT +No B-EVOLUTION +presentó I-EVOLUTION +mejoría I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +3.o-5.o I-EVOLUTION +día. I-EVOLUTION + I-EVOLUTION +Ante I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +descritos, I-EVOLUTION +su I-EVOLUTION +recurrencia I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +cultivos I-EVOLUTION +faríngeos I-EVOLUTION +negativos, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +producían I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +repetida, I-EVOLUTION +se I-EVOLUTION +pensó I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +posibilidad I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +Marshall. I-EVOLUTION +Coincidiendo B-TREATMENT +con I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +pico I-TREATMENT +febril, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +corticoterapia I-TREATMENT +oral. I-TREATMENT +La B-EVOLUTION +duración I-EVOLUTION +del I-EVOLUTION +episodio I-EVOLUTION +se I-EVOLUTION +acortó I-EVOLUTION +a I-EVOLUTION +menos I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +horas I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +toma I-EVOLUTION +de I-EVOLUTION +prednisona. I-EVOLUTION +Dicha I-EVOLUTION +respuesta I-EVOLUTION +fue I-EVOLUTION +comprobada I-EVOLUTION +en I-EVOLUTION +episodios I-EVOLUTION +posteriores, I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +sugiere I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +PFAPA. I-EVOLUTION + I-EVOLUTION + +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Programa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Salud I-PRESENT_ILLNESS +Infantil I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +lactante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +fetal I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tercer I-PAST_MEDICAL_HISTORY +trimestre I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +dilatación I-PAST_MEDICAL_HISTORY +pielocalicial I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +(derecha: I-PAST_MEDICAL_HISTORY +4, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mm; I-PAST_MEDICAL_HISTORY +izquierda: I-PAST_MEDICAL_HISTORY +4, I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +mm). I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +semana I-PAST_MEDICAL_HISTORY +41+4 I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +fallo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inducción. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +5/9 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +precisó I-PAST_MEDICAL_HISTORY +reanimación I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +III; I-PAST_MEDICAL_HISTORY +permaneció I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +transición I-PAST_MEDICAL_HISTORY +menos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +24 I-PAST_MEDICAL_HISTORY +horas. I-PAST_MEDICAL_HISTORY +Antecedentes B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés: I-FAMILY_HISTORY +prima I-FAMILY_HISTORY +hermana I-FAMILY_HISTORY +paterna I-FAMILY_HISTORY +con I-FAMILY_HISTORY +escoliosis I-FAMILY_HISTORY +congénita. I-FAMILY_HISTORY +Exploración: B-EXPLORATION +Peso: I-EXPLORATION +3, I-EXPLORATION +960 I-EXPLORATION +kg I-EXPLORATION +(percentil I-EXPLORATION +25); I-EXPLORATION +talla: I-EXPLORATION +53 I-EXPLORATION +cm I-EXPLORATION +(percentil I-EXPLORATION +50); I-EXPLORATION +y I-EXPLORATION +perímetro I-EXPLORATION +cefálico: I-EXPLORATION +37 I-EXPLORATION +cm I-EXPLORATION +(percentil I-EXPLORATION +25). I-EXPLORATION +Se I-EXPLORATION +aprecian I-EXPLORATION +un I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +cráneo I-EXPLORATION +con I-EXPLORATION +fontanela I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +x I-EXPLORATION +1 I-EXPLORATION +cm, I-EXPLORATION +plagiocefalia I-EXPLORATION +leve, I-EXPLORATION +cuello I-EXPLORATION +corto I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +al I-EXPLORATION +lado I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +ligera I-EXPLORATION +limitación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +movilidad, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +escoliosis I-EXPLORATION +congénita I-EXPLORATION +cervical. I-EXPLORATION +Se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +asimetría I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +tórax I-EXPLORATION +posterior, I-EXPLORATION +con I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +escápula I-EXPLORATION +izquierda: I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +hoyuelo I-EXPLORATION +cutáneo I-EXPLORATION +en I-EXPLORATION +esa I-EXPLORATION +escápula, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +tamaño I-EXPLORATION +inferior I-EXPLORATION +y I-EXPLORATION +parece I-EXPLORATION +más I-EXPLORATION +horizontalizada I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +contralateral. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +y I-EXPLORATION +neurológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Ante B-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +hallazgos I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +escápula I-DERIVED_FROM/TO +elevada, I-DERIVED_FROM/TO +escoliosis, I-DERIVED_FROM/TO +tortícolis I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +plagiocefalia I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +derivación I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +traumatología I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +referencia. I-DERIVED_FROM/TO +Debido B-EXPLORATION +a I-EXPLORATION +sus I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +dilatación I-EXPLORATION +pielocalicial I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominorrenal I-EXPLORATION +de I-EXPLORATION +control. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +revisión I-EVOLUTION +del I-EVOLUTION +cuarto I-EVOLUTION +mes I-EVOLUTION +la I-EVOLUTION +asimetría I-EVOLUTION +escapular I-EVOLUTION +es I-EVOLUTION +más I-EVOLUTION +manifiesta, I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +una I-EVOLUTION +mayor I-EVOLUTION +discrepancia I-EVOLUTION +entre I-EVOLUTION +el I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +ambas I-EVOLUTION +escápulas I-EVOLUTION +(la I-EVOLUTION +derecha I-EVOLUTION +mide I-EVOLUTION +7 I-EVOLUTION +cm, I-EVOLUTION +frente I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4, I-EVOLUTION +5 I-EVOLUTION +cm I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +izquierda), I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +altura I-EVOLUTION +del I-EVOLUTION +ángulo I-EVOLUTION +inferior I-EVOLUTION +de I-EVOLUTION +ambas I-EVOLUTION +dista I-EVOLUTION +2, I-EVOLUTION +5 I-EVOLUTION +cm. I-EVOLUTION +La B-EXPLORATION +movilidad I-EXPLORATION +del I-EXPLORATION +brazo I-EXPLORATION +está I-EXPLORATION +conservada, I-EXPLORATION +aunque I-EXPLORATION +existe I-EXPLORATION +una I-EXPLORATION +limitación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +abducción I-EXPLORATION +del I-EXPLORATION +hombro I-EXPLORATION +izquierdo I-EXPLORATION +(activa: I-EXPLORATION +85o; I-EXPLORATION +pasiva: I-EXPLORATION +115o). I-EXPLORATION +La I-EXPLORATION +plagiocefalia I-EXPLORATION +ahora I-EXPLORATION +es I-EXPLORATION +moderada, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +derivar I-EXPLORATION +al I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +neurocirugía I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +ortesis I-EXPLORATION +craneal. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +fin I-EXPLORATION +de I-EXPLORATION +confirmar I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +y I-EXPLORATION +descartar I-EXPLORATION +otras I-EXPLORATION +alteraciones I-EXPLORATION +asociadas I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizan I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +pruebas I-EXPLORATION +complementarias: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Ecografía I-EXPLORATION +renal I-EXPLORATION +(mayo I-EXPLORATION +de I-EXPLORATION +2009): I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +una I-EXPLORATION +dilatación I-EXPLORATION +pielocalicial I-EXPLORATION +bilateral I-EXPLORATION +de I-EXPLORATION +grado I-EXPLORATION +II/IV, I-EXPLORATION +pelvis I-EXPLORATION +renal I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +mm I-EXPLORATION +e I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Ecografía I-EXPLORATION +de I-EXPLORATION +caderas I-EXPLORATION +(mayo I-EXPLORATION +de I-EXPLORATION +2009) I-EXPLORATION +por I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +displasia I-EXPLORATION +de I-EXPLORATION +caderas: I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +completa I-EXPLORATION +y I-EXPLORATION +escápula I-EXPLORATION +(mayo I-EXPLORATION +de I-EXPLORATION +2009): I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fusión I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +columna I-EXPLORATION +dorsal I-EXPLORATION +alta I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +cervical I-EXPLORATION +baja. I-EXPLORATION +Primera I-EXPLORATION +costilla I-EXPLORATION +izquierda I-EXPLORATION +hipoplásica. I-EXPLORATION +Costillas I-EXPLORATION +2.a I-EXPLORATION +a I-EXPLORATION +5.a I-EXPLORATION +izquierdas I-EXPLORATION +con I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +intercostal. I-EXPLORATION +Elevación I-EXPLORATION +de I-EXPLORATION +escápula I-EXPLORATION +izquierda I-EXPLORATION +("escápula I-EXPLORATION +alada"). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +lateral I-EXPLORATION +(junio I-EXPLORATION +de I-EXPLORATION +2009): I-EXPLORATION +se I-EXPLORATION +objetivan I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +segmentación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +columna I-EXPLORATION +vertebral I-EXPLORATION +dorsal I-EXPLORATION +alta I-EXPLORATION +y I-EXPLORATION +cervical I-EXPLORATION +baja, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +escápula I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Ecocardiograma I-EXPLORATION +y I-EXPLORATION +electrocardiograma: I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +viene I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +odontológica. I-PRESENT_ILLNESS +A B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +acudir I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +exfoliarse I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +segundo I-PAST_MEDICAL_HISTORY +molar I-PAST_MEDICAL_HISTORY +temporal I-PAST_MEDICAL_HISTORY +izquierdo. I-PAST_MEDICAL_HISTORY +Le I-PAST_MEDICAL_HISTORY +realizaron I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ortopantomografía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +observaron I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +agenesia I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +segundo I-PAST_MEDICAL_HISTORY +premolar I-PAST_MEDICAL_HISTORY +inferior I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +mesiodens I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +arcada I-PAST_MEDICAL_HISTORY +superior. I-PAST_MEDICAL_HISTORY +Le I-PAST_MEDICAL_HISTORY +recomendaron I-PAST_MEDICAL_HISTORY +realizarse I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +periódicos. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +exploración I-PAST_MEDICAL_HISTORY +bucodental I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +13 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +observa I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +persistencia I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +molar I-PAST_MEDICAL_HISTORY +temporal. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +sector I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +está I-PAST_MEDICAL_HISTORY +erupcionado I-PAST_MEDICAL_HISTORY +correctamente. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +mesiodens I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +provocado I-PAST_MEDICAL_HISTORY +ninguna I-PAST_MEDICAL_HISTORY +anomalía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +posición I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +incisivos I-PAST_MEDICAL_HISTORY +superiores. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ortopantomografía I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +aprecia I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +mesiodens I-PAST_MEDICAL_HISTORY +incluido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ligera I-PAST_MEDICAL_HISTORY +distoversión, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cúspide I-PAST_MEDICAL_HISTORY +localizada I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +raíces I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +incisivo I-PAST_MEDICAL_HISTORY +central I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +incisivo I-PAST_MEDICAL_HISTORY +lateral I-PAST_MEDICAL_HISTORY +superior I-PAST_MEDICAL_HISTORY +izquierdo, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +1/3 I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +radicular, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ápice I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +línea I-PAST_MEDICAL_HISTORY +media. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +caries I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +molar I-PRESENT_ILLNESS +temporal. I-PRESENT_ILLNESS +Solicitamos B-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +radiografía I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +si I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +obturar I-EXPLORATION +el I-EXPLORATION +molar, I-EXPLORATION +controlar I-EXPLORATION +el I-EXPLORATION +supernumerario I-EXPLORATION +y I-EXPLORATION +valorar I-EXPLORATION +los I-EXPLORATION +cordales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ortopantomografía I-EXPLORATION +observamos I-EXPLORATION +el I-EXPLORATION +mesiodens I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media, I-EXPLORATION +ligeramente I-EXPLORATION +más I-EXPLORATION +verticalizado, I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +cambios I-EXPLORATION +significativos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +posición I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +radiografías I-EXPLORATION +anteriores. I-EXPLORATION +Decidimos B-TREATMENT +seguir I-TREATMENT +realizando I-TREATMENT +controles I-TREATMENT +periódicos I-TREATMENT +del I-TREATMENT +supernumerario I-TREATMENT +y I-TREATMENT +lo B-DERIVED_FROM/TO +remitimos I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +maxilofacial I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +exodoncia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +cordales I-DERIVED_FROM/TO +inferiores I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +falta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +espacio I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +erupción. I-DERIVED_FROM/TO +Recomendamos B-TREATMENT +la I-TREATMENT +obturación I-TREATMENT +del I-TREATMENT +molar I-TREATMENT +temporal. I-TREATMENT + I-TREATMENT + +Un B-PRESENT_ILLNESS +niño I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pediatra I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Atención I-PRESENT_ILLNESS +Primaria I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +febrícula, I-PRESENT_ILLNESS +hiporexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +blandas I-PRESENT_ILLNESS +frecuentes. I-PRESENT_ILLNESS +Fue B-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +gastroenteritis I-EXPLORATION +aguda. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +cardíaca, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +tonos I-EXPLORATION +rítmicos I-EXPLORATION +sin I-EXPLORATION +soplos I-EXPLORATION +ni I-EXPLORATION +anomalías I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segundo I-EXPLORATION +tono, I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +un I-EXPLORATION +dato I-EXPLORATION +que I-EXPLORATION +llamó I-EXPLORATION +la I-EXPLORATION +atención. I-EXPLORATION +Se I-EXPLORATION +interrogó I-EXPLORATION +al I-EXPLORATION +niño I-EXPLORATION +sobre I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +precordalgias, I-EXPLORATION +presíncopes, I-EXPLORATION +síncopes, I-EXPLORATION +síntomas I-EXPLORATION +relacionados I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +ejercicio I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +tolerancia I-EXPLORATION +a I-EXPLORATION +éste, I-EXPLORATION +palpitaciones I-EXPLORATION +y I-EXPLORATION +sensación I-EXPLORATION +de I-EXPLORATION +disritmia I-EXPLORATION +cardíaca, I-EXPLORATION +sin I-EXPLORATION +respuestas I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +patología. I-EXPLORATION +Tras I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +electrocardiograma I-EXPLORATION +(ECG) I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +vez I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +pediatra I-EXPLORATION +confirma I-EXPLORATION +su I-EXPLORATION +sospecha, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +remitido I-EXPLORATION +a I-EXPLORATION +cardiología I-EXPLORATION +infantil I-EXPLORATION +para I-EXPLORATION +completar I-EXPLORATION +el I-EXPLORATION +estudio. I-EXPLORATION + I-EXPLORATION +¿Cuál I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +interpretación I-EXPLORATION +del I-EXPLORATION +ECG?, I-EXPLORATION +¿y I-EXPLORATION +el I-EXPLORATION +hallazgo I-EXPLORATION +auscultatorio I-EXPLORATION +que I-EXPLORATION +llamó I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +al I-EXPLORATION +pediatra?, I-EXPLORATION +¿y I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica? I-EXPLORATION +Es I-EXPLORATION +necesario I-EXPLORATION +revisar I-EXPLORATION +el I-EXPLORATION +ECG I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +seguir I-EXPLORATION +leyendo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +ECG I-EXPLORATION +muestra, I-EXPLORATION +siguiendo I-EXPLORATION +la I-EXPLORATION +lectura I-EXPLORATION +sistemática, I-EXPLORATION +un I-EXPLORATION +ritmo I-EXPLORATION +auricular I-EXPLORATION +ectópico I-EXPLORATION +procedente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +izquierda I-EXPLORATION +(onda I-EXPLORATION +P I-EXPLORATION +negativa I-EXPLORATION +en I-EXPLORATION +I, I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +aVF). I-EXPLORATION +Sin I-EXPLORATION +embargo, I-EXPLORATION +observamos I-EXPLORATION +un I-EXPLORATION +eje I-EXPLORATION +anómalo I-EXPLORATION +(derecho) I-EXPLORATION +de I-EXPLORATION +QRS I-EXPLORATION +y I-EXPLORATION +T I-EXPLORATION +(aproximadamente I-EXPLORATION +180o I-EXPLORATION +en I-EXPLORATION +ambos), I-EXPLORATION +pues I-EXPLORATION +tanto I-EXPLORATION +los I-EXPLORATION +complejos I-EXPLORATION +QRS I-EXPLORATION +como I-EXPLORATION +las I-EXPLORATION +ondas I-EXPLORATION +T I-EXPLORATION +son I-EXPLORATION +negativas I-EXPLORATION +donde I-EXPLORATION +habitualmente I-EXPLORATION +son I-EXPLORATION +positivas I-EXPLORATION +(I, I-EXPLORATION +II, I-EXPLORATION +aVL, I-EXPLORATION +aVF), I-EXPLORATION +y I-EXPLORATION +viceversa. I-EXPLORATION + I-EXPLORATION +Estos I-EXPLORATION +hallazgos I-EXPLORATION +electrocardiográficos I-EXPLORATION +sólo I-EXPLORATION +pueden I-EXPLORATION +deberse I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +incorrecta I-EXPLORATION +colocación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +electrodos I-EXPLORATION +(en I-EXPLORATION +el I-EXPLORATION +hemitórax I-EXPLORATION +equivocado) I-EXPLORATION +o I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +dextrocardia I-EXPLORATION +(ubicación I-EXPLORATION +del I-EXPLORATION +corazón I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemitórax I-EXPLORATION +derecho). I-EXPLORATION +El I-EXPLORATION +dato I-EXPLORATION +auscultatorio I-EXPLORATION +fue I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tonos I-EXPLORATION +cardíacos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemitórax I-EXPLORATION +derecho; I-EXPLORATION +asimismo, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +dextrocardia, I-EXPLORATION +hígado I-EXPLORATION +situado I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +burbuja I-EXPLORATION +gástrica I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +derecho. I-EXPLORATION +Con B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +confirmación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +situs I-DERIVED_FROM/TO +inversus I-DERIVED_FROM/TO +totalis, I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +niño I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +cardiología I-DERIVED_FROM/TO +infantil I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +descartar I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +presencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +cardiopatía I-DERIVED_FROM/TO +congénita. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ocho I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +África I-PAST_MEDICAL_HISTORY +subsahariana, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +macroscópica I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +final I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +micción I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +proteinuria I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Lleva B-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +viviendo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestra I-PAST_MEDICAL_HISTORY +comunidad. I-PAST_MEDICAL_HISTORY +Refiere I-PAST_MEDICAL_HISTORY +baños I-PAST_MEDICAL_HISTORY +anteriores I-PAST_MEDICAL_HISTORY +frecuentes I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +río. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +ni B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +a I-FAMILY_HISTORY +destacar. I-FAMILY_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +muestran I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +anemia I-EXPLORATION +microcítica, I-EXPLORATION +con I-EXPLORATION +Hb I-EXPLORATION +10, I-EXPLORATION +9 I-EXPLORATION +g/dL, I-EXPLORATION +Hto I-EXPLORATION +32, I-EXPLORATION +8%, I-EXPLORATION +VCM I-EXPLORATION +74, I-EXPLORATION +9 I-EXPLORATION +fL I-EXPLORATION +y I-EXPLORATION +eosinofilia I-EXPLORATION +con I-EXPLORATION +767 I-EXPLORATION +eosinófilos/µL; I-EXPLORATION +VSG I-EXPLORATION +40 I-EXPLORATION +mm/h. I-EXPLORATION +La I-EXPLORATION +bioquímica I-EXPLORATION +muestra I-EXPLORATION +urea I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +e I-EXPLORATION +iones I-EXPLORATION +normales. I-EXPLORATION +Estudio I-EXPLORATION +inmunológico I-EXPLORATION +con I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +y I-EXPLORATION +complemento I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +El I-EXPLORATION +sistemático I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +muestra I-EXPLORATION +hematuria I-EXPLORATION +microscópica I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +cristales I-EXPLORATION +de I-EXPLORATION +oxalato I-EXPLORATION +cálcico. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +hidronefrosis I-EXPLORATION +grado I-EXPLORATION +II I-EXPLORATION +de I-EXPLORATION +pelvis I-EXPLORATION +renal I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +investigación I-EXPLORATION +de I-EXPLORATION +Schistosoma I-EXPLORATION +sp. I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +visualizándose I-EXPLORATION +huevos I-EXPLORATION +de I-EXPLORATION +S. I-EXPLORATION +haematobium. I-EXPLORATION +El I-EXPLORATION +coprocultivo I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +Plasmodium I-EXPLORATION +falciparum, I-EXPLORATION +Entamoeba I-EXPLORATION +histolytica, I-EXPLORATION +Schistosoma I-EXPLORATION +sp., I-EXPLORATION +y I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +hepatitis I-EXPLORATION +A, I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +mediante I-TREATMENT +dos I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +praziquantel I-TREATMENT +a I-TREATMENT +20 I-TREATMENT +mg/kg/dosis I-TREATMENT +separadas I-TREATMENT +por I-TREATMENT +12 I-TREATMENT +horas. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +acudió I-EVOLUTION +a I-EVOLUTION +posteriores I-EVOLUTION +revisiones. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +chino, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +movimientos I-PRESENT_ILLNESS +tónico-clónicos I-PRESENT_ILLNESS +generalizados, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +incontinencia I-PRESENT_ILLNESS +esfinteriana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cedió I-PRESENT_ILLNESS +espontáneamente. I-PRESENT_ILLNESS +Desde I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +previas I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +líquidas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +Estaba I-PRESENT_ILLNESS +afebril. I-PRESENT_ILLNESS +Antecedentes B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +y B-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +únicamente I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +leve I-EXPLORATION +sequedad I-EXPLORATION +de I-EXPLORATION +mucosas. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +hemograma, I-EXPLORATION +bioquímica I-EXPLORATION +y I-EXPLORATION +gasometría I-EXPLORATION +venosa, I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +las I-EVOLUTION +siguientes I-EVOLUTION +ocho I-EVOLUTION +horas, I-EVOLUTION +presenta I-EVOLUTION +tres I-EVOLUTION +nuevas I-EVOLUTION +crisis I-EVOLUTION +de I-EVOLUTION +similares I-EVOLUTION +características I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +inicial, I-EVOLUTION +que B-TREATMENT +ceden I-TREATMENT +con I-TREATMENT +diazepam I-TREATMENT +intravenoso I-TREATMENT +(IV) I-TREATMENT +y/o I-TREATMENT +ácido I-TREATMENT +valproico I-TREATMENT +IV I-TREATMENT +en I-TREATMENT +cinco I-TREATMENT +minutos. I-TREATMENT +Se B-EXPLORATION +realizaron I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +electroencefalograma, I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Permaneció B-EVOLUTION +hospitalizada I-EVOLUTION +durante I-EVOLUTION +cuatro I-EVOLUTION +días I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +nuevas I-EVOLUTION +crisis. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +coprocultivo I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +rotavirus. I-EXPLORATION +Su B-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +favorable, I-EVOLUTION +sin I-EVOLUTION +crisis I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +desarrollo I-EVOLUTION +psicomotor I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Lactante B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pediatra I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +mucosidad I-PRESENT_ILLNESS +nasal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +habiéndose I-PRESENT_ILLNESS +hecho I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +persistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +accesos I-PRESENT_ILLNESS +repetidos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +han I-PRESENT_ILLNESS +observado I-PRESENT_ILLNESS +cianosis I-PRESENT_ILLNESS +perioral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ocasionalmente I-PRESENT_ILLNESS +terminan I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +vómito; I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encuentra I-PRESENT_ILLNESS +afebril I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +reducción I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +leche I-PRESENT_ILLNESS +materna. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +un I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +coloración I-EXPLORATION +y I-EXPLORATION +perfusión I-EXPLORATION +periférica, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +dificultad I-EXPLORATION +respiratoria I-EXPLORATION +y I-EXPLORATION +auscultación I-EXPLORATION +cardiopulmonar I-EXPLORATION +normal; I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +dejar I-EXPLORATION +en I-EXPLORATION +observación, I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +episodios I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +acceso I-EXPLORATION +con I-EXPLORATION +varios I-EXPLORATION +golpes I-EXPLORATION +de I-EXPLORATION +tos I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +espiración I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +inspiración I-EXPLORATION +ruidosa I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +gallo I-EXPLORATION +al I-EXPLORATION +finalizar I-EXPLORATION +el I-EXPLORATION +acceso, I-EXPLORATION +acompañado I-EXPLORATION +de I-EXPLORATION +cianosis I-EXPLORATION +facial. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +ingresarlo I-TREATMENT +bajo I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +pertusoide, I-TREATMENT +con I-TREATMENT +monitorización I-TREATMENT +continua I-TREATMENT +de I-TREATMENT +saturación I-TREATMENT +de I-TREATMENT +oxígeno, I-TREATMENT +frecuencia I-TREATMENT +cardiaca I-TREATMENT +y I-TREATMENT +respiratoria. I-TREATMENT +Durante B-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +aumenta I-EVOLUTION +la I-EVOLUTION +frecuencia I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +accesos I-EVOLUTION +de I-EVOLUTION +tos I-EVOLUTION +de I-EVOLUTION +tipo I-EVOLUTION +pertusoide, I-EVOLUTION +se I-EVOLUTION +objetiva I-EVOLUTION +repercusión I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +frecuencia I-EVOLUTION +cardiaca I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +saturación I-EVOLUTION +de I-EVOLUTION +oxígeno I-EVOLUTION +durante I-EVOLUTION +dichos I-EVOLUTION +accesos I-EVOLUTION +e, I-EVOLUTION +incluso, I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +periodos I-EVOLUTION +intercríticos I-EVOLUTION +presenta I-EVOLUTION +pausas I-EVOLUTION +de I-EVOLUTION +apnea I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +recuperan I-EVOLUTION +con I-EVOLUTION +estimulación, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +le I-TREATMENT +administra I-TREATMENT +oxigenoterapia I-TREATMENT +con I-TREATMENT +gafas I-TREATMENT +nasales I-TREATMENT +y I-TREATMENT +también I-TREATMENT +sueroterapia I-TREATMENT +intravenosa I-TREATMENT +hasta I-TREATMENT +que I-TREATMENT +recupera I-TREATMENT +una I-TREATMENT +alimentación I-TREATMENT +enteral I-TREATMENT +suficiente; I-TREATMENT +se I-TREATMENT +trata I-TREATMENT +con I-TREATMENT +azitromicina I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +a I-TREATMENT +los I-TREATMENT +contactos I-TREATMENT +cercanos. I-TREATMENT + I-TREATMENT +Durante B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +hospitalario, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +serológico I-EXPLORATION +para I-EXPLORATION +Bordetella I-EXPLORATION +pertussis I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +negativo I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +determinación I-EXPLORATION +inicial I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +siguiente, I-EXPLORATION +un I-EXPLORATION +mes I-EXPLORATION +después. I-EXPLORATION + I-EXPLORATION + +Lactante B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +días, I-PRESENT_ILLNESS +hijo B-PAST_MEDICAL_HISTORY +único, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Atención I-PRESENT_ILLNESS +Primaria I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +secreción I-PRESENT_ILLNESS +blanquecina I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +conducto I-PRESENT_ILLNESS +auditivo I-PRESENT_ILLNESS +externo I-PRESENT_ILLNESS +(CAE). I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +dicha I-EXPLORATION +secreción, I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +SAMR. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +familiar, I-EXPLORATION +obteniéndose I-EXPLORATION +cultivo I-EXPLORATION +nasal I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +padres, I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Al B-FAMILY_HISTORY +analizar I-FAMILY_HISTORY +la I-FAMILY_HISTORY +historia I-FAMILY_HISTORY +familiar, I-FAMILY_HISTORY +tenemos I-FAMILY_HISTORY +conocimiento I-FAMILY_HISTORY +de I-FAMILY_HISTORY +que I-FAMILY_HISTORY +la I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +había I-FAMILY_HISTORY +presentado I-FAMILY_HISTORY +una I-FAMILY_HISTORY +herida I-FAMILY_HISTORY +quirúrgica I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +momento I-FAMILY_HISTORY +del I-FAMILY_HISTORY +parto, I-FAMILY_HISTORY +cuyo I-FAMILY_HISTORY +cultivo I-FAMILY_HISTORY +fue I-FAMILY_HISTORY +positivo I-FAMILY_HISTORY +para I-FAMILY_HISTORY +SARM I-FAMILY_HISTORY +con I-FAMILY_HISTORY +el I-FAMILY_HISTORY +mismo I-FAMILY_HISTORY +antibiograma I-FAMILY_HISTORY +que I-FAMILY_HISTORY +el I-FAMILY_HISTORY +hallado I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +niño I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +CAE, I-FAMILY_HISTORY +por I-FAMILY_HISTORY +lo I-FAMILY_HISTORY +que I-FAMILY_HISTORY +suponemos I-FAMILY_HISTORY +que I-FAMILY_HISTORY +se I-FAMILY_HISTORY +ha I-FAMILY_HISTORY +producido I-FAMILY_HISTORY +una I-FAMILY_HISTORY +transmisión I-FAMILY_HISTORY +vertical I-FAMILY_HISTORY +de I-FAMILY_HISTORY +dicho I-FAMILY_HISTORY +germen. I-FAMILY_HISTORY +Tras B-EXPLORATION +realizar I-EXPLORATION +estas I-EXPLORATION +investigaciones, I-EXPLORATION +se I-EXPLORATION +vuelve I-EXPLORATION +a I-EXPLORATION +tomar I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +del I-EXPLORATION +CAE I-EXPLORATION +del I-EXPLORATION +niño, I-EXPLORATION +siendo I-EXPLORATION +de I-EXPLORATION +nuevo I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +SARM, I-EXPLORATION +cuyo I-EXPLORATION +antibiograma I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +1. I-EXPLORATION + I-EXPLORATION +Dado B-TREATMENT +que I-TREATMENT +este I-TREATMENT +segundo I-TREATMENT +cultivo I-TREATMENT +es I-TREATMENT +sensible I-TREATMENT +a I-TREATMENT +ciprofloxacino, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +tratamiento I-TREATMENT +local I-TREATMENT +con I-TREATMENT +esa I-TREATMENT +quinolona I-TREATMENT +siendo I-TREATMENT +el I-TREATMENT +cultivo I-TREATMENT +de I-TREATMENT +control I-TREATMENT +negativo. I-TREATMENT + I-TREATMENT + +S. B-PRESENT_ILLNESS +Piris I-PRESENT_ILLNESS +Borregasa, I-PRESENT_ILLNESS +M.R. I-PRESENT_ILLNESS +Acuña I-PRESENT_ILLNESS +Allerb I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +aMIR-Pediatría. I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Universitario I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Octubre. I-PRESENT_ILLNESS +Madrid. I-PRESENT_ILLNESS +España. I-PRESENT_ILLNESS +bPediatra. I-PRESENT_ILLNESS +CS I-PRESENT_ILLNESS +Martín I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Vargas. I-PRESENT_ILLNESS +Madrid. I-PRESENT_ILLNESS +España. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pediatra I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cabecera I-PRESENT_ILLNESS +descubre I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +marcha I-PRESENT_ILLNESS +torpe: I-PRESENT_ILLNESS +sabe I-PRESENT_ILLNESS +ponerse I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +ayuda, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +sabe I-PRESENT_ILLNESS +correr, I-PRESENT_ILLNESS +chuta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +balón I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +pies I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sube I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +escaleras I-PRESENT_ILLNESS +agarrada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +manos. I-PRESENT_ILLNESS +No B-FAMILY_HISTORY +se I-FAMILY_HISTORY +describen I-FAMILY_HISTORY +alteraciones I-FAMILY_HISTORY +neurológicas I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Antecedentes B-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Nacida I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +término I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +presentación I-PAST_MEDICAL_HISTORY +podálica. I-PAST_MEDICAL_HISTORY +Peso I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacer, I-PAST_MEDICAL_HISTORY +2780 I-PAST_MEDICAL_HISTORY +g; I-PAST_MEDICAL_HISTORY +test I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Apgar, I-PAST_MEDICAL_HISTORY +8/9; I-PAST_MEDICAL_HISTORY +reanimación I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II. I-PAST_MEDICAL_HISTORY +Pruebas I-PAST_MEDICAL_HISTORY +endocrinometabólicas I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY +Vacunación I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día. I-PAST_MEDICAL_HISTORY +Desarrollo I-PAST_MEDICAL_HISTORY +psicomotor: I-PAST_MEDICAL_HISTORY +sonrisa I-PAST_MEDICAL_HISTORY +social I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +sostén I-PAST_MEDICAL_HISTORY +cefálico I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +sedestación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +siete I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +gateo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +ocho I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +marcha I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +apoyo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +17 I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +motricidad I-PAST_MEDICAL_HISTORY +fina I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY +Bisílabos I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +referenciales I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +ocho I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +bisílabos I-PAST_MEDICAL_HISTORY +referenciales I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Exploración B-EXPLORATION +física I-EXPLORATION + I-EXPLORATION +Talla, I-EXPLORATION +92 I-EXPLORATION +cm I-EXPLORATION +(percentil I-EXPLORATION +97 I-EXPLORATION +[P97]); I-EXPLORATION +peso, I-EXPLORATION +11, I-EXPLORATION +8 I-EXPLORATION +kg I-EXPLORATION +(P25-50); I-EXPLORATION +perímetro I-EXPLORATION +craneal. I-EXPLORATION +53, I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +(P97). I-EXPLORATION +Buen I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +Bien I-EXPLORATION +nutrida. I-EXPLORATION +Sin I-EXPLORATION +dismorfias I-EXPLORATION +ni I-EXPLORATION +discromías. I-EXPLORATION +Cráneo I-EXPLORATION +normoconfigurado. I-EXPLORATION +Auscultación I-EXPLORATION +cardiopulmonar I-EXPLORATION +normal. I-EXPLORATION +Abdomen I-EXPLORATION +depresible I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +organomegalias. I-EXPLORATION +Genitales I-EXPLORATION +externos I-EXPLORATION +femeninos I-EXPLORATION +y I-EXPLORATION +normales. I-EXPLORATION +Exploración I-EXPLORATION +neurológica: I-EXPLORATION +hábito I-EXPLORATION +longilíneo I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +alineación I-EXPLORATION +del I-EXPLORATION +raquis I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades; I-EXPLORATION +pares I-EXPLORATION +craneales I-EXPLORATION +normales; I-EXPLORATION +tono I-EXPLORATION +activo I-EXPLORATION +normal; I-EXPLORATION +leve I-EXPLORATION +hipotonía I-EXPLORATION +pasiva I-EXPLORATION +con I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bufanda I-EXPLORATION +que I-EXPLORATION +sobrepasa I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +y I-EXPLORATION +dedo I-EXPLORATION +al I-EXPLORATION +antebrazo; I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +miembros I-EXPLORATION +inferiores, I-EXPLORATION +el I-EXPLORATION +ángulo I-EXPLORATION +poplíteo I-EXPLORATION +supera I-EXPLORATION +los I-EXPLORATION +90o I-EXPLORATION +y I-EXPLORATION +hace I-EXPLORATION +abducción I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +caderas; I-EXPLORATION +reflejos I-EXPLORATION +osteotendinosos I-EXPLORATION +presentes I-EXPLORATION +y I-EXPLORATION +simétricos; I-EXPLORATION +llama I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +la I-EXPLORATION +marcha I-EXPLORATION +ligeramente I-EXPLORATION +oscilante, I-EXPLORATION +no I-EXPLORATION +claudicante; I-EXPLORATION +no I-EXPLORATION +dismetría, I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Romberg I-EXPLORATION +negativo; I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +disdiadococinesia; I-EXPLORATION +pinza I-EXPLORATION +digital I-EXPLORATION +normal; I-EXPLORATION +maniobra I-EXPLORATION +de I-EXPLORATION +Gowers I-EXPLORATION +negativa; I-EXPLORATION +sin I-EXPLORATION +hipertrofia I-EXPLORATION +gemelar. I-EXPLORATION + I-EXPLORATION +Evolución B-DERIVED_FROM/TO +posterior I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +El I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Neurología I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +control I-DERIVED_FROM/TO +clínico I-DERIVED_FROM/TO +cada I-DERIVED_FROM/TO +tres I-DERIVED_FROM/TO +meses. I-DERIVED_FROM/TO +Se B-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +hemograma, I-EXPLORATION +una I-EXPLORATION +bioquímica I-EXPLORATION +general, I-EXPLORATION +pruebas I-EXPLORATION +tiroideas I-EXPLORATION +y I-EXPLORATION +creatinfosfocinasa, I-EXPLORATION +con I-EXPLORATION +resultados I-EXPLORATION +normales. I-EXPLORATION +Durante B-EVOLUTION +los I-EVOLUTION +siguientes I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +la I-EVOLUTION +niña I-EVOLUTION +desarrolló I-EVOLUTION +una I-EVOLUTION +macrocefalia I-EVOLUTION +de I-EVOLUTION ++3, I-EVOLUTION +6 I-EVOLUTION +desviaciones I-EVOLUTION +estándar I-EVOLUTION +(DS) I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +discreto I-EVOLUTION +temblor I-EVOLUTION +intencional, I-EVOLUTION +sin I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +torpeza I-EVOLUTION +motora I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +deambulación, I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +cerebral, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +descubrió I-EXPLORATION +una I-EXPLORATION +llamativa I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuatro I-EXPLORATION +ventrículos I-EXPLORATION +cerebrales I-EXPLORATION +con I-EXPLORATION +quiste I-EXPLORATION +retrocerebeloso I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +malformaciones I-EXPLORATION +asociadas, I-EXPLORATION +sugerente I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +posterior I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +del I-EXPLORATION +complejo I-EXPLORATION +de I-EXPLORATION +Dandy-Walker. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +recomendó, I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +Neurología, I-TREATMENT +fisioterapia I-TREATMENT +mediante I-TREATMENT +el I-TREATMENT +método I-TREATMENT +Bobath, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +ha I-TREATMENT +detenido, I-TREATMENT +por I-TREATMENT +el I-TREATMENT +momento, I-TREATMENT +el I-TREATMENT +deterioro I-TREATMENT +neurológico. I-TREATMENT + I-TREATMENT +Dirección I-TREATMENT +para I-TREATMENT +correspondencia: I-TREATMENT +Salvador I-TREATMENT +Piris I-TREATMENT +Borregas I-TREATMENT +dockbps@hotmail.com I-TREATMENT + I-TREATMENT + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sano I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +correctamente I-PAST_MEDICAL_HISTORY +vacunado, I-PAST_MEDICAL_HISTORY +excepto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +varicela. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tuvo B-PRESENT_ILLNESS +escarlatina I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +exantema. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +quinto I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +persiste I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +alta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +izquierdos. I-PRESENT_ILLNESS +Es I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +celulitis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tratado I-PRESENT_ILLNESS +ambulatoriamente I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +amoxicilina-clavulánico I-PRESENT_ILLNESS +oral I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +mg/kg/día I-PRESENT_ILLNESS +(de I-PRESENT_ILLNESS +amoxicilina). I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +aumenta I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tumefacción, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +decide I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presenta I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +varicela I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +pustuloso, I-EXPLORATION +dolor, I-EXPLORATION +tumefacción, I-EXPLORATION +edema I-EXPLORATION +importante I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pie I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tobillo I-EXPLORATION +izquierdos I-EXPLORATION +y I-EXPLORATION +placa I-EXPLORATION +eritematosa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +planta I-EXPLORATION +del I-EXPLORATION +pie. I-EXPLORATION +No I-EXPLORATION +realiza I-EXPLORATION +deambulación I-EXPLORATION +autónoma. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +está I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +control I-EXPLORATION +analítico I-EXPLORATION +muestra I-EXPLORATION +13 I-EXPLORATION +600 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +(68, I-EXPLORATION +3% I-EXPLORATION +neutrófilos); I-EXPLORATION +hemoglobina, I-EXPLORATION +10, I-EXPLORATION +7 I-EXPLORATION +g/dl; I-EXPLORATION +hematocrito, I-EXPLORATION +31, I-EXPLORATION +1%; I-EXPLORATION +plaquetas, I-EXPLORATION +374 I-EXPLORATION +000/mm3, I-EXPLORATION +y I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +(VSG), I-EXPLORATION +116. I-EXPLORATION +Hemocultivo I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +trata I-TREATMENT +con I-TREATMENT +amoxicilina/clavulánico I-TREATMENT +intravenoso I-TREATMENT +(IV), I-TREATMENT +pero I-TREATMENT +al I-TREATMENT +cuarto I-TREATMENT +día I-TREATMENT +presenta I-TREATMENT +un I-TREATMENT +empeoramiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumefacción. I-TREATMENT +Se B-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +músculo I-EXPLORATION +gemelo I-EXPLORATION +interno I-EXPLORATION +con I-EXPLORATION +hipoecogenicidad I-EXPLORATION +y I-EXPLORATION +tumefacción I-EXPLORATION +con I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +patrón I-EXPLORATION +fibroadiposo, I-EXPLORATION +que I-EXPLORATION +refleja I-EXPLORATION +edema I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +graso I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +piomiositis. I-EXPLORATION +No I-EXPLORATION +hay I-EXPLORATION +constancia I-EXPLORATION +de I-EXPLORATION +absceso I-EXPLORATION +susceptible I-EXPLORATION +de I-EXPLORATION +drenaje. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +instaura I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +cefotaxima I-TREATMENT +y I-TREATMENT +cloxacilina, I-TREATMENT +pero I-TREATMENT +al I-TREATMENT +ser I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +clínica, I-TREATMENT +analítica I-TREATMENT +y I-TREATMENT +ecográfica I-TREATMENT +desfavorable, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +un I-TREATMENT +cambio I-TREATMENT +de I-TREATMENT +pauta I-TREATMENT +por I-TREATMENT +clindamicina I-TREATMENT +y I-TREATMENT +vancomicina I-TREATMENT +IV I-TREATMENT +con I-TREATMENT +posterior I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +la I-TREATMENT +VSG I-TREATMENT +y I-TREATMENT +ecografía I-TREATMENT +sin I-TREATMENT +alteraciones I-TREATMENT +significativas. I-TREATMENT +Al B-EVOLUTION +alta I-EVOLUTION +realizaba I-EVOLUTION +deambulación I-EVOLUTION +autónoma I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +presentaba I-EVOLUTION +secuelas I-EVOLUTION +funcionales. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +odinofagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +palpebral I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +llamativo, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +edemas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +otras I-PRESENT_ILLNESS +localizaciones. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +hipertrofia I-EXPLORATION +amigdalar I-EXPLORATION +con I-EXPLORATION +exudado I-EXPLORATION +bilateral, I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +laterocervicales I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño, I-EXPLORATION +además I-EXPLORATION +del I-EXPLORATION +edema I-EXPLORATION +descrito. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +sedimento I-EXPLORATION +urinario I-EXPLORATION +y I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +siendo I-EXPLORATION +normales. I-EXPLORATION +Ante B-TREATMENT +dichos I-TREATMENT +hallazgos, I-TREATMENT +se I-TREATMENT +toma I-TREATMENT +frotis I-TREATMENT +faríngeo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +amoxicilina I-TREATMENT +oral I-TREATMENT +durante I-TREATMENT +una I-TREATMENT +semana. I-TREATMENT +Al B-EVOLUTION +concluir I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +consultar, I-EVOLUTION +manifestando I-EVOLUTION +haber I-EVOLUTION +padecido I-EVOLUTION +fiebre I-EVOLUTION +durante I-EVOLUTION +12 I-EVOLUTION +días I-EVOLUTION +junto I-EVOLUTION +con I-EVOLUTION +astenia. I-EVOLUTION +No I-EVOLUTION +apareció I-EVOLUTION +exantema I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +toma I-EVOLUTION +de I-EVOLUTION +antibiótico. I-EVOLUTION +El B-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +exudado I-EXPLORATION +faríngeo I-EXPLORATION +resultó I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +S. I-EXPLORATION +pyogenes. I-EXPLORATION +Al I-EXPLORATION +explorarlo I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +menor I-EXPLORATION +edema I-EXPLORATION +palpebral, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +mínima I-EXPLORATION +hepatoesplenomegalia I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +mononuclésico I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +control I-EXPLORATION +analítico I-EXPLORATION +con I-EXPLORATION +hemograma, I-EXPLORATION +perfil I-EXPLORATION +hepático I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +VEB I-EXPLORATION +y I-EXPLORATION +citomegalovirus. I-EXPLORATION +Se I-EXPLORATION +encuentra I-EXPLORATION +linfocitosis I-EXPLORATION +relativa I-EXPLORATION +(leucocitos I-EXPLORATION +7480/µl I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +68% I-EXPLORATION +de I-EXPLORATION +linfocitos), I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +transaminasas I-EXPLORATION +(GOT I-EXPLORATION +125 I-EXPLORATION +UI/l, I-EXPLORATION +GPT I-EXPLORATION +171 I-EXPLORATION +UI/l) I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +con I-EXPLORATION +IgM I-EXPLORATION +positiva I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +VEB. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +17 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +encontramos I-EVOLUTION +remisión I-EVOLUTION +completa I-EVOLUTION +del I-EVOLUTION +edema I-EVOLUTION +palpebral I-EVOLUTION +bilateral, I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +hepatoesplenomegalia I-EVOLUTION +y I-EVOLUTION +normalización I-EVOLUTION +del I-EVOLUTION +control I-EVOLUTION +analítico. I-EVOLUTION + I-EVOLUTION + +Lactante B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +revisión. I-PRESENT_ILLNESS +Primer I-PRESENT_ILLNESS +hijo, I-PRESENT_ILLNESS +fruto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +embarazo I-PRESENT_ILLNESS +controlado. I-PRESENT_ILLNESS +Varicela I-PRESENT_ILLNESS +materna I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +gestación. I-PRESENT_ILLNESS +Parto B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +semana I-PAST_MEDICAL_HISTORY +35 I-PAST_MEDICAL_HISTORY ++ I-PAST_MEDICAL_HISTORY +6, I-PAST_MEDICAL_HISTORY +vaginal, I-PAST_MEDICAL_HISTORY +instrumentado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ventosa. I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +9/10. I-PAST_MEDICAL_HISTORY +Somatometría I-PAST_MEDICAL_HISTORY +adecuada I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +(perímetro I-PAST_MEDICAL_HISTORY +cefálico: I-PAST_MEDICAL_HISTORY +33 I-PAST_MEDICAL_HISTORY +cm, I-PAST_MEDICAL_HISTORY +percentil I-PAST_MEDICAL_HISTORY +50-75 I-PAST_MEDICAL_HISTORY +[P50-75]). I-PAST_MEDICAL_HISTORY +No B-FAMILY_HISTORY +refieren I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés. I-FAMILY_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +escafocefalia I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +una I-EXPLORATION +cresta I-EXPLORATION +ósea I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sutura I-EXPLORATION +sagital. I-EXPLORATION +Este I-EXPLORATION +hallazgo I-EXPLORATION +se I-EXPLORATION +interpreta I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +acabalgamiento I-EXPLORATION +de I-EXPLORATION +suturas. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +era I-EXPLORATION +adecuada I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +edad. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +meses I-EXPLORATION +presenta I-EXPLORATION +deformidad I-EXPLORATION +craneal I-EXPLORATION +más I-EXPLORATION +manifiesta, I-EXPLORATION +con I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +prominencia I-EXPLORATION +ósea I-EXPLORATION +sagital. I-EXPLORATION +Se I-EXPLORATION +palpa I-EXPLORATION +fontanela I-EXPLORATION +anterior I-EXPLORATION +a I-EXPLORATION +punta I-EXPLORATION +de I-EXPLORATION +dedo. I-EXPLORATION +Mantiene I-EXPLORATION +desarrollo I-EXPLORATION +neurológico I-EXPLORATION +adecuado I-EXPLORATION +y I-EXPLORATION +crecimiento I-EXPLORATION +del I-EXPLORATION +perímetro I-EXPLORATION +cefálico I-EXPLORATION +(perímetro I-EXPLORATION +cefálico: I-EXPLORATION +40 I-EXPLORATION +cm, I-EXPLORATION +P75). I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +craneosinostosis I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +Rx I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +cráneo, I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +probable I-EXPLORATION +cierre I-EXPLORATION +precoz I-EXPLORATION +de I-EXPLORATION +sutura I-EXPLORATION +sagital I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +deriva I-EXPLORATION +a I-EXPLORATION +Cirugía I-EXPLORATION +Pediátrica. I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +probable I-EXPLORATION +de I-EXPLORATION +craneosinostosis I-EXPLORATION +sagital I-EXPLORATION +y I-EXPLORATION +lambdoidea, I-EXPLORATION +solicitaron I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +craneal I-EXPLORATION +tridimensional I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +cierre I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sutura I-EXPLORATION +sagital. I-EXPLORATION +Se B-EVOLUTION +derivó I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Neurocirugía I-EVOLUTION +de I-EVOLUTION +referencia I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +edad. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +oC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +tos, I-PRESENT_ILLNESS +mocos, I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +líquidas I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +frecuentes, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inapetencia I-PRESENT_ILLNESS +parcial. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +destaca I-EXPLORATION +eritema I-EXPLORATION +amigdalar I-EXPLORATION +con I-EXPLORATION +exudado I-EXPLORATION +escaso, I-EXPLORATION +moco I-EXPLORATION +en I-EXPLORATION +cavum, I-EXPLORATION +eritema I-EXPLORATION +timpánico I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +signos I-EXPLORATION +y I-EXPLORATION +eritema I-EXPLORATION +conjuntival I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +alteraciones. I-EXPLORATION +Se B-TREATMENT +diagnostica I-TREATMENT +de I-TREATMENT +viriasis I-TREATMENT +y I-TREATMENT +se I-TREATMENT +recomienda I-TREATMENT +tratamiento I-TREATMENT +sintomático. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +días, I-EVOLUTION +acude I-EVOLUTION +al I-EVOLUTION +hospital I-EVOLUTION +por I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +lesiones I-EVOLUTION +purpúricas I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +miembros I-EVOLUTION +inferiores I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +pabellones I-EVOLUTION +auriculares, I-EVOLUTION +y I-EVOLUTION +edema I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +dorso I-EVOLUTION +de I-EVOLUTION +manos I-EVOLUTION +y I-EVOLUTION +pies. I-EVOLUTION +Se B-EXPLORATION +ingresa I-EXPLORATION +durante I-EXPLORATION +cinco I-EXPLORATION +días I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +púrpura I-EXPLORATION +de I-EXPLORATION +Schönlein-Henoch I-EXPLORATION +con I-EXPLORATION +estudio I-EXPLORATION +analítico I-EXPLORATION +sanguíneo I-EXPLORATION +con I-EXPLORATION +coagulación I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +(tanto I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +aguda I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +meses I-EXPLORATION +posteriores) I-EXPLORATION +sin I-EXPLORATION +proteinuria I-EXPLORATION +ni I-EXPLORATION +hematuria. I-EXPLORATION +Recibe B-TREATMENT +penicilina I-TREATMENT +oral I-TREATMENT +por I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +etiología I-TREATMENT +estreptocócica, I-TREATMENT +encontrándose I-TREATMENT +en I-TREATMENT +el I-TREATMENT +cultivo I-TREATMENT +del I-TREATMENT +frotis I-TREATMENT +faríngeo I-TREATMENT +un I-TREATMENT +S. I-TREATMENT +pyogenes I-TREATMENT +del I-TREATMENT +grupo I-TREATMENT +A. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +nueve I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +ingreso, I-EVOLUTION +acude I-EVOLUTION +al I-EVOLUTION +centro I-EVOLUTION +de I-EVOLUTION +salud, I-EVOLUTION +donde I-EVOLUTION +se I-EVOLUTION +objetivan I-EVOLUTION +lesiones I-EVOLUTION +residuales I-EVOLUTION +de I-EVOLUTION +púrpura, I-EVOLUTION +sin I-EVOLUTION +edema I-EVOLUTION +articular. I-EVOLUTION +Se B-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +frotis I-EXPLORATION +faríngeo, I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pediatra I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +rutinaria. I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +niño I-PAST_MEDICAL_HISTORY +sano I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +personal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Durante B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +el I-EXPLORATION +pediatra I-EXPLORATION +detecta I-EXPLORATION +un I-EXPLORATION +soplo I-EXPLORATION +cardiaco I-EXPLORATION +sistólico I-EXPLORATION +vibratorio I-EXPLORATION +2/6 I-EXPLORATION +en I-EXPLORATION +borde I-EXPLORATION +esternal I-EXPLORATION +izquierdo I-EXPLORATION +bajo, I-EXPLORATION +no I-EXPLORATION +irradiado I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +modifica I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +postura, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +segundo I-EXPLORATION +tono I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +tonos I-EXPLORATION +arrítmicos I-EXPLORATION +sin I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +respiratoria. I-EXPLORATION +Los I-EXPLORATION +pulsos I-EXPLORATION +periféricos I-EXPLORATION +son I-EXPLORATION +palpables I-EXPLORATION +y I-EXPLORATION +simétricos. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +percentiles I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +talla. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +está I-EXPLORATION +asintomático; I-EXPLORATION +no I-EXPLORATION +refiere I-EXPLORATION +haber I-EXPLORATION +presentado I-EXPLORATION +palpitaciones, I-EXPLORATION +precordalgia I-EXPLORATION +ni I-EXPLORATION +síncopes I-EXPLORATION +y I-EXPLORATION +tiene I-EXPLORATION +una I-EXPLORATION +buena I-EXPLORATION +tolerancia I-EXPLORATION +al I-EXPLORATION +ejercicio I-EXPLORATION +físico. I-EXPLORATION + I-EXPLORATION +En B-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia I-FAMILY_HISTORY +no I-FAMILY_HISTORY +refieren I-FAMILY_HISTORY +enfermedades I-FAMILY_HISTORY +cardiovasculares I-FAMILY_HISTORY +ni I-FAMILY_HISTORY +hay I-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +de I-FAMILY_HISTORY +muerte I-FAMILY_HISTORY +súbita. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Ante B-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tonos I-EXPLORATION +arrítmicos I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +auscultación, I-EXPLORATION +el I-EXPLORATION +pediatra I-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +electrocardiograma I-EXPLORATION +(ECG) I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Fig. I-EXPLORATION +1. I-EXPLORATION + I-EXPLORATION +¿Cuál I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +lectura I-EXPLORATION +e I-EXPLORATION +interpretación I-EXPLORATION +del I-EXPLORATION +electrocardiograma? I-EXPLORATION +1 I-EXPLORATION + I-EXPLORATION +Aunque I-EXPLORATION +lo I-EXPLORATION +primero I-EXPLORATION +que I-EXPLORATION +nos I-EXPLORATION +llama I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +irregularidad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ritmo, I-EXPLORATION +empezamos I-EXPLORATION +nuestra I-EXPLORATION +lectura I-EXPLORATION +sistemática I-EXPLORATION +comprobando I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +un I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +(onda I-EXPLORATION +P I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +I I-EXPLORATION +y I-EXPLORATION +aVF) I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +frecuencia I-EXPLORATION +de I-EXPLORATION +55 I-EXPLORATION +lpm. I-EXPLORATION + I-EXPLORATION +Seguidamente I-EXPLORATION +analizamos I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +del I-EXPLORATION +QRS I-EXPLORATION +siguiendo I-EXPLORATION +tres I-EXPLORATION +pasos: I-EXPLORATION +1) I-EXPLORATION +localizar I-EXPLORATION +el I-EXPLORATION +cuadrante I-EXPLORATION +utilizando I-EXPLORATION +las I-EXPLORATION +derivaciones I-EXPLORATION +I I-EXPLORATION +y I-EXPLORATION +aVF; I-EXPLORATION +2) I-EXPLORATION +encontrar I-EXPLORATION +la I-EXPLORATION +derivación I-EXPLORATION +con I-EXPLORATION +complejo I-EXPLORATION +QRS I-EXPLORATION +equifásico I-EXPLORATION +(altura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +R I-EXPLORATION +similar I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +S) I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +derivaciones I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +miembros I-EXPLORATION +(I, I-EXPLORATION +II, I-EXPLORATION +III, I-EXPLORATION +aVR, I-EXPLORATION +aVL, I-EXPLORATION +aVF), I-EXPLORATION +y I-EXPLORATION +3) I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +QRS I-EXPLORATION +será I-EXPLORATION +perpendicular I-EXPLORATION +a I-EXPLORATION +esta I-EXPLORATION +derivación I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +cuadrante I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +1. I-EXPLORATION +En I-EXPLORATION +nuestro I-EXPLORATION +caso: I-EXPLORATION +1) I-EXPLORATION +el I-EXPLORATION +QRS I-EXPLORATION +es I-EXPLORATION +positivo I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +derivaciones I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +se I-EXPLORATION +encontrará I-EXPLORATION +entre I-EXPLORATION +0 I-EXPLORATION +y I-EXPLORATION +90o; I-EXPLORATION +2) I-EXPLORATION +la I-EXPLORATION +derivación I-EXPLORATION +con I-EXPLORATION +complejo I-EXPLORATION +más I-EXPLORATION +equifásico I-EXPLORATION +sería I-EXPLORATION +la I-EXPLORATION +derivación I-EXPLORATION +I, I-EXPLORATION +cuya I-EXPLORATION +perpendicular I-EXPLORATION +es I-EXPLORATION +90o, I-EXPLORATION +por I-EXPLORATION +tanto I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +QRS I-EXPLORATION +está I-EXPLORATION +a I-EXPLORATION +90o. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +eje I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +T I-EXPLORATION +es I-EXPLORATION +normal I-EXPLORATION +también I-EXPLORATION +pues I-EXPLORATION +está I-EXPLORATION +entre I-EXPLORATION +0 I-EXPLORATION +y I-EXPLORATION +90o. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +duración I-EXPLORATION +del I-EXPLORATION +complejo I-EXPLORATION +QRS I-EXPLORATION +es I-EXPLORATION +normal I-EXPLORATION +(0, I-EXPLORATION +04 I-EXPLORATION +seg). I-EXPLORATION +No I-EXPLORATION +observamos I-EXPLORATION +morfología I-EXPLORATION +de I-EXPLORATION +QRS I-EXPLORATION +que I-EXPLORATION +sugiera I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +conducción I-EXPLORATION +intraventricular I-EXPLORATION +(por I-EXPLORATION +ejemplo, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +rR´ I-EXPLORATION +en I-EXPLORATION +V1) I-EXPLORATION +ni I-EXPLORATION +hallazgos I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +onda I-EXPLORATION +T I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +son I-EXPLORATION +normales; I-EXPLORATION +no I-EXPLORATION +hay I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +repolarización. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +continuación I-EXPLORATION +analizamos I-EXPLORATION +los I-EXPLORATION +intervalos I-EXPLORATION +PR2: I-EXPLORATION +llama I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +intervalo I-EXPLORATION +PR I-EXPLORATION +(desde I-EXPLORATION +el I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +P I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +inicio I-EXPLORATION +del I-EXPLORATION +QRS) I-EXPLORATION +va I-EXPLORATION +variando I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +del I-EXPLORATION +registro, I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +constante. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Fig. I-EXPLORATION +2 I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +el I-EXPLORATION +trazado I-EXPLORATION +en I-EXPLORATION +DII I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +del I-EXPLORATION +quinto I-EXPLORATION +latido I-EXPLORATION +del I-EXPLORATION +ECG I-EXPLORATION +basal: I-EXPLORATION +el I-EXPLORATION +intervalo I-EXPLORATION +PR I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +latido I-EXPLORATION +mide I-EXPLORATION +4, I-EXPLORATION +5 I-EXPLORATION +cuadritos I-EXPLORATION +o I-EXPLORATION +milímetros I-EXPLORATION +(0, I-EXPLORATION +04 I-EXPLORATION +x I-EXPLORATION +4, I-EXPLORATION +5=0, I-EXPLORATION +18 I-EXPLORATION +seg), I-EXPLORATION +que I-EXPLORATION +está I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +límite I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad, I-EXPLORATION +el I-EXPLORATION +segundo I-EXPLORATION +latido I-EXPLORATION +tiene I-EXPLORATION +un I-EXPLORATION +intervalo I-EXPLORATION +PR I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +(0, I-EXPLORATION +22 I-EXPLORATION +seg), I-EXPLORATION +el I-EXPLORATION +tercero I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm I-EXPLORATION +(0, I-EXPLORATION +24 I-EXPLORATION +seg), I-EXPLORATION +el I-EXPLORATION +cuarto I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +mm I-EXPLORATION +(0, I-EXPLORATION +32 I-EXPLORATION +seg), I-EXPLORATION +todos I-EXPLORATION +ellos I-EXPLORATION +por I-EXPLORATION +encima I-EXPLORATION +del I-EXPLORATION +límite I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +Vemos I-EXPLORATION +también I-EXPLORATION +que I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +cuarto I-EXPLORATION +latido I-EXPLORATION +hay I-EXPLORATION +una I-EXPLORATION +onda I-EXPLORATION +P I-EXPLORATION +(marcada I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +flecha) I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +va I-EXPLORATION +seguida I-EXPLORATION +de I-EXPLORATION +complejo I-EXPLORATION +QRS. I-EXPLORATION +Este I-EXPLORATION +registro I-EXPLORATION +electrocardiográfico I-EXPLORATION +(intervalo I-EXPLORATION +PR I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +alarga I-EXPLORATION +progresivamente I-EXPLORATION +hasta I-EXPLORATION +que I-EXPLORATION +una I-EXPLORATION +onda I-EXPLORATION +P I-EXPLORATION +no I-EXPLORATION +conduce) I-EXPLORATION +refleja I-EXPLORATION +un I-EXPLORATION +bloqueo I-EXPLORATION +auriculoventricular I-EXPLORATION +(BAV) I-EXPLORATION +de I-EXPLORATION +segundo I-EXPLORATION +grado I-EXPLORATION +tipo I-EXPLORATION +Mobitz I-EXPLORATION +I. I-EXPLORATION +El I-EXPLORATION +intervalo I-EXPLORATION +QTc I-EXPLORATION +es I-EXPLORATION +normal I-EXPLORATION +(0, I-EXPLORATION +38 I-EXPLORATION +seg). I-EXPLORATION + I-EXPLORATION +Ante B-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +hallazgos I-DERIVED_FROM/TO +electrocardiográficos, I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +pediatra I-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +remitir I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +hospital, I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cardiología I-DERIVED_FROM/TO +Pediátrica, I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +esta I-DERIVED_FROM/TO +arritmia. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +de I-EXPLORATION +Cardiología I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +descartando I-EXPLORATION +patología I-EXPLORATION +estructural. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +nuevo I-EXPLORATION +electrocardiograma I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +a I-EXPLORATION +60 I-EXPLORATION +lpm I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +PR I-EXPLORATION +alargado I-EXPLORATION +(BAV I-EXPLORATION +de I-EXPLORATION +primer I-EXPLORATION +grado), I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lectura I-EXPLORATION +sistemática I-EXPLORATION +normal. I-EXPLORATION +Tras I-EXPLORATION +realizar I-EXPLORATION +ejercicio I-EXPLORATION +leve, I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +finalidad I-EXPLORATION +de I-EXPLORATION +aumentar I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca, I-EXPLORATION +se I-EXPLORATION +repitió I-EXPLORATION +el I-EXPLORATION +ECG, I-EXPLORATION +con I-EXPLORATION +normalización I-EXPLORATION +(acortamiento) I-EXPLORATION +del I-EXPLORATION +intervalo I-EXPLORATION +PR. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +resumen, I-EXPLORATION +estamos I-EXPLORATION +ante I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +asintomático I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +vista I-EXPLORATION +cardiovascular, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +soplo I-EXPLORATION +cardiaco I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +funcionales, I-EXPLORATION +una I-EXPLORATION +ecocardiografía I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +hallazgo I-EXPLORATION +casual I-EXPLORATION +de I-EXPLORATION +BAV I-EXPLORATION +de I-EXPLORATION +primer I-EXPLORATION +grado I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +segundo I-EXPLORATION +grado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ECG. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +ampliar I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +Holter-ECG I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +que I-EXPLORATION +constató I-EXPLORATION +un I-EXPLORATION +BAV I-EXPLORATION +de I-EXPLORATION +primer I-EXPLORATION +grado I-EXPLORATION +con I-EXPLORATION +dos I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +BAV I-EXPLORATION +de I-EXPLORATION +segundo I-EXPLORATION +grado I-EXPLORATION +tipo I-EXPLORATION +Mobitz I-EXPLORATION +I I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +descanso I-EXPLORATION +nocturno. I-EXPLORATION + I-EXPLORATION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +medio, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +asiático, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Atención I-PRESENT_ILLNESS +Primaria I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +siguiente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +llegar I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +orfanato I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +China I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +viviendo, I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +adoptada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +familia I-PRESENT_ILLNESS +española I-PRESENT_ILLNESS +compuesta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +padre, I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +hijos I-PRESENT_ILLNESS +biológicos I-PRESENT_ILLNESS +adolescentes. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +acompaña I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +adoptiva, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +solicita I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +valoración I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +espera I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +atendida I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +referencia I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Comunidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Madrid I-PRESENT_ILLNESS +establece I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +Protocolo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Adopción I-PRESENT_ILLNESS +Internacional. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +destaca I-EXPLORATION +su I-EXPLORATION +fenotipo I-EXPLORATION +mongoloide I-EXPLORATION +racial, I-EXPLORATION +un I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +nutricional I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +comportamiento I-EXPLORATION +tranquilo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +descubre I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +periné I-EXPLORATION +hay I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +lineal I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +horquilla I-EXPLORATION +vulvar I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +ano, I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +herida I-EXPLORATION +incisa, I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +eritematoso, I-EXPLORATION +recubierta I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sangrado. I-EXPLORATION +La I-EXPLORATION +uretra, I-EXPLORATION +la I-EXPLORATION +vagina, I-EXPLORATION +la I-EXPLORATION +vulva I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +ano I-EXPLORATION +tienen I-EXPLORATION +un I-EXPLORATION +aspecto I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +primera I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +fue I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +agresión I-EXPLORATION +sexual, I-EXPLORATION +pero I-EXPLORATION +se I-EXPLORATION +optó I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +actitud I-EXPLORATION +expectante, I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +activo I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +dolor, I-EXPLORATION +al I-EXPLORATION +aspecto I-EXPLORATION +normal I-EXPLORATION +del I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +genitales I-EXPLORATION +externos I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +comportamiento I-EXPLORATION +tranquilo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +niña I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +exploración. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +vías I-EXPLORATION +urinarias, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Tras B-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +controles I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hospital I-EVOLUTION +de I-EVOLUTION +referencia I-EVOLUTION +antes I-EVOLUTION +mencionado, I-EVOLUTION +la I-EVOLUTION +madre I-EVOLUTION +acude I-EVOLUTION +angustiada I-EVOLUTION +al I-EVOLUTION +centro I-EVOLUTION +de I-EVOLUTION +salud, I-EVOLUTION +porque I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hospital I-EVOLUTION +sospechan I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +familia I-EVOLUTION +se I-EVOLUTION +está I-EVOLUTION +abusando I-EVOLUTION +sexualmente I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +niña, I-EVOLUTION +e I-EVOLUTION +incluso I-EVOLUTION +se I-EVOLUTION +les I-EVOLUTION +ha I-EVOLUTION +amenazado I-EVOLUTION +con I-EVOLUTION +denunciarlo I-EVOLUTION +así I-EVOLUTION +ante I-EVOLUTION +las I-EVOLUTION +autoridades. I-EVOLUTION +En I-EVOLUTION +este I-EVOLUTION +intervalo, I-EVOLUTION +la I-EVOLUTION +oportuna I-EVOLUTION +lectura I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +artículo I-EVOLUTION +relacionado I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +surco I-EVOLUTION +perineal3 I-EVOLUTION +proporciona I-EVOLUTION +la I-EVOLUTION +clave I-EVOLUTION +para I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +definitivo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +malformación, I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +consiguiente I-EVOLUTION +alivio I-EVOLUTION +de I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +implicados. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +solicitado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +hospital I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +enfermedades I-EXPLORATION +de I-EXPLORATION +transmisión I-EXPLORATION +sexual I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +(lúes, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +hepatitis I-EXPLORATION +B, I-EXPLORATION +C I-EXPLORATION +y I-EXPLORATION +A, I-EXPLORATION +herpes I-EXPLORATION +y I-EXPLORATION +gonococo). I-EXPLORATION +La B-EVOLUTION +niña I-EVOLUTION +refiere, I-EVOLUTION +de I-EVOLUTION +modo I-EVOLUTION +ocasional, I-EVOLUTION +dolor I-EVOLUTION +leve I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +vulva I-EVOLUTION +y I-EVOLUTION +tiene I-EVOLUTION +cierta I-EVOLUTION +tendencia I-EVOLUTION +al I-EVOLUTION +estreñimiento, I-EVOLUTION +aunque I-EVOLUTION +estas I-EVOLUTION +molestias I-EVOLUTION +no I-EVOLUTION +interfieren I-EVOLUTION +con I-EVOLUTION +su I-EVOLUTION +actividad I-EVOLUTION +habitual I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +hay I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +irritación I-EVOLUTION +local. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +octubre I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39, I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +oC, I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +ocular I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +leve I-EXPLORATION +eritema I-EXPLORATION +palpebral, I-EXPLORATION +sin I-EXPLORATION +oftalmoplejia I-EXPLORATION +ni I-EXPLORATION +proptosis, I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +pauta I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amoxicilina/clavulánico I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +80 I-TREATMENT +mg/kg/día I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +se I-TREATMENT +informa I-TREATMENT +sobre I-TREATMENT +las I-TREATMENT +posibles I-TREATMENT +complicaciones. I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +iniciar I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +urgencia I-EVOLUTION +hospitalaria I-EVOLUTION +por I-EVOLUTION +no I-EVOLUTION +tolerar I-EVOLUTION +el I-EVOLUTION +antibiótico I-EVOLUTION +oral I-EVOLUTION +y I-EVOLUTION +persistir I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +ocular I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +fiebre. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +hospital, I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +ocular I-EXPLORATION +detectó I-EXPLORATION +ptosis I-EXPLORATION +palpebral I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +movilidad I-EXPLORATION +ocular, I-EXPLORATION +discreto I-EXPLORATION +eritema I-EXPLORATION +palpebral, I-EXPLORATION +pupilas I-EXPLORATION +isocóricas I-EXPLORATION +y I-EXPLORATION +normorreactivas, I-EXPLORATION +motilidad I-EXPLORATION +ocular I-EXPLORATION +conservada I-EXPLORATION +y I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +normal. I-EXPLORATION +Entre I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +complementarias, I-EXPLORATION +destaca: I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +leucocitos, I-EXPLORATION +14 I-EXPLORATION +720/μl I-EXPLORATION +(N: I-EXPLORATION +76, I-EXPLORATION +7%; I-EXPLORATION +L: I-EXPLORATION +15, I-EXPLORATION +5%; I-EXPLORATION +M: I-EXPLORATION +7, I-EXPLORATION +7%); I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR), I-EXPLORATION +227, I-EXPLORATION +1 I-EXPLORATION +mg/l; I-EXPLORATION +hemocultivo, I-EXPLORATION +negativo; I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +normal; I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +orbital, I-EXPLORATION +informada I-EXPLORATION +con I-EXPLORATION +cambios I-EXPLORATION +inflamatorios I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +intraorbitaria I-EXPLORATION +extraconal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +cambios I-EXPLORATION +inflamatorios I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +senos I-EXPLORATION +paranasales. I-EXPLORATION +Es B-TREATMENT +ingresado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +pauta I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amoxicilina/clavulánico I-TREATMENT +intravenoso, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantiene I-TREATMENT +durante I-TREATMENT +seis I-TREATMENT +días, I-TREATMENT +y I-TREATMENT +es I-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +con I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +antibiótico I-TREATMENT +oral I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +15 I-TREATMENT +días. I-TREATMENT +Su B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sana, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +inicia, I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso, I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo, I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +nariz, I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +boca. I-PRESENT_ILLNESS +Es B-TREATMENT +valorada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +dermatólogo, I-TREATMENT +el I-TREATMENT +odontólogo I-TREATMENT +y I-TREATMENT +el I-TREATMENT +otorrinolaringólogo; I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +tratamiento I-TREATMENT +por I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +impétigo. I-TREATMENT +No B-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +mejoría; I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +siguientes, I-EVOLUTION +presenta I-EVOLUTION +lesiones I-EVOLUTION +eritematosas I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +dedos I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +manos I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +diagnostica I-EVOLUTION +de I-EVOLUTION +viriasis. I-EVOLUTION +Sigue I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +mejoría, I-EVOLUTION +se I-EVOLUTION +observan I-EVOLUTION +también I-EVOLUTION +dichas I-EVOLUTION +lesiones I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +dedos I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +pies, I-EVOLUTION +asociando I-EVOLUTION +abdominalgias I-EVOLUTION +y I-EVOLUTION +vómitos I-EVOLUTION +ocasionales. I-EVOLUTION +Siempre I-EVOLUTION +afebril, I-EVOLUTION +la I-EVOLUTION +madre I-EVOLUTION +refiere I-EVOLUTION +observar I-EVOLUTION +"caída I-EVOLUTION +del I-EVOLUTION +cabello", I-EVOLUTION +sin I-EVOLUTION +otros I-EVOLUTION +signos I-EVOLUTION +clínicos I-EVOLUTION +asociados. I-EVOLUTION +Antecedentes B-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Antecedentes B-FAMILY_HISTORY +familiares: I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +diagnosticado I-FAMILY_HISTORY +de I-FAMILY_HISTORY +colon I-FAMILY_HISTORY +irritable, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +casos I-FAMILY_HISTORY +reumatológicos I-FAMILY_HISTORY +ni I-FAMILY_HISTORY +clínica I-FAMILY_HISTORY +similar I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +niña; I-FAMILY_HISTORY +una I-FAMILY_HISTORY +prima I-FAMILY_HISTORY +hermana I-FAMILY_HISTORY +materna I-FAMILY_HISTORY +diagnosticada I-FAMILY_HISTORY +hace I-FAMILY_HISTORY +un I-FAMILY_HISTORY +año I-FAMILY_HISTORY +de I-FAMILY_HISTORY +púrpura I-FAMILY_HISTORY +de I-FAMILY_HISTORY +Schonlein-Henoch. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Cuando B-EXPLORATION +ingresa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hospital I-EXPLORATION +está I-EXPLORATION +febril I-EXPLORATION +(38 I-EXPLORATION +oC), I-EXPLORATION +con I-EXPLORATION +buen I-EXPLORATION +aspecto I-EXPLORATION +general. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +eritema I-EXPLORATION +malar I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +respeta I-EXPLORATION +el I-EXPLORATION +pliegue I-EXPLORATION +nasolabial; I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +tumefacción I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +del I-EXPLORATION +lacrimal I-EXPLORATION +izquierdo. I-EXPLORATION +Lesiones I-EXPLORATION +purpúricas I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +pulpejos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +manos, I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +pies I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +talones. I-EXPLORATION +Presenta I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +orofaringe I-EXPLORATION +aftas, I-EXPLORATION +estomatitis I-EXPLORATION +y I-EXPLORATION +enantema. I-EXPLORATION +No I-EXPLORATION +tiene I-EXPLORATION +adenopatías. I-EXPLORATION +Las I-EXPLORATION +exploraciones I-EXPLORATION +osteoarticular I-EXPLORATION +y I-EXPLORATION +neurológica, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +cardiopulmonar, I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Estudios I-EXPLORATION +complementarios I-EXPLORATION +solicitados: I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemograma, I-EXPLORATION +Hb I-EXPLORATION +10, I-EXPLORATION +6 I-EXPLORATION +g/dl, I-EXPLORATION +leucocitos I-EXPLORATION +3500/μl I-EXPLORATION +con I-EXPLORATION +fórmula I-EXPLORATION +normal, I-EXPLORATION +plaquetas I-EXPLORATION +126 I-EXPLORATION +000/ I-EXPLORATION +μl I-EXPLORATION +(un I-EXPLORATION +mes I-EXPLORATION +antes I-EXPLORATION +solo I-EXPLORATION +destacar I-EXPLORATION +4400 I-EXPLORATION +leucocitos/ I-EXPLORATION +μl). I-EXPLORATION +Frotis I-EXPLORATION +sanguíneo I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +morfológicas. I-EXPLORATION +Velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +44 I-EXPLORATION +mm/hora. I-EXPLORATION +Reactantes I-EXPLORATION +fase I-EXPLORATION +aguda: I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +0, I-EXPLORATION +18 I-EXPLORATION +mg/dl, I-EXPLORATION +procalcitonina I-EXPLORATION +0, I-EXPLORATION +06 I-EXPLORATION +ng/ml. I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +coagulación, I-EXPLORATION +pruebas I-EXPLORATION +reumáticas I-EXPLORATION +y I-EXPLORATION +proteinograma I-EXPLORATION +normales. I-EXPLORATION +Inmunoglobulinas I-EXPLORATION +con I-EXPLORATION +IgG I-EXPLORATION +1830 I-EXPLORATION +mg/dl I-EXPLORATION +e I-EXPLORATION +IgA I-EXPLORATION +271 I-EXPLORATION +mg/dl. I-EXPLORATION +Complementos I-EXPLORATION +C3 I-EXPLORATION +23, I-EXPLORATION +7 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +C4 I-EXPLORATION +4, I-EXPLORATION +2 I-EXPLORATION +mg/dl. I-EXPLORATION +Autoinmunidad: I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(ANA) I-EXPLORATION ++ I-EXPLORATION +1/1280, I-EXPLORATION +anti-SM I-EXPLORATION +positivo, I-EXPLORATION +anti-ADN I-EXPLORATION +fuertemente I-EXPLORATION +positivo. I-EXPLORATION +Sistemático I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +150-250 I-EXPLORATION +eritrocitos/campo. I-EXPLORATION +Serologías I-EXPLORATION +bacteriana I-EXPLORATION +a I-EXPLORATION +Mycoplasma, I-EXPLORATION +parasitaria I-EXPLORATION +a I-EXPLORATION +toxoplasma I-EXPLORATION +y I-EXPLORATION +vírica I-EXPLORATION +a I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein-Barr, I-EXPLORATION +parvovirus I-EXPLORATION +B19, I-EXPLORATION +adenovirus, I-EXPLORATION +echovirus I-EXPLORATION +y I-EXPLORATION +coxsakie I-EXPLORATION +negativas. I-EXPLORATION +Destacar I-EXPLORATION +una I-EXPLORATION +IgM I-EXPLORATION +a I-EXPLORATION +citomegalovirus I-EXPLORATION +positiva. I-EXPLORATION +Hemocultivo I-EXPLORATION +y I-EXPLORATION +frotis I-EXPLORATION +faríngeo, I-EXPLORATION +bucal, I-EXPLORATION +conjuntiva I-EXPLORATION +y I-EXPLORATION +punción I-EXPLORATION +púrpura, I-EXPLORATION +negativos. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +clínica I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +complementarios I-EXPLORATION +referidos, I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +lupus I-EXPLORATION +eritematoso I-EXPLORATION +sistémico I-EXPLORATION +(LES), I-EXPLORATION +se I-EXPLORATION +solicitan I-EXPLORATION +anticuerpos I-EXPLORATION +antifosfolípidos I-EXPLORATION +(AAF), I-EXPLORATION +antilúpicos I-EXPLORATION +positivos I-EXPLORATION +y I-EXPLORATION +anticardiolipina I-EXPLORATION +positiva I-EXPLORATION +(IgG, I-EXPLORATION +IgM), I-EXPLORATION +una I-EXPLORATION +ecocardiografía I-EXPLORATION +(función I-EXPLORATION +y I-EXPLORATION +estructura I-EXPLORATION +cardiacas I-EXPLORATION +normales) I-EXPLORATION +y I-EXPLORATION +opinión I-EXPLORATION +dermatológica. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +cumplir I-EXPLORATION +más I-EXPLORATION +de I-EXPLORATION +cuatro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +criterios I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Asociación I-EXPLORATION +Americana I-EXPLORATION +de I-EXPLORATION +Reumatología, I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +LES I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +nefrológica I-EXPLORATION +y I-EXPLORATION +reumatológica. I-EXPLORATION +Se B-TREATMENT +pauta I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +medidas I-TREATMENT +generales, I-TREATMENT +antipalúdicos I-TREATMENT +(hidroxicloroquina) I-TREATMENT +y I-TREATMENT +corticoides I-TREATMENT +(prednisona) I-TREATMENT +orales, I-TREATMENT +manteniéndose I-TREATMENT +revisiones I-TREATMENT +correspondientes I-TREATMENT +en I-TREATMENT +su I-TREATMENT +seguimiento I-TREATMENT +multidisciplinar. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +contusión I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +parte I-PRESENT_ILLNESS +lateral I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Durante B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +presenta I-EXPLORATION +cierta I-EXPLORATION +tumefacción I-EXPLORATION +sin I-EXPLORATION +hematoma I-EXPLORATION +y I-EXPLORATION +escaso I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +del I-EXPLORATION +pie, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +tobillo I-EXPLORATION +normal. I-EXPLORATION +Al B-TREATMENT +no I-TREATMENT +sospechar I-TREATMENT +fractura, I-TREATMENT +se I-TREATMENT +recomienda I-TREATMENT +inmovilización I-TREATMENT +y I-TREATMENT +reposo I-TREATMENT +físico I-TREATMENT +relativo, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +analgésico, I-TREATMENT +indicando I-TREATMENT +control I-TREATMENT +en I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +según I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +clínica. I-TREATMENT +Transcurrido B-EVOLUTION +el I-EVOLUTION +periodo I-EVOLUTION +de I-EVOLUTION +inmovilización, I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +consulta, I-EVOLUTION +se I-EVOLUTION +retira I-EVOLUTION +la I-EVOLUTION +inmovilización I-EVOLUTION +y, I-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +sintomatología, I-EVOLUTION +se I-EVOLUTION +da I-EVOLUTION +de I-EVOLUTION +alta, I-EVOLUTION +retomando I-EVOLUTION +su I-EVOLUTION +actividad I-EVOLUTION +física I-EVOLUTION +habitual I-EVOLUTION +como I-EVOLUTION +portero I-EVOLUTION +de I-EVOLUTION +waterpolo. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +semanas, I-EVOLUTION +acude I-EVOLUTION +a I-EVOLUTION +Urgencias I-EVOLUTION +del I-EVOLUTION +centro I-EVOLUTION +de I-EVOLUTION +salud I-EVOLUTION +por I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cara I-EVOLUTION +lateral I-EVOLUTION +del I-EVOLUTION +pie I-EVOLUTION +derecho. I-EVOLUTION +Ha I-EVOLUTION +estado I-EVOLUTION +practicando I-EVOLUTION +waterpolo I-EVOLUTION +y I-EVOLUTION +niega I-EVOLUTION +antecedente I-EVOLUTION +traumático I-EVOLUTION +en I-EVOLUTION +este I-EVOLUTION +periodo I-EVOLUTION +de I-EVOLUTION +tiempo. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +exploración I-EVOLUTION +destaca I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +tumefacción I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +proximal I-EVOLUTION +del I-EVOLUTION +quinto I-EVOLUTION +metatarsiano I-EVOLUTION +del I-EVOLUTION +pie I-EVOLUTION +derecho, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +realizan I-EVOLUTION +una I-EVOLUTION +radiología I-EVOLUTION +frontal I-EVOLUTION +y I-EVOLUTION +otra I-EVOLUTION +lateral I-EVOLUTION +de I-EVOLUTION +dicho I-EVOLUTION +pie, I-EVOLUTION +informándose I-EVOLUTION +como I-EVOLUTION +posible I-EVOLUTION +fractura I-EVOLUTION +de I-EVOLUTION +Jones. I-EVOLUTION +Posteriormente, I-EVOLUTION +es I-EVOLUTION +valorado I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +pediatra, I-EVOLUTION +que I-EVOLUTION +observa I-EVOLUTION +tumefacción I-EVOLUTION +no I-EVOLUTION +dolorosa I-EVOLUTION +también I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +pie I-EVOLUTION +izquierdo; I-EVOLUTION +al I-EVOLUTION +tratarse I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +preadolescente I-EVOLUTION +que I-EVOLUTION +realiza I-EVOLUTION +deporte I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +habitual, I-EVOLUTION +sin I-EVOLUTION +un I-EVOLUTION +antecedente I-EVOLUTION +traumático I-EVOLUTION +conocido, I-EVOLUTION +y I-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +sospecha I-EVOLUTION +de I-EVOLUTION +posible I-EVOLUTION +apofisitis, I-EVOLUTION +decide I-EVOLUTION +realizar I-EVOLUTION +una I-EVOLUTION +radiología I-EVOLUTION +bilateral I-EVOLUTION +oblicua, I-EVOLUTION +que I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +imagen I-EVOLUTION +de I-EVOLUTION +fragmentación I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +base I-EVOLUTION +del I-EVOLUTION +quinto I-EVOLUTION +metatarsiano I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +pies. I-EVOLUTION +Se B-TREATMENT +diagnostica I-TREATMENT +de I-TREATMENT +apofisitis I-TREATMENT +del I-TREATMENT +quinto I-TREATMENT +metatarsiano, I-TREATMENT +también I-TREATMENT +conocida I-TREATMENT +como I-TREATMENT +enfermedad I-TREATMENT +de I-TREATMENT +Iselin, I-TREATMENT +recibiendo I-TREATMENT +tratamiento I-TREATMENT +analgésico I-TREATMENT +y I-TREATMENT +antiinflamatorio, I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +reposo I-TREATMENT +deportivo I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +desaparición I-TREATMENT +del I-TREATMENT +dolor. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +vuelto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +práctica I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +actividad I-EVOLUTION +deportiva I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +molestias I-EVOLUTION +de I-EVOLUTION +nuevo. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas I-PAST_MEDICAL_HISTORY +conocidas. I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bronquiolitis I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +brotes I-PAST_MEDICAL_HISTORY +recurrentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dermatitis I-PAST_MEDICAL_HISTORY +atópica. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +consultas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Alergología I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +episódica I-PAST_MEDICAL_HISTORY +estacional I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sensibilización I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +pólenes I-PAST_MEDICAL_HISTORY +(gramíneas, I-PAST_MEDICAL_HISTORY +olivos, I-PAST_MEDICAL_HISTORY +malezas), I-PAST_MEDICAL_HISTORY +ácaros I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +queso, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +asocia I-PAST_MEDICAL_HISTORY +rinoconjuntivitis. I-PAST_MEDICAL_HISTORY +Precisa I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +inmunoterapia I-PAST_MEDICAL_HISTORY +específica I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +pólenes I-PAST_MEDICAL_HISTORY +(gramíneas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +olivo) I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +sublingual, I-PAST_MEDICAL_HISTORY +fluticasona I-PAST_MEDICAL_HISTORY +tópica I-PAST_MEDICAL_HISTORY +nasal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antihistamínicos I-PAST_MEDICAL_HISTORY +orales, I-PAST_MEDICAL_HISTORY +asociando I-PAST_MEDICAL_HISTORY +budesonida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +salbutamol I-PAST_MEDICAL_HISTORY +inhalados I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +periodos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +crisis. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Durante B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +brote I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dermatitis I-PRESENT_ILLNESS +atópica, I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +administran I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +jugo I-PRESENT_ILLNESS +directo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +planta I-PRESENT_ILLNESS +Aloe I-PRESENT_ILLNESS +vera I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +uno I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +hombros, I-PRESENT_ILLNESS +desarrollando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +pocos I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +habonosas I-PRESENT_ILLNESS +confluentes I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +intensamente I-PRESENT_ILLNESS +pruriginosas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +toda I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +superficie I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +espalda, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +asociar I-PRESENT_ILLNESS +afectación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +aérea. I-PRESENT_ILLNESS +Se B-TREATMENT +pauta I-TREATMENT +dexclorfeniramina I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +clínica I-TREATMENT +en I-TREATMENT +las I-TREATMENT +siguientes I-TREATMENT +horas. I-TREATMENT +Tras B-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +en I-EVOLUTION +dosis I-EVOLUTION +habituales, I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +desaparecieron I-EVOLUTION +por I-EVOLUTION +completo I-EVOLUTION +sin I-EVOLUTION +dejar I-EVOLUTION +cicatrices. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +hipopigmentadas I-PRESENT_ILLNESS +posinflamatorias I-PRESENT_ILLNESS +residuales I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +dibujan I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +contorno I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +uno I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estos I-PRESENT_ILLNESS +tatuajes I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +realización, I-PRESENT_ILLNESS +afectando I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +superficie I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +extensión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +antebrazos. I-PRESENT_ILLNESS +Las I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +representan I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Ash® I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Pikachu®, I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +personajes I-PRESENT_ILLNESS +protagonistas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +serie I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dibujos I-PRESENT_ILLNESS +animados I-PRESENT_ILLNESS +Pokemon®. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +previas I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +consultado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +localidad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +veraneaba I-PRESENT_ILLNESS +porque I-PRESENT_ILLNESS +presentaba, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tatuaje, I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +vesiculoampollosas I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +base I-PRESENT_ILLNESS +eritematosa, I-PRESENT_ILLNESS +pruriginosas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sobreinfección I-PRESENT_ILLNESS +secundaria. I-PRESENT_ILLNESS +Pasado B-EVOLUTION +un I-EVOLUTION +año, I-EVOLUTION +aún I-EVOLUTION +se I-EVOLUTION +aprecian I-EVOLUTION +lesiones I-EVOLUTION +residuales I-EVOLUTION +con I-EVOLUTION +prurito I-EVOLUTION +ocasional. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +afebril, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +amigdalitis I-PRESENT_ILLNESS +pultácea, I-PRESENT_ILLNESS +frotis I-PRESENT_ILLNESS +faríngeo I-PRESENT_ILLNESS +negativo I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +estreptococo, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +resto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +exploración I-PRESENT_ILLNESS +física I-PRESENT_ILLNESS +normal. I-PRESENT_ILLNESS +Dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +tuvo I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea. I-PRESENT_ILLNESS +Por B-TREATMENT +todo I-TREATMENT +ello I-TREATMENT +se I-TREATMENT +orienta I-TREATMENT +como I-TREATMENT +un I-TREATMENT +cuadro I-TREATMENT +vírico, I-TREATMENT +realizando I-TREATMENT +tratamiento I-TREATMENT +sintomático. I-TREATMENT +A B-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +días, I-EXPLORATION +por I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +deposiciones I-EXPLORATION +líquidas, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +coprocultivo I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +positivo I-EXPLORATION +a I-EXPLORATION +Salmonella I-EXPLORATION +typhimurium. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +cuadro, I-EVOLUTION +el I-EVOLUTION +niño I-EVOLUTION +presenta I-EVOLUTION +unas I-EVOLUTION +lesiones I-EVOLUTION +eritematosas I-EVOLUTION +y I-EVOLUTION +algunos I-EVOLUTION +nódulos I-EVOLUTION +pretibiales, I-EVOLUTION +dolorosas, I-EVOLUTION +en I-EVOLUTION +ambas I-EVOLUTION +extremidades I-EVOLUTION +inferiores, I-EVOLUTION +en I-EVOLUTION +número I-EVOLUTION +de I-EVOLUTION +8-9, I-EVOLUTION +de I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +2-3 I-EVOLUTION +cm I-EVOLUTION +de I-EVOLUTION +diámetro, I-EVOLUTION +sin I-EVOLUTION +otros I-EVOLUTION +signos I-EVOLUTION +ni I-EVOLUTION +síntomas. I-EVOLUTION + I-EVOLUTION +Ante B-EXPLORATION +la I-EXPLORATION +clínica, I-EXPLORATION +orientamos I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +como I-EXPLORATION +EN I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +S. I-EXPLORATION +typhimurium. I-EXPLORATION +Solicitamos I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +hemograma, I-EXPLORATION +bioquímica, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +(VSG), I-EXPLORATION +factor I-EXPLORATION +reumatoide, I-EXPLORATION +antiestreptolisinas I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(ANA), I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +otras I-EXPLORATION +posibles I-EXPLORATION +etiologías1. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +no I-EXPLORATION +objetiva I-EXPLORATION +alteraciones I-EXPLORATION +radiológicas I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +determinaciones I-EXPLORATION +analíticas I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +desaparecen I-EVOLUTION +los I-EVOLUTION +nódulos, I-EVOLUTION +con I-EVOLUTION +curación I-EVOLUTION +completa. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +llevada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +frontal, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +máxima I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +°C I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tumefacción I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas. I-PRESENT_ILLNESS +Presentaba B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +corrección I-PAST_MEDICAL_HISTORY +quirúrgica I-PAST_MEDICAL_HISTORY +endoscópica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trigonocefalia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +ingreso, I-EXPLORATION +presentaba I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +137 I-EXPLORATION +lpm, I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +de I-EXPLORATION +25 I-EXPLORATION +rpm, I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +102/60 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +36, I-EXPLORATION +8 I-EXPLORATION +°C. I-EXPLORATION +Neurológicamente I-EXPLORATION +estaba I-EXPLORATION +consciente, I-EXPLORATION +orientada I-EXPLORATION +y I-EXPLORATION +colaboradora, I-EXPLORATION +con I-EXPLORATION +Glasgow I-EXPLORATION +15/15. I-EXPLORATION +Rigidez I-EXPLORATION +de I-EXPLORATION +nuca I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +Kernig I-EXPLORATION +y I-EXPLORATION +Brudzinski I-EXPLORATION +positivos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +periorbitaria I-EXPLORATION +derecha I-EXPLORATION +presentaba I-EXPLORATION +tumefacción I-EXPLORATION +con I-EXPLORATION +eritema, I-EXPLORATION +calor I-EXPLORATION +local I-EXPLORATION +y I-EXPLORATION +movimientos I-EXPLORATION +oculares I-EXPLORATION +conservados. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +leucocitosis I-EXPLORATION +14 I-EXPLORATION +500/mm3, I-EXPLORATION +neutrofilia I-EXPLORATION +13 I-EXPLORATION +900/mm3, I-EXPLORATION +linfopenia I-EXPLORATION +390/mm3 I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda: I-EXPLORATION +fibrinógeno I-EXPLORATION +881 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +241 I-EXPLORATION +mg/l. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +punción I-EXPLORATION +lumbar, I-EXPLORATION +tras I-EXPLORATION +confirmar I-EXPLORATION +normalidad I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo, I-EXPLORATION +obteniéndose I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +turbio, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +citoquímico I-EXPLORATION +mostraba I-EXPLORATION +380 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +38% I-EXPLORATION +de I-EXPLORATION +polimorfonucleares, I-EXPLORATION +hipoglucorraquia I-EXPLORATION +41 I-EXPLORATION +mg/dl I-EXPLORATION +e I-EXPLORATION +hiperproteinorraquia I-EXPLORATION +240 I-EXPLORATION +mg/dl; I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +bacterias. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemocultivo I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +S. I-EXPLORATION +pyogenes. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +craneal I-EXPLORATION +evidenciaba I-EXPLORATION +ocupación I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +celdillas I-EXPLORATION +etmoidales I-EXPLORATION +izquierdas I-EXPLORATION +y I-EXPLORATION +frontales I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +tumefacción I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +periorbitaria I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +cefotaxima I-TREATMENT +y I-TREATMENT +vancomicina, I-TREATMENT +suspendiendo I-TREATMENT +este I-TREATMENT +último I-TREATMENT +al I-TREATMENT +aislarse I-TREATMENT +S. I-TREATMENT +pyogenes, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +asoció I-TREATMENT +clindamicina I-TREATMENT +por I-TREATMENT +presentar I-TREATMENT +exantema I-TREATMENT +escarlatiniforme. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +séptimo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +tuvo I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +convulsivo I-EVOLUTION +tónico-clónico I-EVOLUTION +focalizado I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hemicuerpo I-EVOLUTION +izquierdo I-EVOLUTION +que I-EVOLUTION +posteriormente I-EVOLUTION +se I-EVOLUTION +generalizó. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +craneal, I-EXPLORATION +encontrando I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +sugestiva I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +oftálmica I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +ocupación I-EXPLORATION +parcial I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +cavernoso I-EXPLORATION +derecho, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +realce I-EXPLORATION +meníngeo. I-EXPLORATION +Fue B-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +ácido I-TREATMENT +valpróico I-TREATMENT +y I-TREATMENT +dexametasona, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +anticoagulación. I-TREATMENT +Posteriormente, B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +satisfactoriamente I-EVOLUTION +manteniéndose B-TREATMENT +21 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +intravenoso, I-TREATMENT +con B-EVOLUTION +controles I-EVOLUTION +clínicos, I-EVOLUTION +neurológico, I-EVOLUTION +electrocardiográfico I-EVOLUTION +y I-EVOLUTION +mediante I-EVOLUTION +resonancia I-EVOLUTION +magnética I-EVOLUTION +normales I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +secuelas I-EVOLUTION +neurológicas. I-EVOLUTION + I-EVOLUTION + +Adolescente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +constante I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +iliaca I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +vómito I-PRESENT_ILLNESS +aislado. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +tenido I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +inespecíficas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pierna I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +apreciar I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +calor. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +fecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +última I-PRESENT_ILLNESS +regla I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +visita I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +acné, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ciproterona I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +mg I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +asociación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +acetato I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ciproterona, I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +mg, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +etinilestradiol, I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +µg. I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +únicamente I-EXPLORATION +destaca I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +derecha, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +patología I-EXPLORATION +apendicular, I-EXPLORATION +se I-EXPLORATION +realiza, I-EXPLORATION +una I-EXPLORATION +analítica, I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +normal I-EXPLORATION +excepto I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +dímero I-EXPLORATION +D I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +sensibilidad, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +9958 I-EXPLORATION +ng/ml, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ecogenicidad I-EXPLORATION +del I-EXPLORATION +contenido I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +iliaca I-EXPLORATION +común I-EXPLORATION +derecha I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +trombo I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +sin I-EXPLORATION +ocupación I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +iliaca I-EXPLORATION +superficial I-EXPLORATION +ipsilateral, I-EXPLORATION +estando I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +femoral I-EXPLORATION +común I-EXPLORATION +permeable. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior, I-EXPLORATION +se I-EXPLORATION +completa I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +helicoidal I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +cuyos I-EXPLORATION +hallazgos I-EXPLORATION +son I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +defectos I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +pulmonares I-EXPLORATION +lobares I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +arterias I-EXPLORATION +pulmonares I-EXPLORATION +principales, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +ni I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +derecho. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +radiológicos I-EXPLORATION +resultan I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tromboembolismo I-EXPLORATION +pulmonar I-EXPLORATION +(TEP) I-EXPLORATION +masivo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +caudal I-EXPLORATION +del I-EXPLORATION +trombo I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +recibe I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +subcutánea I-TREATMENT +y I-TREATMENT +presenta I-TREATMENT +una I-TREATMENT +evolución I-TREATMENT +clínica I-TREATMENT +favorable. I-TREATMENT +Se B-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +trombofilia I-EXPLORATION +encontrando I-EXPLORATION +como I-EXPLORATION +única I-EXPLORATION +alteración I-EXPLORATION +un I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +S I-EXPLORATION +libre I-EXPLORATION +antigénica I-EXPLORATION +del I-EXPLORATION +19% I-EXPLORATION +(valor I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +normal I-EXPLORATION +por I-EXPLORATION +encima I-EXPLORATION +del I-EXPLORATION +54%). I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +embarazo I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +controlado, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +(G4A0V3), I-PRESENT_ILLNESS +inmune I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +rubeola I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +toxoplasma. I-PRESENT_ILLNESS +Exudado I-PRESENT_ILLNESS +rectovaginal I-PRESENT_ILLNESS +estreptocócico I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +recogido. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +gestacional I-PRESENT_ILLNESS +estimada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +biometría I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33-34 I-PRESENT_ILLNESS +semanas. I-PRESENT_ILLNESS +Recibe B-TREATMENT +un I-TREATMENT +ciclo I-TREATMENT +de I-TREATMENT +corticoides I-TREATMENT +completo I-TREATMENT +y I-TREATMENT +precisa I-TREATMENT +tratamiento I-TREATMENT +por I-TREATMENT +preeclampsia I-TREATMENT +y I-TREATMENT +edema I-TREATMENT +agudo I-TREATMENT +de I-TREATMENT +pulmón. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +cesárea I-TREATMENT +urgente I-TREATMENT +por I-TREATMENT +causa I-TREATMENT +materna, I-TREATMENT +con I-TREATMENT +bolsa I-TREATMENT +rota I-TREATMENT +intraoperatoria I-TREATMENT +y I-TREATMENT +líquido I-TREATMENT +amniótico I-TREATMENT +claro. I-TREATMENT +Test B-EVOLUTION +de I-EVOLUTION +Apgar I-EVOLUTION +7/9, I-EVOLUTION +REA I-EVOLUTION +III. I-EVOLUTION +Peso I-EVOLUTION +del I-EVOLUTION +recién I-EVOLUTION +nacido I-EVOLUTION +(RN) I-EVOLUTION +de I-EVOLUTION +1600 I-EVOLUTION +g. I-EVOLUTION +No I-EVOLUTION +fue I-EVOLUTION +tallado I-EVOLUTION +por I-EVOLUTION +inestabilidad I-EVOLUTION +clínica. I-EVOLUTION +Precisa B-DERIVED_FROM/TO +traslado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cuidados I-DERIVED_FROM/TO +Intensivos I-DERIVED_FROM/TO +Neonatales I-DERIVED_FROM/TO +(UCIN) I-DERIVED_FROM/TO +tipo I-DERIVED_FROM/TO +IIIC I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +12 I-DERIVED_FROM/TO +horas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vida I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +cuadro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +enfermedad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +membrana I-DERIVED_FROM/TO +hialina, I-DERIVED_FROM/TO +hipertensión I-DERIVED_FROM/TO +pulmonar I-DERIVED_FROM/TO +grave I-DERIVED_FROM/TO +e I-DERIVED_FROM/TO +inestabilidad I-DERIVED_FROM/TO +hemodinámica. I-DERIVED_FROM/TO +En B-TREATMENT +este I-TREATMENT +centro I-TREATMENT +precisa I-TREATMENT +varios I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +antibioterapia I-TREATMENT +por I-TREATMENT +sepsis I-TREATMENT +nosocomial I-TREATMENT +y I-TREATMENT +por I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +enterocolitis I-TREATMENT +necrotizante I-TREATMENT +no I-TREATMENT +confirmada, I-TREATMENT +y I-TREATMENT +recibe I-TREATMENT +una I-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +concentrado I-TREATMENT +de I-TREATMENT +hematíes. I-TREATMENT +Se B-EVOLUTION +realiza I-EVOLUTION +seguimiento I-EVOLUTION +con I-EVOLUTION +ecografías I-EVOLUTION +cerebrales I-EVOLUTION +seriadas, I-EVOLUTION +sin I-EVOLUTION +hallazgos I-EVOLUTION +significativos. I-EVOLUTION +Electroencefalografía I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION +A B-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +26 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vida, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +edad I-DERIVED_FROM/TO +gestacional I-DERIVED_FROM/TO +corregida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +36+4 I-DERIVED_FROM/TO +semanas, I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +trasladado I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vuelta I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro. I-DERIVED_FROM/TO +A B-EVOLUTION +los I-EVOLUTION +38 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida, I-EVOLUTION +se I-EVOLUTION +objetiva I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +movimiento I-EVOLUTION +espontáneo I-EVOLUTION +del I-EVOLUTION +brazo I-EVOLUTION +derecho, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +reflejo I-EVOLUTION +de I-EVOLUTION +Moro I-EVOLUTION +asimétrico I-EVOLUTION +y I-EVOLUTION +escasa I-EVOLUTION +prensión I-EVOLUTION +palmar, I-EVOLUTION +junto I-EVOLUTION +con I-EVOLUTION +tumefacción I-EVOLUTION +y I-EVOLUTION +mínimo I-EVOLUTION +eritema I-EVOLUTION +del I-EVOLUTION +hombro I-EVOLUTION +derecho, I-EVOLUTION +que I-EVOLUTION +resulta I-EVOLUTION +doloroso, I-EVOLUTION +con I-EVOLUTION +llanto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +palpación I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +movilización. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +articular I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +derrame I-EXPLORATION +articular I-EXPLORATION +leve-moderado, I-EXPLORATION +hiperecogénico I-EXPLORATION +y I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +derrame I-EXPLORATION +complicado. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +punción I-TREATMENT +y I-TREATMENT +drenaje I-TREATMENT +con I-TREATMENT +aguja I-TREATMENT +fina I-TREATMENT +sin I-TREATMENT +incidencias, I-TREATMENT +obteniendo I-TREATMENT +2 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +hemopurulento I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +cefotaxima I-TREATMENT +y I-TREATMENT +cloxacilina I-TREATMENT +intravenosa. I-TREATMENT +Tras B-EVOLUTION +el I-EVOLUTION +drenaje I-EVOLUTION +se I-EVOLUTION +reduce I-EVOLUTION +la I-EVOLUTION +tumefacción I-EVOLUTION +si I-EVOLUTION +bien I-EVOLUTION +persiste I-EVOLUTION +una I-EVOLUTION +asimetría I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tamaño I-EVOLUTION +del I-EVOLUTION +hombro I-EVOLUTION +derecho I-EVOLUTION +respecto I-EVOLUTION +al I-EVOLUTION +izquierdo. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +se I-EVOLUTION +confirma I-EVOLUTION +que I-EVOLUTION +crece I-EVOLUTION +E. I-EVOLUTION +coli I-EVOLUTION +sin I-EVOLUTION +resistencias I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +antibiograma, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +suspende I-EVOLUTION +la I-EVOLUTION +cloxacilina, I-EVOLUTION +manteniendo I-EVOLUTION +la I-EVOLUTION +cefotaxima I-EVOLUTION +en I-EVOLUTION +monoterapia. I-EVOLUTION +A B-EXPLORATION +los I-EXPLORATION +cinco I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +intravenoso, I-EXPLORATION +se I-EXPLORATION +obtiene I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +14, I-EXPLORATION +6 I-EXPLORATION +mg/dl, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +no I-EXPLORATION +presentar I-EXPLORATION +empeoramiento I-EXPLORATION +clínico I-EXPLORATION +del I-EXPLORATION +hombro. I-EXPLORATION +Se I-EXPLORATION +repite I-EXPLORATION +de I-EXPLORATION +nuevo I-EXPLORATION +la I-EXPLORATION +ecografía, I-EXPLORATION +que I-EXPLORATION +evidencia I-EXPLORATION +un I-EXPLORATION +mínimo I-EXPLORATION +derrame I-EXPLORATION +articular I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +abscesificada I-EXPLORATION +incipiente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +capsular. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +drenaje I-TREATMENT +guiado I-TREATMENT +por I-TREATMENT +ecografía. I-TREATMENT +Se I-TREATMENT +obtienen I-TREATMENT +0, I-TREATMENT +3 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +muestra, I-TREATMENT +en I-TREATMENT +cuyo I-TREATMENT +cultivo I-TREATMENT +crece I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +E. I-TREATMENT +coli I-TREATMENT +multisensible. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +siete I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +asociar I-TREATMENT +amikacina I-TREATMENT +intravenosa I-TREATMENT +para I-TREATMENT +potenciar I-TREATMENT +el I-TREATMENT +efecto I-TREATMENT +antibiótico I-TREATMENT +por I-TREATMENT +aumento I-TREATMENT +leve I-TREATMENT +de I-TREATMENT +la I-TREATMENT +PCR. I-TREATMENT +Tras B-EVOLUTION +esto, I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +horas I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +marcada I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +analítica. I-EVOLUTION +Ante B-TREATMENT +la I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +analítica, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +pasar I-TREATMENT +a I-TREATMENT +cefuroxima-axetilo I-TREATMENT +para I-TREATMENT +completar I-TREATMENT +tres I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +antibiótico I-TREATMENT +oral. I-TREATMENT + I-TREATMENT + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +cuyos I-PRESENT_ILLNESS +padres I-PRESENT_ILLNESS +consultaron I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +porque I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +diario I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +sueño I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +inquieto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ronquido I-PRESENT_ILLNESS +continuo, I-PRESENT_ILLNESS +respiración I-PRESENT_ILLNESS +bucal, I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +profusa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +frecuentes I-PRESENT_ILLNESS +despertares I-PRESENT_ILLNESS +nocturnos. I-PRESENT_ILLNESS +Sus I-PRESENT_ILLNESS +ronquidos I-PRESENT_ILLNESS +eran I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +ruidosos, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +modificaban I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +cambiar I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +postura I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acentuaban I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +cuadros I-PRESENT_ILLNESS +catarrales. I-PRESENT_ILLNESS +Los I-PRESENT_ILLNESS +padres I-PRESENT_ILLNESS +dudaban I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +pudiera I-PRESENT_ILLNESS +tener I-PRESENT_ILLNESS +apneas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +negaban I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cianosis. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +niño I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +mostraba I-PRESENT_ILLNESS +cansado, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +quejaba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +matutina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +habitual I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tenía I-PRESENT_ILLNESS +poco I-PRESENT_ILLNESS +apetito. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +periodo I-PRESENT_ILLNESS +escolar I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +padecido I-PRESENT_ILLNESS +infecciones I-PRESENT_ILLNESS +respiratorias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +repetida. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +colegio, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +maestra I-PRESENT_ILLNESS +les I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +comentado I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +prestaba I-PRESENT_ILLNESS +atención I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +jugaba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +poco I-PRESENT_ILLNESS +entusiasmo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +energía. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dormir I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +niño I-PRESENT_ILLNESS +afectaba I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +calidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +padres, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +lograban I-PRESENT_ILLNESS +conseguir I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +sueño I-PRESENT_ILLNESS +reparador I-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +continuas I-PRESENT_ILLNESS +interrupciones I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +mostraban I-PRESENT_ILLNESS +preocupados I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rendidos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +un I-EXPLORATION +estancamiento I-EXPLORATION +importante I-EXPLORATION +y I-EXPLORATION +progresivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +curva I-EXPLORATION +ponderoestatural I-EXPLORATION +desde I-EXPLORATION +los I-EXPLORATION +18 I-EXPLORATION +meses. I-EXPLORATION +Presentaba I-EXPLORATION +facies I-EXPLORATION +adenoidea I-EXPLORATION +con I-EXPLORATION +hipertofia I-EXPLORATION +amigdalar I-EXPLORATION +grado I-EXPLORATION +IV/IV I-EXPLORATION +y I-EXPLORATION +respiración I-EXPLORATION +oral. I-EXPLORATION +La I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +polisomnográfico I-EXPLORATION +nocturno I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Unidad I-EXPLORATION +del I-EXPLORATION +Sueño I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +SAOS I-EXPLORATION +infantil I-EXPLORATION +con I-EXPLORATION +predominio I-EXPLORATION +obstructivo. I-EXPLORATION +Los I-EXPLORATION +datos I-EXPLORATION +registrados I-EXPLORATION +pusieron I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +sueño I-EXPLORATION +anómalo, I-EXPLORATION +fragmentado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +mantenimiento I-EXPLORATION +por I-EXPLORATION +eventos I-EXPLORATION +respiratorios I-EXPLORATION +obstructivos I-EXPLORATION +en I-EXPLORATION +número I-EXPLORATION +patológico. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +adenoidectomía I-TREATMENT +y I-TREATMENT +radiofrecuencia I-TREATMENT +inducida I-TREATMENT +amigdalar. I-TREATMENT +El B-EVOLUTION +niño I-EVOLUTION +mejoró, I-EVOLUTION +presentando I-EVOLUTION +remisión I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +nocturnos I-EVOLUTION +y I-EVOLUTION +diurnos I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +inmediata. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +siguientes I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +recuperó I-EVOLUTION +un I-EVOLUTION +crecimiento I-EVOLUTION +y I-EVOLUTION +ganancia I-EVOLUTION +ponderal I-EVOLUTION +adecuados I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +vio I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +procesos I-EVOLUTION +respiratorios I-EVOLUTION +de I-EVOLUTION +repetición I-EVOLUTION +que I-EVOLUTION +venía I-EVOLUTION +padeciendo I-EVOLUTION +con I-EVOLUTION +anterioridad. I-EVOLUTION +La I-EVOLUTION +familia I-EVOLUTION +manifestó I-EVOLUTION +estar I-EVOLUTION +muy I-EVOLUTION +contenta I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +niño I-EVOLUTION +y, I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +también I-EVOLUTION +es I-EVOLUTION +importante, I-EVOLUTION +todos I-EVOLUTION +habían I-EVOLUTION +vuelto I-EVOLUTION +a I-EVOLUTION +dormir I-EVOLUTION +bien. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +alta, I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +odinofagia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +azitromicina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +genitales I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +dolorosas. I-PRESENT_ILLNESS +Ausencia B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +menarquia, I-PAST_MEDICAL_HISTORY +contacto I-PAST_MEDICAL_HISTORY +sexual I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +traumatismos I-PAST_MEDICAL_HISTORY +genitales I-PAST_MEDICAL_HISTORY +previos. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +genital I-EXPLORATION +presenta I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +labios I-EXPLORATION +mayores, I-EXPLORATION +con I-EXPLORATION +úlceras I-EXPLORATION +profundas, I-EXPLORATION +simétricas, I-EXPLORATION +negruzcas, I-EXPLORATION +la I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +longitudinal I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +labios I-EXPLORATION +menores I-EXPLORATION +y I-EXPLORATION +varias I-EXPLORATION +lesiones I-EXPLORATION +satélites I-EXPLORATION +menores I-EXPLORATION +perivulvares, I-EXPLORATION +recubiertas I-EXPLORATION +algunas I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +fibrinoide I-EXPLORATION +y I-EXPLORATION +muy I-EXPLORATION +dolorosa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +manipulación. I-EXPLORATION +Resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +relevantes. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +destaca I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +22, I-EXPLORATION +38/µl I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +de I-EXPLORATION +138, I-EXPLORATION +9 I-EXPLORATION +mg/l, I-EXPLORATION +con I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +sedimento I-EXPLORATION +urinario I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +una I-EXPLORATION +úlcera I-EXPLORATION +genital I-EXPLORATION +aguda, I-EXPLORATION +planteamos I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +infeccioso, I-EXPLORATION +ya I-EXPLORATION +sea I-EXPLORATION +venéreo I-EXPLORATION +(sífilis, I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simple, I-EXPLORATION +linfogranuloma I-EXPLORATION +venéreo, I-EXPLORATION +chancroide) I-EXPLORATION +o I-EXPLORATION +no I-EXPLORATION +venéreo I-EXPLORATION +(virus I-EXPLORATION +de I-EXPLORATION +Epstein-Barr I-EXPLORATION +[VEB], I-EXPLORATION +citomegalovirus I-EXPLORATION +[CMV], I-EXPLORATION +Brucella), I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +no I-EXPLORATION +infeccioso I-EXPLORATION +(enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn, I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Behçet, I-EXPLORATION +pénfigo I-EXPLORATION +vulgar, I-EXPLORATION +liquen I-EXPLORATION +escleroso, I-EXPLORATION +aftosis I-EXPLORATION +idiopática, I-EXPLORATION +eritema I-EXPLORATION +fijo I-EXPLORATION +medicamentoso, I-EXPLORATION +eritema I-EXPLORATION +multiforme) I-EXPLORATION +1-3. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +ingresa I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +con I-TREATMENT +analgesia, I-TREATMENT +lubricante I-TREATMENT +cicratizante I-TREATMENT +y I-TREATMENT +fomentos I-TREATMENT +con I-TREATMENT +suero I-TREATMENT +fisiológico. I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +tórpida, I-TREATMENT +se I-TREATMENT +añaden I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +antibióticos I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro, I-TREATMENT +aciclovir I-TREATMENT +IV I-TREATMENT +y I-TREATMENT +corticoterapia I-TREATMENT +oral, I-TREATMENT +en I-TREATMENT +espera I-TREATMENT +de I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +de I-TREATMENT +los I-TREATMENT +cultivos. I-TREATMENT +El B-EXPLORATION +urocultivo, I-EXPLORATION +el I-EXPLORATION +hemocultivo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +exudado I-EXPLORATION +vaginal I-EXPLORATION +y I-EXPLORATION +cervical I-EXPLORATION +(para I-EXPLORATION +C. I-EXPLORATION +trachomatis), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +frotis I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +úlceras I-EXPLORATION +genitales, I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +VEB, I-EXPLORATION +CMV, I-EXPLORATION +Brucella, I-EXPLORATION +Rosa I-EXPLORATION +de I-EXPLORATION +Bengala, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana I-EXPLORATION +y I-EXPLORATION +lúes I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +Se I-EXPLORATION +solicita I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +ADN I-EXPLORATION +del I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simple I-EXPLORATION +tipos I-EXPLORATION +I I-EXPLORATION +y I-EXPLORATION +II, I-EXPLORATION +mediante I-EXPLORATION +reacción I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +polimerasa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +úlcera I-EXPLORATION +genital, I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +finalmente I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +Se B-EVOLUTION +establece I-EVOLUTION +el I-EVOLUTION +diagnóstico, I-EVOLUTION +por I-EVOLUTION +exclusión, I-EVOLUTION +de I-EVOLUTION +úlcera I-EVOLUTION +de I-EVOLUTION +Lipschütz I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +forma I-EVOLUTION +gangrenosa I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +decide I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +ingreso, I-EVOLUTION +persistiendo I-EVOLUTION +las I-EVOLUTION +ulceraciones I-EVOLUTION +múltiples I-EVOLUTION +con I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +tejido, I-EVOLUTION +sin I-EVOLUTION +aspecto I-EVOLUTION +inflamatorio I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +cicatrización, I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +más I-EVOLUTION +externas, I-EVOLUTION +sin I-EVOLUTION +apreciarse I-EVOLUTION +retracción I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +mucosas I-EVOLUTION +genitales I-EVOLUTION +ni I-EVOLUTION +secreciones I-EVOLUTION +vaginales. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +cuadro I-EVOLUTION +estaba I-EVOLUTION +casi I-EVOLUTION +totalmente I-EVOLUTION +resuelto I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +siete I-EVOLUTION +semanas I-EVOLUTION +del I-EVOLUTION +diagnóstico. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +caso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +niña I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diez I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +chino, I-PAST_MEDICAL_HISTORY +con B-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +°C I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología. I-PRESENT_ILLNESS +Alimentada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +lactancia I-PRESENT_ILLNESS +artificial. I-PRESENT_ILLNESS +Sin B-FAMILY_HISTORY +ambiente I-FAMILY_HISTORY +epidémico I-FAMILY_HISTORY +familiar. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +mantenido I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +normales; I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +eutócico I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +infeccioso, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +precisó I-PAST_MEDICAL_HISTORY +reanimación I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +pruebas I-PAST_MEDICAL_HISTORY +metabólicas I-PAST_MEDICAL_HISTORY +estaban I-PAST_MEDICAL_HISTORY +pendientes I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +momento. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presentaba I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +sin I-EXPLORATION +aspecto I-EXPLORATION +séptico, I-EXPLORATION +siendo I-EXPLORATION +normal I-EXPLORATION +por I-EXPLORATION +aparatos. I-EXPLORATION + I-EXPLORATION +En B-TREATMENT +Urgencias I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +fiebre I-TREATMENT +sin I-TREATMENT +foco I-TREATMENT +en I-TREATMENT +paciente I-TREATMENT +neonatal I-TREATMENT +(analítica I-TREATMENT +sanguínea, I-TREATMENT +urinaria I-TREATMENT +y I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +cefalorraquídeo I-TREATMENT +normales) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +pauta I-TREATMENT +antibioterapia I-TREATMENT +empírica. I-TREATMENT + I-TREATMENT +Permanece B-EVOLUTION +afebril I-EVOLUTION +desde I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +y I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +alta, I-EVOLUTION +sin I-EVOLUTION +incidencias I-EVOLUTION +salvo I-EVOLUTION +por I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +exantema I-EVOLUTION +maculopapular I-EVOLUTION +al I-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +ingreso, I-EVOLUTION +que I-EVOLUTION +remite I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +espontánea I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +siguientes I-EVOLUTION +24-48 I-EVOLUTION +horas. I-EVOLUTION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +viriasis, I-TREATMENT +y I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +que I-TREATMENT +se I-TREATMENT +confirman I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +definitivos I-TREATMENT +de I-TREATMENT +los I-TREATMENT +cultivos I-TREATMENT +(negativos), I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +la I-TREATMENT +antibioterapia. I-TREATMENT +Se B-EVOLUTION +decide I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida. I-EVOLUTION + I-EVOLUTION +Dos I-EVOLUTION +días I-EVOLUTION +después, I-EVOLUTION +acude I-EVOLUTION +al I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencias I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +exantema I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +generalizado, I-EVOLUTION +a I-EVOLUTION +expensas I-EVOLUTION +de I-EVOLUTION +elementos I-EVOLUTION +“en I-EVOLUTION +diana” I-EVOLUTION +con I-EVOLUTION +aclaramiento I-EVOLUTION +central, I-EVOLUTION +sobreelevados I-EVOLUTION +y I-EVOLUTION +confluyentes. I-EVOLUTION +Leve B-EXPLORATION +coloración I-EXPLORATION +amoratada, I-EXPLORATION +más I-EXPLORATION +intensa I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +borra I-EXPLORATION +parcialmente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión, I-EXPLORATION +sin I-EXPLORATION +petequias. I-EXPLORATION +Como I-EXPLORATION +única I-EXPLORATION +clínica I-EXPLORATION +acompañante, I-EXPLORATION +presentaba I-EXPLORATION +deposiciones I-EXPLORATION +líquidas I-EXPLORATION +escasas. I-EXPLORATION + I-EXPLORATION +Se B-EVOLUTION +mantuvo I-EVOLUTION +en I-EVOLUTION +observación I-EVOLUTION +durante I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +y, I-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +no I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +el I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION +Tras I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +en I-EVOLUTION +domicilio, I-EVOLUTION +acude I-EVOLUTION +nuevamente I-EVOLUTION +por I-EVOLUTION +shock I-EVOLUTION +hipovolémico I-EVOLUTION +secundario I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +diarrea I-EVOLUTION +abundante I-EVOLUTION +desde I-EVOLUTION +18 I-EVOLUTION +horas I-EVOLUTION +antes, I-EVOLUTION +sin I-EVOLUTION +vómitos I-EVOLUTION +ni I-EVOLUTION +rechazo I-EVOLUTION +de I-EVOLUTION +tomas. I-EVOLUTION +Las B-EXPLORATION +lesiones I-EXPLORATION +cutáneas I-EXPLORATION +habían I-EXPLORATION +desaparecido. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +coprocultivo I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +germen I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +virología I-EXPLORATION +fecal I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +Recibió B-TREATMENT +reposición I-TREATMENT +con I-TREATMENT +fluidoterapia I-TREATMENT +intravenosa, I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +retirándose I-TREATMENT +según I-TREATMENT +mejoraba I-TREATMENT +la I-TREATMENT +tolerancia I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +leche I-TREATMENT +hidrolizada I-TREATMENT +y I-TREATMENT +tras I-TREATMENT +descartar I-TREATMENT +afectación I-TREATMENT +intestinal. I-TREATMENT +Las B-EVOLUTION +deposiciones I-EVOLUTION +mejoraron I-EVOLUTION +progresivamente I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +controles I-EVOLUTION +sucesivos I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +adecuada I-EVOLUTION +ganancia I-EVOLUTION +ponderoestatural, I-EVOLUTION +con I-EVOLUTION +deposiciones I-EVOLUTION +de I-EVOLUTION +consistencia I-EVOLUTION +normal. I-EVOLUTION +Mantuvo I-EVOLUTION +la I-EVOLUTION +alimentación I-EVOLUTION +con I-EVOLUTION +fórmula I-EVOLUTION +hidrolizada I-EVOLUTION +durante I-EVOLUTION +unas I-EVOLUTION +semanas, I-EVOLUTION +con I-EVOLUTION +posterior I-EVOLUTION +tolerancia I-EVOLUTION +de I-EVOLUTION +fórmula I-EVOLUTION +artificial, I-EVOLUTION +sin I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +nuevas I-EVOLUTION +lesiones I-EVOLUTION +cutáneas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia, I-PAST_MEDICAL_HISTORY +de B-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +inicia I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +padecimiento I-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +detectar I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manera I-PRESENT_ILLNESS +súbita I-PRESENT_ILLNESS +alteración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha, I-PRESENT_ILLNESS +descrito I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +“arrastrando I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +izquierdo”; I-PRESENT_ILLNESS +esto I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +causaba I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +equilibrio, I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +inhabilidad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +desplazarse. I-PRESENT_ILLNESS +Así I-PRESENT_ILLNESS +mismo, I-PRESENT_ILLNESS +nota I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +brazo I-PRESENT_ILLNESS +ipsilateral I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +movimientos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +discapacidad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +manipular I-PRESENT_ILLNESS +objetos, I-PRESENT_ILLNESS +caracterizada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pasarlos I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +mano, I-PRESENT_ILLNESS +niega I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +poder I-PRESENT_ILLNESS +localizar I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +exactitud I-PRESENT_ILLNESS +si I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +predominio I-PRESENT_ILLNESS +proximal I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +distal; I-PRESENT_ILLNESS +esto I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manera I-PRESENT_ILLNESS +constante, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +ceder, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +horario I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +calendario, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +atenuantes, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +exacerbantes I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +acompañantes. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +funciones I-EXPLORATION +superiores I-EXPLORATION +preservadas, I-EXPLORATION +nervios I-EXPLORATION +craneales I-EXPLORATION +sin I-EXPLORATION +alteraciones, I-EXPLORATION +sistema I-EXPLORATION +sensorial I-EXPLORATION +—lo I-EXPLORATION +posible I-EXPLORATION +de I-EXPLORATION +valorar I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +cooperación I-EXPLORATION +del I-EXPLORATION +paciente— I-EXPLORATION +normal, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +muscular I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +las I-EXPLORATION +cuatro I-EXPLORATION +extremidades I-EXPLORATION +simétricas I-EXPLORATION +y I-EXPLORATION +eutróficas I-EXPLORATION +con I-EXPLORATION +tono I-EXPLORATION +muscular I-EXPLORATION +sin I-EXPLORATION +alteraciones, I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +activa I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +fuerza I-EXPLORATION +3/5 I-EXPLORATION +en I-EXPLORATION +porcion I-EXPLORATION +distal I-EXPLORATION +y I-EXPLORATION +4/5 I-EXPLORATION +en I-EXPLORATION +seccion I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +hemicuerpo I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +5/5 I-EXPLORATION +en I-EXPLORATION +extremidades I-EXPLORATION +de I-EXPLORATION +hemicuerpo I-EXPLORATION +derecho. I-EXPLORATION +No I-EXPLORATION +presenta I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +mantener I-EXPLORATION +la I-EXPLORATION +bipedestación I-EXPLORATION +sin I-EXPLORATION +apoyo. I-EXPLORATION +La I-EXPLORATION +marcha I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +sin I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +sustentación, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +contacto I-EXPLORATION +simetrica I-EXPLORATION +bilateral, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +discreta I-EXPLORATION +rotación I-EXPLORATION +externa I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +miembro I-EXPLORATION +pelvico I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +caída I-EXPLORATION +del I-EXPLORATION +pie I-EXPLORATION +golpeando I-EXPLORATION +el I-EXPLORATION +suelo I-EXPLORATION +con I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +planta I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +oscilación, I-EXPLORATION +con I-EXPLORATION +movimientos I-EXPLORATION +asimétricos, I-EXPLORATION +acompañados I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +incompleta I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +izquierda. I-EXPLORATION +Puede I-EXPLORATION +realizar I-EXPLORATION +la I-EXPLORATION +marcha I-EXPLORATION +sin I-EXPLORATION +apoyo. I-EXPLORATION +Reflejos I-EXPLORATION +primitivos I-EXPLORATION +ausentes, I-EXPLORATION +Babinski I-EXPLORATION +negativo, I-EXPLORATION +reflejo I-EXPLORATION +braquioradial I-EXPLORATION +2/4, I-EXPLORATION +bicipital I-EXPLORATION +2/4, I-EXPLORATION +tricipital I-EXPLORATION +2/4, I-EXPLORATION +rotulaino I-EXPLORATION +2/4, I-EXPLORATION +aquileo I-EXPLORATION +2/4 I-EXPLORATION +bilaterales. I-EXPLORATION +Rigidez I-EXPLORATION +nucal, I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Brudsinski I-EXPLORATION +y I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Kernig I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitan I-EXPLORATION +radiografías I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +y I-EXPLORATION +cadera, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +reportan I-EXPLORATION +como I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +cráneo, I-EXPLORATION +sin I-EXPLORATION +encontrar I-EXPLORATION +datos I-EXPLORATION +radiográficos I-EXPLORATION +sugestivos I-EXPLORATION +del I-EXPLORATION +origen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sintomatología, I-EXPLORATION +razón I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +contrastada I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +y I-EXPLORATION +médula I-EXPLORATION +espinal, I-EXPLORATION +encontrándose I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +intramedular I-EXPLORATION +heterogénea I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +desde I-EXPLORATION +C3 I-EXPLORATION +hasta I-EXPLORATION +T3 I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +hipointensas I-EXPLORATION +en I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +zonas I-EXPLORATION +hiperintensas I-EXPLORATION +en I-EXPLORATION +T2 I-EXPLORATION +que I-EXPLORATION +involucran I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +medular I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +mide I-EXPLORATION +7, I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +y I-EXPLORATION +oblitera I-EXPLORATION +el I-EXPLORATION +espacio I-EXPLORATION +subaracnoideo. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +preparó I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia, I-EXPLORATION +extrayéndose I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +análisis I-EXPLORATION +por I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Patología, I-EXPLORATION +que I-EXPLORATION +observó I-EXPLORATION +neoplasia I-EXPLORATION +fibrilar I-EXPLORATION +compuesta I-EXPLORATION +de I-EXPLORATION +hipercelularidad I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +astrocítica I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +hemorragia; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +necrosis I-EXPLORATION +ni I-EXPLORATION +hiperplasia I-EXPLORATION +vascular, I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +células I-EXPLORATION +irregulares, I-EXPLORATION +cromatina I-EXPLORATION +grumosa I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +ninguna I-EXPLORATION +mitosis, I-EXPLORATION +realizándose I-EXPLORATION +el I-EXPLORATION +diagnostico I-EXPLORATION +de I-EXPLORATION +astrocitoma I-EXPLORATION +fibrilar I-EXPLORATION +difuso I-EXPLORATION +grado I-EXPLORATION +II I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +OMS I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +intramedular. I-EXPLORATION + I-EXPLORATION +Posteriormente B-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +traslada I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +especializado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +patología I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +EE. I-DERIVED_FROM/TO +UU., I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realiza I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +extracción I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +mayor I-DERIVED_FROM/TO +cantidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tumoración, I-DERIVED_FROM/TO +aproximadamente I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +80-90%, I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +envía I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +muestra I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +patología I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +encuentran I-DERIVED_FROM/TO +dos I-DERIVED_FROM/TO +mitosis I-DERIVED_FROM/TO +positivas, I-DERIVED_FROM/TO +reclasificando I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +tumoración I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +grado I-DERIVED_FROM/TO +III I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +OMS. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Niña B-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +sana, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés; I-PAST_MEDICAL_HISTORY +está I-PAST_MEDICAL_HISTORY +correctamente I-PAST_MEDICAL_HISTORY +vacunada. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +tiene I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +primer I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +parotídea. I-PRESENT_ILLNESS +Cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +parotídea I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +borraba I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ángulo I-PRESENT_ILLNESS +mandibular, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +inflamatorios I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +supuración I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +conducto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Stenon. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +leucocitosis I-EXPLORATION +(19 I-EXPLORATION +700/mm3) I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(65%), I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +45 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +amilasa I-EXPLORATION +de I-EXPLORATION +881 I-EXPLORATION +U/l. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +inflamación I-EXPLORATION +bilateral I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +parótidas, I-EXPLORATION +sin I-EXPLORATION +colecciones. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +ingreso I-TREATMENT +para I-TREATMENT +antibioterapia I-TREATMENT +intravenosa I-TREATMENT +con I-TREATMENT +amoxicilina-clavulánico, I-TREATMENT +analgesia I-TREATMENT +y I-TREATMENT +antiinflamatorios. I-TREATMENT +Dada B-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +evolución, I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +para I-EVOLUTION +continuar I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +ambulatoria. I-EVOLUTION + I-EVOLUTION +Posteriormente I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +sucesivos I-EVOLUTION +episodios I-EVOLUTION +(cuatro I-EVOLUTION +más) I-EVOLUTION +de I-EVOLUTION +características I-EVOLUTION +clínicas I-EVOLUTION +y I-EVOLUTION +analíticas I-EVOLUTION +similares, I-EVOLUTION +que I-EVOLUTION +han I-EVOLUTION +sido I-EVOLUTION +tratados I-EVOLUTION +con I-EVOLUTION +antibioterapia I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +ambulatoria I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +evolución. I-EVOLUTION +Son I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +duración I-EVOLUTION +aproximadamente, I-EVOLUTION +bilaterales, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +predominio I-EVOLUTION +de I-EVOLUTION +afectación I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +lado I-EVOLUTION +izquierdo. I-EVOLUTION + I-EVOLUTION +Es I-EVOLUTION +seguida I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +de I-EVOLUTION +Infectología I-EVOLUTION +Pediátrica I-EVOLUTION +donde I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +completado I-EVOLUTION +el I-EVOLUTION +estudio. I-EVOLUTION +Todas B-EXPLORATION +las I-EXPLORATION +serologías I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +reumatoideas I-EXPLORATION +son I-EXPLORATION +negativas. I-EXPLORATION +Se I-EXPLORATION +repiten I-EXPLORATION +ecografías I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +el I-EXPLORATION +aumento I-EXPLORATION +glandular, I-EXPLORATION +con I-EXPLORATION +fotos I-EXPLORATION +heterogéneos I-EXPLORATION +hipoecogénicos. I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +sin I-EVOLUTION +nuevos I-EVOLUTION +episodios. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +diagnostica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +neumonía I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +condensación I-PRESENT_ILLNESS +parenquimatosa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +lóbulo I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +hay I-PAST_MEDICAL_HISTORY +datos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Embarazo I-PAST_MEDICAL_HISTORY +controlado I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +incidencias, I-PAST_MEDICAL_HISTORY +nacida I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +38 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +gestacional, I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +falta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +progresión. I-PAST_MEDICAL_HISTORY +Peso I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2870 I-PAST_MEDICAL_HISTORY +g. I-PAST_MEDICAL_HISTORY +Vacunas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desarrollo I-PAST_MEDICAL_HISTORY +psicomotor I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY +Refieren I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +bebe I-PAST_MEDICAL_HISTORY +bastantes I-PAST_MEDICAL_HISTORY +líquidos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diuresis I-PAST_MEDICAL_HISTORY +abundante. I-PAST_MEDICAL_HISTORY +Peso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +talla I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +percentil I-PAST_MEDICAL_HISTORY +50. I-PAST_MEDICAL_HISTORY +Refieren I-PAST_MEDICAL_HISTORY +avidez I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +sal I-PAST_MEDICAL_HISTORY +(se I-PAST_MEDICAL_HISTORY +bebe I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +agua I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +playa I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +avidez I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +prefiere I-PAST_MEDICAL_HISTORY +alimentos I-PAST_MEDICAL_HISTORY +salados) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +calambres I-PAST_MEDICAL_HISTORY +musculares I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ocasiones. I-PAST_MEDICAL_HISTORY +No B-FAMILY_HISTORY +hay I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +a I-FAMILY_HISTORY +destacar. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Peso B-EXPLORATION +12, I-EXPLORATION +4 I-EXPLORATION +kg I-EXPLORATION +(p10-25), I-EXPLORATION +talla I-EXPLORATION +95 I-EXPLORATION +cm I-EXPLORATION +(p50), I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +100/60 I-EXPLORATION +mmHg, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +90 I-EXPLORATION +lpm, I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +28 I-EXPLORATION +rpm, I-EXPLORATION +temperatura I-EXPLORATION +38, I-EXPLORATION +3 I-EXPLORATION +oC. I-EXPLORATION +Regular I-EXPLORATION +aspecto I-EXPLORATION +general I-EXPLORATION +por I-EXPLORATION +facies I-EXPLORATION +febril, I-EXPLORATION +decaída I-EXPLORATION +y I-EXPLORATION +discreta I-EXPLORATION +sequedad I-EXPLORATION +de I-EXPLORATION +mucosas. I-EXPLORATION +Cráneo I-EXPLORATION +normal. I-EXPLORATION +Signos I-EXPLORATION +meníngeos I-EXPLORATION +negativos. I-EXPLORATION +No I-EXPLORATION +presenta I-EXPLORATION +exantemas I-EXPLORATION +ni I-EXPLORATION +petequias. I-EXPLORATION +Otoscopia I-EXPLORATION +y I-EXPLORATION +orofaringe I-EXPLORATION +normal. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +entrada I-EXPLORATION +de I-EXPLORATION +aire I-EXPLORATION +en I-EXPLORATION +base I-EXPLORATION +derecha. I-EXPLORATION +Abdomen I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +palpan I-EXPLORATION +masas, I-EXPLORATION +ni I-EXPLORATION +visceromegalias. I-EXPLORATION +Genitales I-EXPLORATION +normales I-EXPLORATION +de I-EXPLORATION +niña. I-EXPLORATION +Región I-EXPLORATION +lumbosacra I-EXPLORATION +normal. I-EXPLORATION +Resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +análisis I-EXPLORATION +realizados I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +infección I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +22 I-EXPLORATION +000 I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(neutrófilos I-EXPLORATION +87%) I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +de I-EXPLORATION +200 I-EXPLORATION +mg/l, I-EXPLORATION +pero I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +hipopotasemia I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +2 I-EXPLORATION +mmol/l I-EXPLORATION +con I-EXPLORATION +Na I-EXPLORATION +129 I-EXPLORATION +mmol/l, I-EXPLORATION +Cl I-EXPLORATION +92, I-EXPLORATION +2 I-EXPLORATION +mmol/l, I-EXPLORATION +Ca I-EXPLORATION +9, I-EXPLORATION +5 I-EXPLORATION +mg/dl, I-EXPLORATION +Mg I-EXPLORATION +1, I-EXPLORATION +7 I-EXPLORATION +mg/dl, I-EXPLORATION +Cr I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +alcalosis I-EXPLORATION +metabólica I-EXPLORATION +(pH I-EXPLORATION +7, I-EXPLORATION +50 I-EXPLORATION +y I-EXPLORATION +bicarbonato I-EXPLORATION +24, I-EXPLORATION +1 I-EXPLORATION +mmol/l). I-EXPLORATION +Renina I-EXPLORATION +y I-EXPLORATION +aldosterona I-EXPLORATION +elevadas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +orina: I-EXPLORATION +densidad I-EXPLORATION +1005, I-EXPLORATION +PH I-EXPLORATION +8, I-EXPLORATION +sedimento I-EXPLORATION +normal. I-EXPLORATION +Iones I-EXPLORATION +en I-EXPLORATION +orina: I-EXPLORATION +K I-EXPLORATION +17, I-EXPLORATION +5 I-EXPLORATION +mEq/l, I-EXPLORATION +Cl I-EXPLORATION +10 I-EXPLORATION +mEq/l, I-EXPLORATION +Na I-EXPLORATION +7 I-EXPLORATION +mEq/l; I-EXPLORATION +Na I-EXPLORATION +orina/K I-EXPLORATION +orina I-EXPLORATION +0, I-EXPLORATION +4. I-EXPLORATION +Excreciones I-EXPLORATION +fraccionadas I-EXPLORATION +de I-EXPLORATION +K I-EXPLORATION +elevadas I-EXPLORATION +(8,32%), I-EXPLORATION +de I-EXPLORATION +Na I-EXPLORATION +(0,06%) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +Cl I-EXPLORATION +(0,11%) I-EXPLORATION +en I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +normalidad. I-EXPLORATION +Ca/Cr I-EXPLORATION +0, I-EXPLORATION +56 I-EXPLORATION +mg/mg. I-EXPLORATION +Aclaramiento I-EXPLORATION +de I-EXPLORATION +creatinina I-EXPLORATION +normal, I-EXPLORATION +filtrado I-EXPLORATION +glomerular I-EXPLORATION +104, I-EXPLORATION +50 I-EXPLORATION +ml/min/1, I-EXPLORATION +73m2, I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +renal I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +electrocardiograma I-EXPLORATION +(ECG) I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +hipopotasemia I-EXPLORATION +por I-EXPLORATION +prolongación I-EXPLORATION +del I-EXPLORATION +PR I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ECG. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +neumonía I-TREATMENT +basal I-TREATMENT +derecha, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +cefuroxima I-TREATMENT +intravenosa I-TREATMENT +y B-EVOLUTION +de I-EVOLUTION +modo I-EVOLUTION +progresivo I-EVOLUTION +fue I-EVOLUTION +mejorando I-EVOLUTION +clínica, I-EVOLUTION +radiológica I-EVOLUTION +y I-EVOLUTION +analíticamente. I-EVOLUTION + I-EVOLUTION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +tubulopatía, I-TREATMENT +dada I-TREATMENT +la I-TREATMENT +hipopotasemia I-TREATMENT +y I-TREATMENT +la I-TREATMENT +pérdida I-TREATMENT +urinaria I-TREATMENT +elevada I-TREATMENT +de I-TREATMENT +este I-TREATMENT +electrolito, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +suplementos I-TREATMENT +intravenosos I-TREATMENT +de I-TREATMENT +potasio I-TREATMENT +y B-EVOLUTION +se I-EVOLUTION +corrigieron I-EVOLUTION +poco I-EVOLUTION +a I-EVOLUTION +poco I-EVOLUTION +las I-EVOLUTION +cifras, I-EVOLUTION +siendo I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +el I-EVOLUTION +K I-EVOLUTION +de I-EVOLUTION +3, I-EVOLUTION +9 I-EVOLUTION +mmol/l. I-EVOLUTION + I-EVOLUTION +Se I-EVOLUTION +controló I-EVOLUTION +en I-EVOLUTION +consultas I-EVOLUTION +de I-EVOLUTION +Nefrología I-EVOLUTION +Pediátrica, I-EVOLUTION +confirmándose I-EVOLUTION +la I-EVOLUTION +tubulopatía I-EVOLUTION +genéticamente I-EVOLUTION +(síndrome I-EVOLUTION +de I-EVOLUTION +Gitelman) I-EVOLUTION +y I-EVOLUTION +manteniendo I-EVOLUTION +adecuados I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +K I-EVOLUTION +sérico I-EVOLUTION +con B-TREATMENT +suplementos I-TREATMENT +orales I-TREATMENT +y I-TREATMENT +dieta I-TREATMENT +rica I-TREATMENT +en I-TREATMENT +este I-TREATMENT +electrolito. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +portadora I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +variaciones I-EXPLORATION +p. I-EXPLORATION +Gly741Arg I-EXPLORATION +y I-EXPLORATION +p. I-EXPLORATION +Cys994Tyr, I-EXPLORATION +ambas I-EXPLORATION +en I-EXPLORATION +heterocigosis, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +SLC12A3, I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +brazo I-EXPLORATION +largo I-EXPLORATION +del I-EXPLORATION +cromosoma I-EXPLORATION +16. I-EXPLORATION +Transmisión I-EXPLORATION +autosómica I-EXPLORATION +recesiva. I-EXPLORATION + I-EXPLORATION +Nuestra B-TREATMENT +paciente, I-TREATMENT +desde I-TREATMENT +su I-TREATMENT +diagnóstico, I-TREATMENT +recibe I-TREATMENT +una I-TREATMENT +dieta I-TREATMENT +rica I-TREATMENT +en I-TREATMENT +potasio I-TREATMENT +y I-TREATMENT +magnesio I-TREATMENT +y I-TREATMENT +suplementos I-TREATMENT +orales I-TREATMENT +de I-TREATMENT +potasio. I-TREATMENT +Tras I-TREATMENT +varios I-TREATMENT +años I-TREATMENT +de I-TREATMENT +tratamiento, I-TREATMENT +dada I-TREATMENT +las I-TREATMENT +altas I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +suplementos I-TREATMENT +orales I-TREATMENT +de I-TREATMENT +K I-TREATMENT +(4, I-TREATMENT +3 I-TREATMENT +mEq/kg/día) I-TREATMENT +para I-TREATMENT +mantener I-TREATMENT +niveles I-TREATMENT +séricos I-TREATMENT +de I-TREATMENT +K I-TREATMENT +3, I-TREATMENT +1-3, I-TREATMENT +5 I-TREATMENT +mmol/l, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +asociar I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +diuréticos I-TREATMENT +ahorradores I-TREATMENT +de I-TREATMENT +potasio. I-TREATMENT + I-TREATMENT +En I-TREATMENT +ocasiones, I-TREATMENT +coincidiendo I-TREATMENT +con I-TREATMENT +episodios I-TREATMENT +de I-TREATMENT +diarrea I-TREATMENT +y I-TREATMENT +vómitos, I-TREATMENT +presenta I-TREATMENT +hipopotasemia I-TREATMENT +sintomática, I-TREATMENT +que I-TREATMENT +precisa I-TREATMENT +suplementos I-TREATMENT +intravenosos I-TREATMENT +de I-TREATMENT +potasio. I-TREATMENT + I-TREATMENT +No I-TREATMENT +hay I-TREATMENT +datos I-TREATMENT +de I-TREATMENT +hipomagnesemia I-TREATMENT +en I-TREATMENT +ningún I-TREATMENT +momento, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +no I-TREATMENT +recibe I-TREATMENT +suplementos I-TREATMENT +de I-TREATMENT +magnesio I-TREATMENT +orales, I-TREATMENT +solo I-TREATMENT +una I-TREATMENT +dieta I-TREATMENT +rica I-TREATMENT +en I-TREATMENT +magnesio. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +trata I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +enfermedad I-EVOLUTION +de I-EVOLUTION +carácter I-EVOLUTION +permanente I-EVOLUTION +con I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +pronóstico I-EVOLUTION +favorables I-EVOLUTION +si I-EVOLUTION +se I-EVOLUTION +cumple I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +cutáneas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +cuyo I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +coincidió I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +faringoamigdalitis I-PRESENT_ILLNESS +tratada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +amoxicilina. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +vesículo-ampollosas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +artralgias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +tobillos, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +impiden I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +deambulación. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +purpúricas I-EXPLORATION +palpables, I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +piernas, I-EXPLORATION +glúteos, I-EXPLORATION +codos I-EXPLORATION +y I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +manos, I-EXPLORATION +acompañadas I-EXPLORATION +de I-EXPLORATION +ampollas I-EXPLORATION +de I-EXPLORATION +contenido I-EXPLORATION +serohemorrágico. I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +edema I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +izquierda, I-EXPLORATION +pies I-EXPLORATION +y I-EXPLORATION +tobillos, I-EXPLORATION +e I-EXPLORATION +hiperemia I-EXPLORATION +amigdalar I-EXPLORATION +sin I-EXPLORATION +exudados. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +exploraciones I-EXPLORATION +complementarias I-EXPLORATION +(hemograma, I-EXPLORATION +bioquímica, I-EXPLORATION +coagulación I-EXPLORATION +y I-EXPLORATION +tira I-EXPLORATION +reactiva I-EXPLORATION +de I-EXPLORATION +orina) I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +PSH I-TREATMENT +con I-TREATMENT +afectación I-TREATMENT +sistémica, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +hospitalizado I-TREATMENT +para I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +esteroideo I-TREATMENT +(prednisona I-TREATMENT +2 I-TREATMENT +mg/kg/día). I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +articulares, I-EVOLUTION +siendo I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +hospitalización. I-EVOLUTION + I-EVOLUTION + +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nueve I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +indurada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +externa I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +muslo, I-PRESENT_ILLNESS +única, I-PRESENT_ILLNESS +lineal, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dudosa I-PRESENT_ILLNESS +adherencia I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +planos I-PRESENT_ILLNESS +profundos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Dicha B-TREATMENT +lesión I-TREATMENT +es I-TREATMENT +extirpada I-TREATMENT +y B-EXPLORATION +Anatomía I-EXPLORATION +Patológica I-EXPLORATION +aporta I-EXPLORATION +el I-EXPLORATION +siguiente I-EXPLORATION +informe: I-EXPLORATION +“Paniculitits I-EXPLORATION +neutrofílica I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +lobular I-EXPLORATION +con I-EXPLORATION +alta I-EXPLORATION +proporción I-EXPLORATION +de I-EXPLORATION +esclerosis I-EXPLORATION +periférica. I-EXPLORATION +Existe I-EXPLORATION +destrucción I-EXPLORATION +masiva I-EXPLORATION +de I-EXPLORATION +adipocitos I-EXPLORATION +con I-EXPLORATION +extenso I-EXPLORATION +granuloma I-EXPLORATION +lipofágico, I-EXPLORATION +todo I-EXPLORATION +delimitado I-EXPLORATION +por I-EXPLORATION +tejido I-EXPLORATION +conjuntivo I-EXPLORATION +fibroso I-EXPLORATION +abundante”. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +descripción I-EXPLORATION +microscópica, I-EXPLORATION +refiere I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +restos I-EXPLORATION +intracelulares I-EXPLORATION +PAS+ I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +gigantes I-EXPLORATION +tipo I-EXPLORATION +Touton I-EXPLORATION +escasas. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +inflamatorias I-EXPLORATION +presentan I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +habituales I-EXPLORATION +descartando I-EXPLORATION +naturaleza I-EXPLORATION +neoplásica. I-EXPLORATION +Añaden I-EXPLORATION +como I-EXPLORATION +posibles I-EXPLORATION +causas5-8: I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Reacción I-EXPLORATION +tipo I-EXPLORATION +autoeccematización I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +infección, I-EXPLORATION +predominantemente I-EXPLORATION +bacteriana8. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Esclerodermia I-EXPLORATION +localizada I-EXPLORATION +profunda I-EXPLORATION +juvenil5, I-EXPLORATION +aunque I-EXPLORATION +en I-EXPLORATION +esta I-EXPLORATION +el I-EXPLORATION +infiltrado I-EXPLORATION +neutrofílico I-EXPLORATION +suele I-EXPLORATION +ser I-EXPLORATION +menos I-EXPLORATION +patente. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Lesiones I-EXPLORATION +evolutivas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Weber I-EXPLORATION +Christian. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Paniculitis I-EXPLORATION +asociada I-EXPLORATION +al I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +α1-antitripsina. I-EXPLORATION + I-EXPLORATION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que, B-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +recordar I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +previo, I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +dolorosa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +advertida I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +dolorosa I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +× I-EXPLORATION +11 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +medio-distal I-EXPLORATION +del I-EXPLORATION +muslo I-EXPLORATION +izquierdo. I-EXPLORATION +La I-EXPLORATION +extremidad I-EXPLORATION +está I-EXPLORATION +mínimamente I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +contralateral. I-EXPLORATION +La I-EXPLORATION +piel I-EXPLORATION +presenta I-EXPLORATION +coloración I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +clínicos I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +del I-EXPLORATION +fémur I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +evidencia I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +calcificada. I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +ecografía I-EXPLORATION +del I-EXPLORATION +muslo, I-EXPLORATION +que I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +oval I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +hiperecogénicas I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +que I-EXPLORATION +provocan I-EXPLORATION +sombras I-EXPLORATION +acústicas I-EXPLORATION +posteriores, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +sugiere I-EXPLORATION +un I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo. I-EXPLORATION +Para I-EXPLORATION +concretar I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC), I-EXPLORATION +que I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +calcificada I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +engloba I-EXPLORATION +estructuras I-EXPLORATION +neuromusculares, I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +aparentemente I-EXPLORATION +benignas, I-EXPLORATION +pero I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +permite I-EXPLORATION +descartar I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trate I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +condroma I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +patología I-EXPLORATION +maligna, I-EXPLORATION +se I-EXPLORATION +deriva I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +hospital I-EXPLORATION +de I-EXPLORATION +tercer I-EXPLORATION +nivel I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +valoración, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +reevalúa I-EXPLORATION +el I-EXPLORATION +caso. I-EXPLORATION +Un I-EXPLORATION +familiar I-EXPLORATION +recuerda I-EXPLORATION +un I-EXPLORATION +traumatismo I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +manillar I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bicicleta I-EXPLORATION +unos I-EXPLORATION +cuatro I-EXPLORATION +meses I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +inicial, I-EXPLORATION +seguido I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +e I-EXPLORATION +inflamación I-EXPLORATION +los I-EXPLORATION +siete I-EXPLORATION +días I-EXPLORATION +posteriores. I-EXPLORATION +El B-TREATMENT +caso I-TREATMENT +se I-TREATMENT +orienta I-TREATMENT +inicialmente I-TREATMENT +como I-TREATMENT +un I-TREATMENT +hematoma I-TREATMENT +calcificado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +sugiere I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +conservador I-TREATMENT +y I-TREATMENT +una I-TREATMENT +visita I-TREATMENT +de I-TREATMENT +seguimiento I-TREATMENT +tres I-TREATMENT +meses I-TREATMENT +después. I-TREATMENT +Pasado B-EVOLUTION +ese I-EVOLUTION +tiempo, I-EVOLUTION +solicitan I-EVOLUTION +una I-EVOLUTION +radiografía I-EVOLUTION +simple I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +muestra I-EVOLUTION +cambios I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +previa. I-EVOLUTION +Ante I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +clínica, I-EVOLUTION +revaloran I-EVOLUTION +la I-EVOLUTION +TC I-EVOLUTION +inicial I-EVOLUTION +y I-EVOLUTION +reorientan I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +como I-EVOLUTION +miositis I-EVOLUTION +osificante I-EVOLUTION +traumática I-EVOLUTION +(MOT). I-EVOLUTION +Cuatro I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +apenas I-EVOLUTION +ha I-EVOLUTION +disminuido I-EVOLUTION +su I-EVOLUTION +tamaño, I-EVOLUTION +pero I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +plantea I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +clínicamente I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Lactante B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +visita I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +recién I-PRESENT_ILLNESS +nacido. I-PRESENT_ILLNESS +Varón, B-PAST_MEDICAL_HISTORY +fruto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +segunda I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +término I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +eutócico I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +incidencias. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +vértice I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +nacimiento. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +evidencia I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +limpios, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sobreinfección. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +aplasia I-EXPLORATION +cutis I-EXPLORATION +congénita I-EXPLORATION +(ACC) I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +cerebral I-EXPLORATION +transfontanelar, I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +genograma I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +enfermedades I-EXPLORATION +genéticas, I-EXPLORATION +pero B-FAMILY_HISTORY +el I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +también I-FAMILY_HISTORY +presentaba I-FAMILY_HISTORY +una I-FAMILY_HISTORY +zona I-FAMILY_HISTORY +de I-FAMILY_HISTORY +alopecia I-FAMILY_HISTORY +cicatricial I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +vértice I-FAMILY_HISTORY +del I-FAMILY_HISTORY +cuero I-FAMILY_HISTORY +cabelludo, I-FAMILY_HISTORY +que I-FAMILY_HISTORY +refiere I-FAMILY_HISTORY +desde I-FAMILY_HISTORY +la I-FAMILY_HISTORY +infancia. I-FAMILY_HISTORY + I-FAMILY_HISTORY + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ocho I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +provincia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Huesca I-PAST_MEDICAL_HISTORY +(España), I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +ante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +dérmica I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +adenopatías I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +localización I-PRESENT_ILLNESS +cérvico-occipital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +costrosa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuero I-EXPLORATION +cabelludo I-EXPLORATION +occipital, I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +× I-EXPLORATION +3 I-EXPLORATION +cm, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +desprende I-EXPLORATION +fácilmente, I-EXPLORATION +sin I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +escara I-EXPLORATION +ni I-EXPLORATION +zona I-EXPLORATION +eritematosa. I-EXPLORATION +De I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +manera, I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +tres I-EXPLORATION +adenopatías I-EXPLORATION +retroauriculares I-EXPLORATION +y I-EXPLORATION +occipitales, I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +muy I-EXPLORATION +dolorosas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +picadura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +garrapata I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +días, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +identificada I-PAST_MEDICAL_HISTORY +dentro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +especie I-PAST_MEDICAL_HISTORY +Dermacentor I-PAST_MEDICAL_HISTORY +marginatus. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Se B-TREATMENT +pauta I-TREATMENT +eritromicina I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +mg/kg/día I-TREATMENT +durante I-TREATMENT +ocho I-TREATMENT +días I-TREATMENT +y I-TREATMENT +se I-TREATMENT +solicita I-TREATMENT +serología I-TREATMENT +para I-TREATMENT +Toxoplasma, I-TREATMENT +Borrelia, I-TREATMENT +citomegalovirus, I-TREATMENT +virus I-TREATMENT +de I-TREATMENT +Epstein-Barr I-TREATMENT +y I-TREATMENT +Rickettsia I-TREATMENT +conorii, I-TREATMENT +evidenciándose I-TREATMENT +una I-TREATMENT +positivización I-TREATMENT +de I-TREATMENT +IgG I-TREATMENT +para I-TREATMENT +citomegalovirus I-TREATMENT +y I-TREATMENT +de I-TREATMENT +anticuerpos I-TREATMENT +para I-TREATMENT +Rickettsia I-TREATMENT +conorii I-TREATMENT +(1/640) I-TREATMENT +mediante I-TREATMENT +inmonofluorescencia I-TREATMENT +indirecta I-TREATMENT +y I-TREATMENT +posterior I-TREATMENT +aumento I-TREATMENT +a I-TREATMENT +los I-TREATMENT +40 I-TREATMENT +días. I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +medicación I-EVOLUTION +pautada, I-EVOLUTION +presenta I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +tres I-EVOLUTION +adenopatías I-EVOLUTION +durante I-EVOLUTION +un I-EVOLUTION +mes, I-EVOLUTION +que I-EVOLUTION +sigue I-EVOLUTION +siendo I-EVOLUTION +dolorosa I-EVOLUTION +al I-EVOLUTION +tacto, I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +posterior. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +cuatro I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +habiéndose I-EVOLUTION +encontrado I-EVOLUTION +asintomática I-EVOLUTION +durante I-EVOLUTION +este I-EVOLUTION +periodo, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +consulta I-EVOLUTION +por I-EVOLUTION +aparición I-EVOLUTION +nuevamente I-EVOLUTION +de I-EVOLUTION +pequeños I-EVOLUTION +nódulos I-EVOLUTION +discretamente I-EVOLUTION +dolorosos I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +palpación I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +cráneo-cervical I-EVOLUTION +bilateral, I-EVOLUTION +apreciándose I-EVOLUTION +ecográficamente I-EVOLUTION +cuatro I-EVOLUTION +lesiones I-EVOLUTION +compatibles I-EVOLUTION +con I-EVOLUTION +adenopatías I-EVOLUTION +de I-EVOLUTION +aspecto I-EVOLUTION +inflamatorio I-EVOLUTION +residual I-EVOLUTION +sin I-EVOLUTION +otros I-EVOLUTION +hallazgos I-EVOLUTION +valorables, I-EVOLUTION +ninguna I-EVOLUTION +de I-EVOLUTION +ellas I-EVOLUTION +de I-EVOLUTION +tamaño I-EVOLUTION +significativo, I-EVOLUTION +que I-EVOLUTION +fueron I-EVOLUTION +tratadas I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +sintomática. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sano, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +celulitis I-PRESENT_ILLNESS +indurada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +violácea I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +muslo, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +conglomerado I-PRESENT_ILLNESS +adenopático I-PRESENT_ILLNESS +inguinal, I-PRESENT_ILLNESS +acompañados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +febrícula I-PRESENT_ILLNESS +intermitente. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +puerta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +entrada I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +herida I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +producida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +playa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Brasil I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +antes, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +cicatrizado. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +pesar I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +amoxicilina-clavulánico I-PRESENT_ILLNESS +endovenoso, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +mejoró I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +sintomatología. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +conglomerado I-EXPLORATION +adenopático. I-EXPLORATION +La I-EXPLORATION +punción I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF) I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +adenopatías I-EXPLORATION +mostraba I-EXPLORATION +histológicamente I-EXPLORATION +granulomas I-EXPLORATION +epitelioides I-EXPLORATION +con I-EXPLORATION +necrosis. I-EXPLORATION +La I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +Mantoux I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +induración I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +con I-EXPLORATION +vesículas I-EXPLORATION +y I-EXPLORATION +necrosis I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +horas. I-EXPLORATION +La I-EXPLORATION +cuantificación I-EXPLORATION +de I-EXPLORATION +interferón I-EXPLORATION +gamma I-EXPLORATION +fue I-EXPLORATION +positiva. I-EXPLORATION +No I-EXPLORATION +había I-EXPLORATION +recibido I-EXPLORATION +vacunación I-EXPLORATION +con I-EXPLORATION +bacilo I-EXPLORATION +de I-EXPLORATION +Calmette-Guérin I-EXPLORATION +(BCG). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +herida I-EXPLORATION +del I-EXPLORATION +pie, I-EXPLORATION +siendo I-EXPLORATION +positiva I-EXPLORATION +la I-EXPLORATION +reacción I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +polimerasa I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +ADN I-EXPLORATION +de I-EXPLORATION +Mycobacterium I-EXPLORATION +tuberculosis I-EXPLORATION +(PCR-TB). I-EXPLORATION +Se I-EXPLORATION +confirmó I-EXPLORATION +microbiológicamente I-EXPLORATION +aislando I-EXPLORATION +Mycobacterium I-EXPLORATION +tuberculosis I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +isoniazida I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +PAAF I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +cutánea. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fueron I-EXPLORATION +normales, I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +baciloscopias I-EXPLORATION +y I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +jugo I-EXPLORATION +gástrico, I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunitario I-EXPLORATION +(con I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas, I-EXPLORATION +inmunidad I-EXPLORATION +celular I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana) I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +terapia I-TREATMENT +antituberculosa I-TREATMENT +(isoniazida, I-TREATMENT +rifampicina I-TREATMENT +y I-TREATMENT +pirazinamida). I-TREATMENT +Esta I-TREATMENT +tuvo I-TREATMENT +que I-TREATMENT +ser I-TREATMENT +sustituida I-TREATMENT +por I-TREATMENT +etambutol I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +un I-TREATMENT +exantema I-TREATMENT +cutáneo I-TREATMENT +pruriginoso I-TREATMENT +presuntamente I-TREATMENT +causado I-TREATMENT +por I-TREATMENT +pirazinamida I-TREATMENT +y I-TREATMENT +que I-TREATMENT +desapareció I-TREATMENT +tras I-TREATMENT +su I-TREATMENT +retirada. I-TREATMENT +Un B-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +aparecieron I-EVOLUTION +dos I-EVOLUTION +fístulas I-EVOLUTION +cutáneas I-EVOLUTION +profundas, I-EVOLUTION +que B-TREATMENT +requirieron I-TREATMENT +desbridamiento I-TREATMENT +quirúrgico. I-TREATMENT +Tras B-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +se I-EVOLUTION +resolvieron I-EVOLUTION +la I-EVOLUTION +escrófula I-EVOLUTION +cutánea I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +adenopatías I-EVOLUTION +inguinales. I-EVOLUTION +No B-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +paciente I-EXPLORATION +bacilífero I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +familiar I-EXPLORATION +con I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +Mantoux I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nueve I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedente, I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +directo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +misma I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +semana I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +manillar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +patinete. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm, I-EXPLORATION +blanda I-EXPLORATION +y I-EXPLORATION +móvil, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios I-EXPLORATION +adyacentes I-EXPLORATION +y I-EXPLORATION +dolorosa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +Es B-TREATMENT +diagnosticada I-TREATMENT +de I-TREATMENT +adenitis I-TREATMENT +laterocervical, I-TREATMENT +iniciando I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amoxicilina-clavulánico I-TREATMENT +oral. I-TREATMENT + I-TREATMENT +Tras B-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +semana I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +revisada I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +consulta, I-DERIVED_FROM/TO +persistiendo I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +dolor I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +tumoración, I-DERIVED_FROM/TO +esta I-DERIVED_FROM/TO +vez I-DERIVED_FROM/TO +indurada, I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +otros I-DERIVED_FROM/TO +síntomas I-DERIVED_FROM/TO +acompañantes, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +Urgencias I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +referencia, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +realiza I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +ecografía I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +visualiza I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +lesión I-DERIVED_FROM/TO +abscesificada I-DERIVED_FROM/TO +subyacente I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +músculo I-DERIVED_FROM/TO +esternocleidomastoideo I-DERIVED_FROM/TO +(ECM), I-DERIVED_FROM/TO +decidiéndose I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +ingreso I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +administrar I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +antibiótico I-DERIVED_FROM/TO +intravenoso. I-DERIVED_FROM/TO +Reexplorando B-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente, I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +el I-EXPLORATION +músculo I-EXPLORATION +ECM I-EXPLORATION +izquierdo I-EXPLORATION +engrosado I-EXPLORATION +en I-EXPLORATION +toda I-EXPLORATION +su I-EXPLORATION +extensión, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +repetir I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +cervical I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +bilateral. I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +indica I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +del I-EXPLORATION +músculo I-EXPLORATION +ECM I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ecogenicidad, I-EXPLORATION +visualizándose I-EXPLORATION +dos I-EXPLORATION +focos I-EXPLORATION +hipoecoicos I-EXPLORATION +intramusculares I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +piomiositis, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +absceso I-EXPLORATION +subyacente I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +6 I-EXPLORATION +× I-EXPLORATION +2, I-EXPLORATION +7 I-EXPLORATION +cm. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +permanece I-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +intravenoso I-TREATMENT +con I-TREATMENT +cloxacilina I-TREATMENT +y I-TREATMENT +clindamicina I-TREATMENT +durante I-TREATMENT +siete I-TREATMENT +días, I-TREATMENT +presentando I-TREATMENT +una I-TREATMENT +mejoría I-TREATMENT +progresiva I-TREATMENT +de I-TREATMENT +la I-TREATMENT +clínica, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +da I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +clindamicina I-TREATMENT +oral. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +nuevamente I-EXPLORATION +revisada I-EXPLORATION +en I-EXPLORATION +consulta I-EXPLORATION +15 I-EXPLORATION +días I-EXPLORATION +después, I-EXPLORATION +presentando I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +cervical I-EXPLORATION +izquierda, I-EXPLORATION +aunque I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +tamaño. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +ecografía I-EXPLORATION +cervical I-EXPLORATION +bilateral I-EXPLORATION +donde I-EXPLORATION +ya I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +datos I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +piomiositis, I-EXPLORATION +pero I-EXPLORATION +sí I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +del I-EXPLORATION +absceso I-EXPLORATION +subyacente I-EXPLORATION +al I-EXPLORATION +músculo, I-EXPLORATION +aunque I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +reducción I-EXPLORATION +significativa I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +tamaño. I-EXPLORATION +Se B-EVOLUTION +mantiene I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +durante I-EVOLUTION +cuatro I-EVOLUTION +semanas, I-EVOLUTION +presentando I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +total I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +cuadro. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +bronquial I-PAST_MEDICAL_HISTORY +intermitente I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +base, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Pediatría I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +brusca I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +cervical, I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +esa I-PRESENT_ILLNESS +mañana I-PRESENT_ILLNESS +(aproximadamente I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución), I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +contexto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +asmática I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +niño I-PRESENT_ILLNESS +estaba I-PRESENT_ILLNESS +tratando I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +salbutamol I-PRESENT_ILLNESS +inhalado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +domicilio. I-PRESENT_ILLNESS +A B-EXPLORATION +su I-EXPLORATION +llegada I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +palidez I-EXPLORATION +cutánea, I-EXPLORATION +taquipnea I-EXPLORATION +y I-EXPLORATION +tiraje I-EXPLORATION +intercostal; I-EXPLORATION +con I-EXPLORATION +hipoventilación I-EXPLORATION +generalizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +auscultación. I-EXPLORATION +Se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +edema I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cervical I-EXPLORATION +bilateral, I-EXPLORATION +con I-EXPLORATION +crepitación I-EXPLORATION +en I-EXPLORATION +dicha I-EXPLORATION +zona. I-EXPLORATION +Ante B-TREATMENT +crisis I-TREATMENT +asmática I-TREATMENT +con I-TREATMENT +score I-TREATMENT +moderado I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +broncodilatador I-TREATMENT +y I-TREATMENT +corticoideo I-TREATMENT +y B-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +deriva I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +Urgencias I-DERIVED_FROM/TO +hospitalarias. I-DERIVED_FROM/TO +Allí B-EXPLORATION +realizan I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +encontrando I-EXPLORATION +neumomediastino I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +enfisema I-EXPLORATION +subcutáneo I-EXPLORATION +torácico I-EXPLORATION +y I-EXPLORATION +cervical, I-EXPLORATION +sin I-EXPLORATION +neumotórax. I-EXPLORATION +Se B-TREATMENT +pauta I-TREATMENT +analgesia I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +oxígeno, I-TREATMENT +broncodilatadores I-TREATMENT +y I-TREATMENT +prednisona I-TREATMENT +oral; I-TREATMENT +experimentó B-EVOLUTION +mejoría I-EVOLUTION +progresiva, I-EVOLUTION +dándole I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +cuatro I-EVOLUTION +días I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés, I-FAMILY_HISTORY +salvo I-FAMILY_HISTORY +un I-FAMILY_HISTORY +caso I-FAMILY_HISTORY +de I-FAMILY_HISTORY +liquen I-FAMILY_HISTORY +plano I-FAMILY_HISTORY +cutáneo I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +años I-FAMILY_HISTORY +antes. I-FAMILY_HISTORY +No B-PAST_MEDICAL_HISTORY +hay I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +salvo I-PAST_MEDICAL_HISTORY +estreñimiento I-PAST_MEDICAL_HISTORY +funcional I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dermatitis I-PAST_MEDICAL_HISTORY +atópica I-PAST_MEDICAL_HISTORY +leve. I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +ungueales I-PRESENT_ILLNESS +(piqueteado, I-PRESENT_ILLNESS +líneas I-PRESENT_ILLNESS +transversales, I-PRESENT_ILLNESS +descamación I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +uñas I-PRESENT_ILLNESS +quebradizas) I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +algunas I-PRESENT_ILLNESS +uñas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pies, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Sin I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +referido. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +hábito I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +chupeteado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dedos. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +hay I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +cutáneas I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +mucosas. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +asociada. I-PAST_MEDICAL_HISTORY +Refiere I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +dieta I-PAST_MEDICAL_HISTORY +variada, I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +algo I-PAST_MEDICAL_HISTORY +deficitaria I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +frutas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Exploración B-EXPLORATION +clínica I-EXPLORATION +normal, I-EXPLORATION +salvo I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +ungueales I-EXPLORATION +descritas; I-EXPLORATION +peso I-EXPLORATION +y I-EXPLORATION +talla I-EXPLORATION +en I-EXPLORATION +percentil I-EXPLORATION +50-75. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +un I-TREATMENT +polivitamínico I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +déficit I-TREATMENT +vitamínico, I-TREATMENT +pero I-TREATMENT +tras I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +seguían I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +sin I-TREATMENT +cambios. I-TREATMENT + I-TREATMENT +El B-DERIVED_FROM/TO +piqueteado I-DERIVED_FROM/TO +ungueal I-DERIVED_FROM/TO +nos I-DERIVED_FROM/TO +hacía I-DERIVED_FROM/TO +sospechar I-DERIVED_FROM/TO +varias I-DERIVED_FROM/TO +enfermedades I-DERIVED_FROM/TO +como I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +diferencial I-DERIVED_FROM/TO +(eccema, I-DERIVED_FROM/TO +psoriasis I-DERIVED_FROM/TO +ungueal, I-DERIVED_FROM/TO +liquen I-DERIVED_FROM/TO +plano I-DERIVED_FROM/TO +ungueal I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +alopecia I-DERIVED_FROM/TO +areata), I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +Dermatología I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración. I-DERIVED_FROM/TO +Fue B-EXPLORATION +diagnosticada I-EXPLORATION +inicialmente I-EXPLORATION +de I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +dermatitis I-EXPLORATION +de I-EXPLORATION +contacto I-EXPLORATION +o I-EXPLORATION +lesiones I-EXPLORATION +secundarias I-EXPLORATION +a I-EXPLORATION +atopia. I-EXPLORATION +Se I-EXPLORATION +descartaron I-EXPLORATION +alergias, I-EXPLORATION +inclusive I-EXPLORATION +a I-EXPLORATION +metales I-EXPLORATION +pesados I-EXPLORATION +y I-EXPLORATION +níquel. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +materiales I-EXPLORATION +o I-EXPLORATION +productos I-EXPLORATION +que I-EXPLORATION +le I-EXPLORATION +pudiesen I-EXPLORATION +causar I-EXPLORATION +dermatitis I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lecho I-EXPLORATION +ungueal, I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +atopia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +analítico I-EXPLORATION +para I-EXPLORATION +completar I-EXPLORATION +el I-EXPLORATION +estudio. I-EXPLORATION +Se I-EXPLORATION +analizó I-EXPLORATION +el I-EXPLORATION +metabolismo I-EXPLORATION +férrico, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +otros I-EXPLORATION +posibles I-EXPLORATION +déficits I-EXPLORATION +nutricionales I-EXPLORATION +(zinc, I-EXPLORATION +1-25 I-EXPLORATION +hidroxi-colecalciferol, I-EXPLORATION +vitaminas I-EXPLORATION +B12 I-EXPLORATION +y I-EXPLORATION +B6), I-EXPLORATION +tirotropina I-EXPLORATION +(TSH) I-EXPLORATION +y I-EXPLORATION +tiroxina I-EXPLORATION +(T4), I-EXPLORATION +resultando I-EXPLORATION +todos I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +también I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +autoinmunidad I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +psoriasis I-EXPLORATION +ungueal, I-EXPLORATION +siendo I-EXPLORATION +negativos I-EXPLORATION +el I-EXPLORATION +factor I-EXPLORATION +reumatoide I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +normalidad I-TREATMENT +de I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +analíticos I-TREATMENT +y I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones, I-TREATMENT +que I-TREATMENT +hacían I-TREATMENT +sospechar I-TREATMENT +como I-TREATMENT +posibilidades I-TREATMENT +diagnósticas I-TREATMENT +la I-TREATMENT +psoriasis I-TREATMENT +ungueal, I-TREATMENT +sin I-TREATMENT +poder I-TREATMENT +descartar I-TREATMENT +un I-TREATMENT +liquen I-TREATMENT +plano I-TREATMENT +ungueal, I-TREATMENT +o I-TREATMENT +lesiones I-TREATMENT +de I-TREATMENT +eccema I-TREATMENT +ungueal, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tazaroteno I-TREATMENT +tópico I-TREATMENT +(un I-TREATMENT +derivado I-TREATMENT +de I-TREATMENT +vitamina I-TREATMENT +A) I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +lámina I-TREATMENT +ungueal I-TREATMENT +durante I-TREATMENT +tres I-TREATMENT +meses. I-TREATMENT +Evolucionó B-EVOLUTION +favorablemente, I-EVOLUTION +normalizándose I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +ungueales. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +autolimitados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipotermia I-PRESENT_ILLNESS +asociados I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +fría I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +palidez I-PRESENT_ILLNESS +cutánea. I-PRESENT_ILLNESS +Ocurren I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +diaria, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +duración I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +horas, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +frecuentes I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sueño. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acompañan I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +movimientos I-PRESENT_ILLNESS +tónico-clónicos, I-PRESENT_ILLNESS +desconexión I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +medio, I-PRESENT_ILLNESS +relajación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esfínteres I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +periodo I-PRESENT_ILLNESS +poscrítico. I-PRESENT_ILLNESS +Así I-PRESENT_ILLNESS +mismo I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +asocia I-PRESENT_ILLNESS +tiritona. I-PRESENT_ILLNESS +Entre I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +mantiene I-PRESENT_ILLNESS +asintomática. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +consta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sospecha I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +comicial I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +confirmada, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +transfontanelar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +electroencefalograma I-PAST_MEDICAL_HISTORY +(EEG) I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY +No B-FAMILY_HISTORY +hay I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +epilepsia I-FAMILY_HISTORY +familiar. I-FAMILY_HISTORY +Un I-FAMILY_HISTORY +tío I-FAMILY_HISTORY +materno I-FAMILY_HISTORY +está I-FAMILY_HISTORY +afecto I-FAMILY_HISTORY +de I-FAMILY_HISTORY +migraña. I-FAMILY_HISTORY + I-FAMILY_HISTORY +A B-EXPLORATION +su I-EXPLORATION +llegada I-EXPLORATION +a I-EXPLORATION +Urgencias, I-EXPLORATION +presenta I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +y I-EXPLORATION +neurológica I-EXPLORATION +normal, I-EXPLORATION +con I-EXPLORATION +constantes I-EXPLORATION +normales, I-EXPLORATION +salvo I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +hipotermia, I-EXPLORATION +aunque I-EXPLORATION +la I-EXPLORATION +familia I-EXPLORATION +aporta I-EXPLORATION +un I-EXPLORATION +registro I-EXPLORATION +exhaustivo I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +días I-EXPLORATION +previos, I-EXPLORATION +con I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +temperatura I-EXPLORATION +rectal I-EXPLORATION +de I-EXPLORATION +entre I-EXPLORATION +34 I-EXPLORATION +y I-EXPLORATION +35 I-EXPLORATION +°C. I-EXPLORATION + I-EXPLORATION +Todos I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +realizados I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +(analítica I-EXPLORATION +general, I-EXPLORATION +gasometría, I-EXPLORATION +estudio I-EXPLORATION +metabólico I-EXPLORATION +y I-EXPLORATION +endocrinológico, I-EXPLORATION +tóxicos I-EXPLORATION +en I-EXPLORATION +orina, I-EXPLORATION +EEG, I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +[RM], I-EXPLORATION +Holter I-EXPLORATION +y I-EXPLORATION +ecocardiograma). I-EXPLORATION +Después I-EXPLORATION +de I-EXPLORATION +rehistoriar I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +familia, I-EXPLORATION +refieren I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +niña I-EXPLORATION +padece I-EXPLORATION +desde I-EXPLORATION +hace I-EXPLORATION +unos I-EXPLORATION +meses I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +recurrente, I-EXPLORATION +autolimitados, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +añade I-EXPLORATION +al I-EXPLORATION +estudio I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +con I-EXPLORATION +resultado I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +HPE I-TREATMENT +y I-TREATMENT +teniendo I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +el I-TREATMENT +alto I-TREATMENT +número I-TREATMENT +de I-TREATMENT +episodios, I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +el I-TREATMENT +antecedente I-TREATMENT +familiar I-TREATMENT +migrañoso, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ciproheptadina. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +rechaza I-TREATMENT +su I-TREATMENT +ingesta, I-TREATMENT +a B-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +lo I-EVOLUTION +cual I-EVOLUTION +los I-EVOLUTION +episodios I-EVOLUTION +se I-EVOLUTION +autolimitan I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tiempo. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +debut, I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hiperemia I-PRESENT_ILLNESS +conjuntival I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lagrimeo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +destacables I-PAST_MEDICAL_HISTORY +constan I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +ácaros, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +bronquial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +rinitis I-PAST_MEDICAL_HISTORY +alérgica I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +crónico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +budesonida I-PAST_MEDICAL_HISTORY +inhalada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +terbutalina I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +demanda. I-PAST_MEDICAL_HISTORY +No B-FAMILY_HISTORY +presenta I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés. I-FAMILY_HISTORY +Se B-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +tópico, I-TREATMENT +acudiendo B-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +cuatro I-EVOLUTION +semanas I-EVOLUTION +por I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +clínica I-EVOLUTION +bilateral, I-EVOLUTION +sin I-EVOLUTION +secreción I-EVOLUTION +purulenta. I-EVOLUTION +Durante I-EVOLUTION +los I-EVOLUTION +siete I-EVOLUTION +meses I-EVOLUTION +posteriores I-EVOLUTION +persiste I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +intermitente I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +antihistáminicos I-EVOLUTION +orales I-EVOLUTION +y I-EVOLUTION +oftálmicos, I-EVOLUTION +asociando I-EVOLUTION +además I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +días I-EVOLUTION +tumefacción I-EVOLUTION +palpebral I-EVOLUTION +con I-EVOLUTION +fotofobia I-EVOLUTION +e I-EVOLUTION +hiperemia I-EVOLUTION +conjuntival I-EVOLUTION +bilateral I-EVOLUTION +matutina, I-EVOLUTION +sin I-EVOLUTION +prurito, I-EVOLUTION +estornudos, I-EVOLUTION +cuadro I-EVOLUTION +catarral I-EVOLUTION +ni I-EVOLUTION +fiebre. I-EVOLUTION +Ante B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +escasa I-DERIVED_FROM/TO +respuesta I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +tratamientos I-DERIVED_FROM/TO +habituales, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +derivar I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Oftalmología. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +queratitis I-EXPLORATION +bilateral I-EXPLORATION +de I-EXPLORATION +posible I-EXPLORATION +etiología I-EXPLORATION +herpética, I-EXPLORATION +pautándose B-TREATMENT +terapia I-TREATMENT +antiviral, I-TREATMENT +ciclopléjico I-TREATMENT +y I-TREATMENT +antibiótico I-TREATMENT +tópicos, I-TREATMENT +sin I-TREATMENT +apreciar I-TREATMENT +mejoría. I-TREATMENT +Dada B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +persistencia I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +cuadro, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +queratitis I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +exposición I-DERIVED_FROM/TO +nocturna I-DERIVED_FROM/TO +secundaria I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +exoftalmos I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +deriva I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +endocrinología I-DERIVED_FROM/TO +pediátrica I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +función I-DERIVED_FROM/TO +tiroidea, I-DERIVED_FROM/TO +alcanzando I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +final I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hipertiroidismo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +causa I-DERIVED_FROM/TO +autoinmune I-DERIVED_FROM/TO +o I-DERIVED_FROM/TO +enfermedad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Graves I-DERIVED_FROM/TO +(EG). I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +africano, I-PAST_MEDICAL_HISTORY +a B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +detecta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +genu I-PRESENT_ILLNESS +varo I-PRESENT_ILLNESS +simétrico I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +llamativo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +puericultura. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +ni B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés. I-FAMILY_HISTORY +Presenta B-EXPLORATION +un I-EXPLORATION +desarrollo I-EXPLORATION +psicomotor I-EXPLORATION +normal. I-EXPLORATION +Es B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Traumatología, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realiza I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +radiológico I-DERIVED_FROM/TO +confirmándose I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +alteración I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +ángulo I-DERIVED_FROM/TO +metafisodiafisario, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +componente I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +torsión I-DERIVED_FROM/TO +tibial I-DERIVED_FROM/TO +interna I-DERIVED_FROM/TO +marcado I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +alteración I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +cartílago I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +crecimiento I-DERIVED_FROM/TO +proximal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +tibia. I-DERIVED_FROM/TO +Se B-EXPLORATION +completa I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +análisis I-EXPLORATION +del I-EXPLORATION +metabolismo I-EXPLORATION +óseo, I-EXPLORATION +siendo I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +ortésico I-TREATMENT +inicial I-TREATMENT +sin I-TREATMENT +observarse I-TREATMENT +mejoría I-TREATMENT +tras I-TREATMENT +diez I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +seguimiento, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +corrector I-TREATMENT +(osteotomía I-TREATMENT +desrotatoria I-TREATMENT +tibial I-TREATMENT +distal I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +osteotomía I-TREATMENT +valguizante I-TREATMENT +proximal) I-TREATMENT +con I-TREATMENT +muy I-TREATMENT +buena I-TREATMENT +evolución. I-TREATMENT +Los B-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +son I-EVOLUTION +favorables, I-EVOLUTION +manteniendo I-EVOLUTION +un I-EVOLUTION +alineamiento I-EVOLUTION +correcto I-EVOLUTION +de I-EVOLUTION +ambas I-EVOLUTION +extremidades. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tórax I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +× I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +eritematosas, I-PRESENT_ILLNESS +ligeramente I-PRESENT_ILLNESS +descamativas, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +pruriginosas. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +brazo I-EXPLORATION +presenta I-EXPLORATION +otra I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +similares, I-EXPLORATION +de I-EXPLORATION +mayor I-EXPLORATION +tamaño, I-EXPLORATION +también I-EXPLORATION +asintomática. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +pitiriasis I-TREATMENT +rosada, I-TREATMENT +no I-TREATMENT +se I-TREATMENT +pauta I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +se I-TREATMENT +espera I-TREATMENT +para I-TREATMENT +ver I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +del I-TREATMENT +cuadro. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +la I-EVOLUTION +semana I-EVOLUTION +acude I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +a I-EVOLUTION +consulta, I-EVOLUTION +presentando I-EVOLUTION +un I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +número I-EVOLUTION +de I-EVOLUTION +lesiones, I-EVOLUTION +distribuidas I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +tronco, I-EVOLUTION +el I-EVOLUTION +abdomen, I-EVOLUTION +el I-EVOLUTION +dorso I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +cervical, I-EVOLUTION +y I-EVOLUTION +respetando I-EVOLUTION +la I-EVOLUTION +cara, I-EVOLUTION +el I-EVOLUTION +cuero I-EVOLUTION +cabelludo I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +extremidades I-EVOLUTION +inferiores. I-EVOLUTION +Al B-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +semana I-EXPLORATION +anterior, I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +son I-EXPLORATION +asintomáticas. I-EXPLORATION + I-EXPLORATION +Dado I-EXPLORATION +la I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +lesiones, I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +consultar I-EXPLORATION +vía I-EXPLORATION +telemática I-EXPLORATION +a I-EXPLORATION +Dermatología, I-EXPLORATION +quienes I-EXPLORATION +emiten I-EXPLORATION +como I-EXPLORATION +diagnóstico I-EXPLORATION +más I-EXPLORATION +probable I-EXPLORATION +una I-EXPLORATION +pitiriasis I-EXPLORATION +rosada, I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +probable I-EXPLORATION +lesión I-EXPLORATION +heraldo I-EXPLORATION +del I-EXPLORATION +brazo, I-EXPLORATION +la I-EXPLORATION +descamación I-EXPLORATION +periférica I-EXPLORATION +en I-EXPLORATION +algunas I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +distribución. I-EXPLORATION + I-EXPLORATION +Aconsejan B-TREATMENT +no I-TREATMENT +tratar I-TREATMENT +y I-TREATMENT +nos I-TREATMENT +recuerdan I-TREATMENT +que I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +puede I-TREATMENT +durar I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +6-8 I-TREATMENT +semanas. I-TREATMENT + I-TREATMENT + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +quística I-PRESENT_ILLNESS +sobreelevada I-PRESENT_ILLNESS +azulada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diámetro I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +raíz I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +sucesivas I-PRESENT_ILLNESS +visitas. I-PRESENT_ILLNESS +Según B-EXPLORATION +el I-EXPLORATION +especialista, I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +sugiere I-EXPLORATION +un I-EXPLORATION +pilomatricoma I-EXPLORATION +o I-EXPLORATION +epitelioma I-EXPLORATION +calcificante I-EXPLORATION +de I-EXPLORATION +Malherbe I-EXPLORATION +(puede I-EXPLORATION +ser I-EXPLORATION +azulado I-EXPLORATION +por I-EXPLORATION +su I-EXPLORATION +componente I-EXPLORATION +cálcico). I-EXPLORATION +Recomienda B-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +quirúrgica I-TREATMENT +como I-TREATMENT +actuación I-TREATMENT +diagnóstico-terapéutica. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +argelino I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +prisión. I-PAST_MEDICAL_HISTORY +Es I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaco I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +marihuana, I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +beber I-PAST_MEDICAL_HISTORY +cerveza I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +diaria I-PAST_MEDICAL_HISTORY +previamente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +prisión, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +niega I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +drogas I-PAST_MEDICAL_HISTORY +tanto I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +parenteral I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +vías. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Presenta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +trastorno I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +impulsos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sigue I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +benzodiacepinas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ansiolíticos. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tiene I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conducta I-PAST_MEDICAL_HISTORY +violenta I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +insultos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +personal I-PAST_MEDICAL_HISTORY +sanitario I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +destrozo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mobiliario. I-PAST_MEDICAL_HISTORY +También I-PAST_MEDICAL_HISTORY +existen I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diversas I-PAST_MEDICAL_HISTORY +autoagresiones: I-PAST_MEDICAL_HISTORY +huelgas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hambre, I-PAST_MEDICAL_HISTORY +autocontusiones, I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +superficiales I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +brazos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +piernas, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +ingesta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuchillas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +objetos I-PAST_MEDICAL_HISTORY +extraños I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +finalmente I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +evacuados I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +natural I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +apoyo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +dieta I-PAST_MEDICAL_HISTORY +rica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +fibra. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +esta I-PRESENT_ILLNESS +ocasión, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +ingerido I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cortauñas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +queja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +mismo I-PRESENT_ILLNESS +tiempo I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +iniciado I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +huelga I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hambre, I-PRESENT_ILLNESS +ingiriendo I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +infusiones I-PRESENT_ILLNESS +azucaradas. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +blando, I-EXPLORATION +depresible I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +observar I-EXPLORATION +una I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +cortauñas I-EXPLORATION +situada I-EXPLORATION +en I-EXPLORATION +intestino I-EXPLORATION +delgado. I-EXPLORATION +A B-DERIVED_FROM/TO +pesar I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +quedar I-DERIVED_FROM/TO +descartado I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +abdomen I-DERIVED_FROM/TO +agudo I-DERIVED_FROM/TO +quirúrgico, I-DERIVED_FROM/TO +dado I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +sigue I-DERIVED_FROM/TO +quejando I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +intenso I-DERIVED_FROM/TO +dolor, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +deriva I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +urgencias I-DERIVED_FROM/TO +hospitalario, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +confirman I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +prescribiendo I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +dieta I-DERIVED_FROM/TO +rica I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +fibra I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +aconsejado I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +seguimiento I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +paciente. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-EXPLORATION +los I-EXPLORATION +6 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +placa, I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +radiografía I-EXPLORATION +nos I-EXPLORATION +muestra I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +pieza I-EXPLORATION +descrita I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +ascendente, I-EXPLORATION +pero I-EXPLORATION +vemos I-EXPLORATION +la I-EXPLORATION +otra I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +cortauñas I-EXPLORATION +ingerido I-EXPLORATION +posteriormente I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +tramo I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +tubo I-EXPLORATION +digestivo. I-EXPLORATION +Trascurridos I-EXPLORATION +9 I-EXPLORATION +días I-EXPLORATION +del I-EXPLORATION +inicio I-EXPLORATION +del I-EXPLORATION +cuadro, I-EXPLORATION +realizamos I-EXPLORATION +otra I-EXPLORATION +placa I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +y I-EXPLORATION +apreciamos I-EXPLORATION +cómo I-EXPLORATION +ambas I-EXPLORATION +piezas I-EXPLORATION +de I-EXPLORATION +ese I-EXPLORATION +cortaúñas I-EXPLORATION +se I-EXPLORATION +han I-EXPLORATION +situado I-EXPLORATION +juntas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +descendente. I-EXPLORATION +Nos B-TREATMENT +refiere I-TREATMENT +que I-TREATMENT +abandona I-TREATMENT +la I-TREATMENT +huelga I-TREATMENT +de I-TREATMENT +hambre I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +instaura I-TREATMENT +una I-TREATMENT +dieta I-TREATMENT +rica I-TREATMENT +en I-TREATMENT +fibra. I-TREATMENT + I-TREATMENT +Nuevas B-EXPLORATION +radiografías I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +nos I-EXPLORATION +muestran I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +citado I-EXPLORATION +cuerpo I-EXPLORATION +extraño I-EXPLORATION +no I-EXPLORATION +avanza I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +trasverso I-EXPLORATION +hasta I-EXPLORATION +que I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +placa I-EXPLORATION +realizada I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +30 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +ingesta, I-EXPLORATION +revela I-EXPLORATION +ambas I-EXPLORATION +partes I-EXPLORATION +del I-EXPLORATION +cortauñas I-EXPLORATION +en I-EXPLORATION +últimos I-EXPLORATION +tramos I-EXPLORATION +del I-EXPLORATION +tubo I-EXPLORATION +digestivo, I-EXPLORATION +siendo B-EVOLUTION +expulsados I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +defecación, I-EVOLUTION +según I-EVOLUTION +nos I-EVOLUTION +informa I-EVOLUTION +el I-EVOLUTION +propio I-EVOLUTION +paciente. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +natural I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Perú, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Centro I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2012. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +reconocimiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +negó I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Dentro B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +hábitos I-PRESENT_ILLNESS +tóxicos I-PRESENT_ILLNESS +refirió I-PRESENT_ILLNESS +consumo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +150 I-PRESENT_ILLNESS +gr. I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alcohol I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +fines I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +heroína I-PRESENT_ILLNESS +fumada I-PRESENT_ILLNESS +ocasional. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +cuanto I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +prácticas I-PRESENT_ILLNESS +sexuales I-PRESENT_ILLNESS +manifestó I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +heterosexual I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +tenido I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +parejas, I-PRESENT_ILLNESS +frecuentemente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +contexto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +intoxicación I-PRESENT_ILLNESS +enólica I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +tomar I-PRESENT_ILLNESS +medidas I-PRESENT_ILLNESS +preventivas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +numerosas I-EXPLORATION +lesiones I-EXPLORATION +cutáneas I-EXPLORATION +maculares I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +en I-EXPLORATION +tórax, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +orientó I-EXPLORATION +como I-EXPLORATION +pitiriasis I-EXPLORATION +rosada. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +analítica I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +ingresos: I-EXPLORATION +hemograma, I-EXPLORATION +bioquímica I-EXPLORATION +y I-EXPLORATION +serologías I-EXPLORATION +VIH, I-EXPLORATION +hepatitis I-EXPLORATION +y I-EXPLORATION +lues, I-EXPLORATION +detectándose I-EXPLORATION +Treponema I-EXPLORATION +pallidum I-EXPLORATION +anticuerpos I-EXPLORATION +reagínicos I-EXPLORATION +1/8, I-EXPLORATION +Treponema I-EXPLORATION +pallidum I-EXPLORATION +anticuerpos I-EXPLORATION +treponémicos I-EXPLORATION +positivos, I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +resultados I-EXPLORATION +analíticos. I-EXPLORATION + I-EXPLORATION +Reinterrogado, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +negó I-EXPLORATION +haber I-EXPLORATION +presentado I-EXPLORATION +ninguna I-EXPLORATION +manifestación I-EXPLORATION +de I-EXPLORATION +sífilis I-EXPLORATION +primaria, I-EXPLORATION +si I-EXPLORATION +bien, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +numerosas I-EXPLORATION +placas I-EXPLORATION +alopécicas I-EXPLORATION +en I-EXPLORATION +cuero I-EXPLORATION +cabelludo I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +irregular, I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +no I-EXPLORATION +cicatriciales, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios I-EXPLORATION +ni I-EXPLORATION +descamación, I-EXPLORATION +menores I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +centímetro I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +mal I-EXPLORATION +definidos, I-EXPLORATION +no I-EXPLORATION +desprovistas I-EXPLORATION +completamente I-EXPLORATION +de I-EXPLORATION +pelo, I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +temporo-occipital. I-EXPLORATION + I-EXPLORATION +Esta I-EXPLORATION +manifestación I-EXPLORATION +la I-EXPLORATION +había I-EXPLORATION +observado I-EXPLORATION +el I-EXPLORATION +propio I-EXPLORATION +paciente I-EXPLORATION +hacía I-EXPLORATION +cinco I-EXPLORATION +días, I-EXPLORATION +coincidiendo I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +corte I-EXPLORATION +de I-EXPLORATION +pelo, I-EXPLORATION +sin I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +hubiese I-EXPLORATION +percatado I-EXPLORATION +antes. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +dermatológica I-EXPLORATION +descrita I-EXPLORATION +es I-EXPLORATION +coincidente I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +denominada I-EXPLORATION +alopecia I-EXPLORATION +apolillada, I-EXPLORATION +un I-EXPLORATION +signo I-EXPLORATION +infrecuente I-EXPLORATION +de I-EXPLORATION +secundarismo I-EXPLORATION +luético. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +G I-TREATMENT +benzatina I-TREATMENT +2.400.000 I-TREATMENT +UI. I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +única. I-TREATMENT +Posteriormente B-EVOLUTION +se I-EVOLUTION +procedió I-EVOLUTION +a I-EVOLUTION +seguimiento I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +serológico. I-EVOLUTION + I-EVOLUTION +Se I-EVOLUTION +considera I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +alopecia I-EVOLUTION +se I-EVOLUTION +resuelve I-EVOLUTION +totalmente I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +secuelas I-EVOLUTION +hacia I-EVOLUTION +el I-EVOLUTION +tercer I-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +tratamiento1. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +incidencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +infección I-EVOLUTION +por I-EVOLUTION +sífilis I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +medio I-EVOLUTION +penitenciario I-EVOLUTION +es I-EVOLUTION +más I-EVOLUTION +alta I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +población I-EVOLUTION +general2. I-EVOLUTION +La I-EVOLUTION +alopecia I-EVOLUTION +en I-EVOLUTION +cuero I-EVOLUTION +cabelludo I-EVOLUTION +es I-EVOLUTION +una I-EVOLUTION +manifestación I-EVOLUTION +poco I-EVOLUTION +común I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +sífilis I-EVOLUTION +secundaria3, I-EVOLUTION +se I-EVOLUTION +estima I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +presenta I-EVOLUTION +entre I-EVOLUTION +el I-EVOLUTION +4 I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +11% I-EVOLUTION +según I-EVOLUTION +diversos I-EVOLUTION +estudios I-EVOLUTION +publicados4, I-EVOLUTION +5, I-EVOLUTION +pudiendo I-EVOLUTION +tratarse I-EVOLUTION +tanto I-EVOLUTION +de I-EVOLUTION +alopecias I-EVOLUTION +difusas I-EVOLUTION +como I-EVOLUTION +de I-EVOLUTION +aspecto I-EVOLUTION +apolillado6. I-EVOLUTION + I-EVOLUTION +Si I-EVOLUTION +bien I-EVOLUTION +la I-EVOLUTION +sífilis I-EVOLUTION +es I-EVOLUTION +poco I-EVOLUTION +habitual I-EVOLUTION +dentro I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +diferencial I-EVOLUTION +de I-EVOLUTION +alopecia, I-EVOLUTION +debe I-EVOLUTION +ser I-EVOLUTION +tenido I-EVOLUTION +en I-EVOLUTION +cuenta I-EVOLUTION +el I-EVOLUTION +secundarismo I-EVOLUTION +luético, I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +contexto I-EVOLUTION +epidemiológico I-EVOLUTION +de I-EVOLUTION +riesgo. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +español I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +28 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +institucionalizado B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +prisión I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +diciembre I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +2009 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +salvo I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +bronquial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +broncodilatadores I-PAST_MEDICAL_HISTORY +inhalados. I-PAST_MEDICAL_HISTORY +Previo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +prisión, I-PAST_MEDICAL_HISTORY +residió I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +nordeste I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Brasil, I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Ceará, I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +marzo I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +2008 I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +agosto I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +2009, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +áreas I-PAST_MEDICAL_HISTORY +suburbanas I-PAST_MEDICAL_HISTORY +("favelas"). I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +estancia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Brasil I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +consumido I-PAST_MEDICAL_HISTORY +agua I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +grifo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ensaladas I-PAST_MEDICAL_HISTORY +frescas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +caminado I-PAST_MEDICAL_HISTORY +descalzo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +barro. I-PAST_MEDICAL_HISTORY +También I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sufrido I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +diarreico I-PAST_MEDICAL_HISTORY +autolimitado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +aclarado. I-PAST_MEDICAL_HISTORY +Doce B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +prisión I-PRESENT_ILLNESS +inicia I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +marcado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +adelgazamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +Kgs I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mareos, I-PRESENT_ILLNESS +cefaleas I-PRESENT_ILLNESS +ocasionales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +dispépsica. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +líquida, I-PRESENT_ILLNESS +acompañados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +patológicos. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +únicamente I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +palidez I-EXPLORATION +marcada I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica, I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +9, I-EXPLORATION +4 I-EXPLORATION +gr/ I-EXPLORATION +dL, I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +29, I-EXPLORATION +3%, I-EXPLORATION +un I-EXPLORATION +volumen I-EXPLORATION +corpuscular I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +65fL, I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +10.900/mm3 I-EXPLORATION +(eosinófilos I-EXPLORATION +2.800/mm3), I-EXPLORATION +plaquetas I-EXPLORATION +431.000/mm3. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +de I-EXPLORATION +VIH, I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +Se I-EXPLORATION +derivó I-EXPLORATION +para I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +hospital I-EXPLORATION +de I-EXPLORATION +referencia, I-EXPLORATION +donde I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +completa, I-EXPLORATION +incluidas I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +radiología I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +alteraciones. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +parásitos I-EXPLORATION +en I-EXPLORATION +heces I-EXPLORATION +en I-EXPLORATION +3 I-EXPLORATION +muestras I-EXPLORATION +consecutivas I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +concentración I-EXPLORATION +con I-EXPLORATION +éterformol, I-EXPLORATION +observándose I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +huevos I-EXPLORATION +de I-EXPLORATION +uncinarias. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +Strongyloides I-EXPLORATION +stercoralis I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +mediante I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +ELISA I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +titulación I-EXPLORATION +de I-EXPLORATION +0.6 I-EXPLORATION +unidades I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +óptica. I-EXPLORATION +Se B-TREATMENT +pautó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +albendazol I-TREATMENT +400 I-TREATMENT +mg/12 I-TREATMENT +horas I-TREATMENT +(d.u) I-TREATMENT +e I-TREATMENT +ivermectina I-TREATMENT +200 I-TREATMENT +microgramos/Kg/día I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +consecutivos I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +sulfato I-TREATMENT +férrico I-TREATMENT +oral I-TREATMENT +durante I-TREATMENT +3 I-TREATMENT +meses. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +una I-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +hematológicos I-EVOLUTION +y I-EVOLUTION +negativización I-EVOLUTION +tanto I-EVOLUTION +del I-EVOLUTION +análisis I-EVOLUTION +coproparasitológico I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parásitos I-EVOLUTION +intestinales I-EVOLUTION +como I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +serología I-EVOLUTION +para I-EVOLUTION +Strongiloydes I-EVOLUTION +stercoralis. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +portadora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +prótesis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rodilla I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colecistectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +herniorrafia I-PAST_MEDICAL_HISTORY +umbilical, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +geniana I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +ido I-PRESENT_ILLNESS +disminuyendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +lentamente. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +única I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +referida I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +derivada I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tumor. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +dos I-EXPLORATION +tumoraciones, I-EXPLORATION +aparentemente I-EXPLORATION +independientes I-EXPLORATION +entre I-EXPLORATION +sí I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +parótida, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +2 I-EXPLORATION +ó I-EXPLORATION +3 I-EXPLORATION +cm, I-EXPLORATION +móviles, I-EXPLORATION +bien I-EXPLORATION +definidas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +PAAF I-EXPLORATION +preoperatoria I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +frotis I-EXPLORATION +con I-EXPLORATION +cuadro I-EXPLORATION +citológico I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +mixto I-EXPLORATION +de I-EXPLORATION +glándula I-EXPLORATION +salival. I-EXPLORATION +Dado I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +se I-EXPLORATION +localiza, I-EXPLORATION +en I-EXPLORATION +principio, I-EXPLORATION +independiente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +parótida I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +localización I-EXPLORATION +poco I-EXPLORATION +frecuente I-EXPLORATION +para I-EXPLORATION +un I-EXPLORATION +adenoma I-EXPLORATION +pleomorfo, I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +RNM. I-EXPLORATION +Esta I-EXPLORATION +evidencia I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +ocupante I-EXPLORATION +de I-EXPLORATION +espacio I-EXPLORATION +en I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mejilla I-EXPLORATION +izquierda, I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +homogénea, I-EXPLORATION +hipointensa I-EXPLORATION +en I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +marcadamente I-EXPLORATION +hiperintensa I-EXPLORATION +en I-EXPLORATION +T2. I-EXPLORATION +Esta I-EXPLORATION +imagen I-EXPLORATION +es I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +linfangioma, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +parte I-EXPLORATION +craneal I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +del I-EXPLORATION +límite I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita I-EXPLORATION +y I-EXPLORATION +desciende I-EXPLORATION +en I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +borde I-EXPLORATION +externo I-EXPLORATION +del I-EXPLORATION +masetero I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +bucal I-EXPLORATION +donde I-EXPLORATION +lo I-EXPLORATION +bordea I-EXPLORATION +anteriormente I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +introduce I-EXPLORATION +medialmente I-EXPLORATION +contactando I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +externa I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +realizar I-TREATMENT +preoperatorio, I-TREATMENT +se I-TREATMENT +practica I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +mediante I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +intraoral. I-TREATMENT +Al B-EXPLORATION +incidir I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +hernia, I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +fácil I-EXPLORATION +de I-EXPLORATION +separar I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tejidos I-EXPLORATION +circundantes I-EXPLORATION +mediante I-EXPLORATION +disección I-EXPLORATION +roma. I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +final I-EXPLORATION +nos I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +quístico I-EXPLORATION +y I-EXPLORATION +forma I-EXPLORATION +tubular I-EXPLORATION +arrosariada. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +extirpada I-EXPLORATION +muestra I-EXPLORATION +macroscópicamente I-EXPLORATION +una I-EXPLORATION +formación I-EXPLORATION +elongada, I-EXPLORATION +cilíndrica, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +11 I-EXPLORATION +x I-EXPLORATION +1, I-EXPLORATION +7 I-EXPLORATION +cm I-EXPLORATION +cubierta I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +cápsula I-EXPLORATION +con I-EXPLORATION +vasos I-EXPLORATION +prominentes I-EXPLORATION +en I-EXPLORATION +superficie I-EXPLORATION +y I-EXPLORATION +estructuras I-EXPLORATION +cilíndricas I-EXPLORATION +adheridas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +formación I-EXPLORATION +principal. I-EXPLORATION +Al I-EXPLORATION +corte I-EXPLORATION +presenta I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +fibroso I-EXPLORATION +denso, I-EXPLORATION +hialinizado, I-EXPLORATION +alternando I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +más I-EXPLORATION +laxo. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +con I-EXPLORATION +citoplasma I-EXPLORATION +eosinófilo, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +mal I-EXPLORATION +definidos, I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +fusiformes I-EXPLORATION +con I-EXPLORATION +sus I-EXPLORATION +extremos I-EXPLORATION +elongados, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +disponen I-EXPLORATION +en I-EXPLORATION +haces I-EXPLORATION +adquiriendo I-EXPLORATION +a I-EXPLORATION +veces I-EXPLORATION +un I-EXPLORATION +aspecto I-EXPLORATION +serpenteante I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +figuras I-EXPLORATION +de I-EXPLORATION +mitosis. I-EXPLORATION +La I-EXPLORATION +tumoración I-EXPLORATION +presenta I-EXPLORATION +zonas I-EXPLORATION +más I-EXPLORATION +densas I-EXPLORATION +que I-EXPLORATION +alternan I-EXPLORATION +con I-EXPLORATION +otras I-EXPLORATION +mucho I-EXPLORATION +más I-EXPLORATION +laxas, I-EXPLORATION +contiene I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +paredes I-EXPLORATION +a I-EXPLORATION +veces I-EXPLORATION +hialinizadas, I-EXPLORATION +en I-EXPLORATION +general I-EXPLORATION +finas I-EXPLORATION +y I-EXPLORATION +algunas I-EXPLORATION +dilatadas I-EXPLORATION +quísticamente. I-EXPLORATION +La I-EXPLORATION +tumoración I-EXPLORATION +aparece I-EXPLORATION +bien I-EXPLORATION +delimitada I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +fascículos I-EXPLORATION +nerviosos, I-EXPLORATION +algunos I-EXPLORATION +con I-EXPLORATION +comienzo I-EXPLORATION +de I-EXPLORATION +proliferación. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +neurofibroma I-EXPLORATION +plexiforme. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +nuestro I-EXPLORATION +caso I-EXPLORATION +no I-EXPLORATION +encontramos I-EXPLORATION +ningún I-EXPLORATION +hallazgo I-EXPLORATION +clínico I-EXPLORATION +ni I-EXPLORATION +antecedente I-EXPLORATION +personal I-EXPLORATION +ó I-EXPLORATION +familiar I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +neurofibromatosis I-EXPLORATION +tipo I-EXPLORATION +I I-EXPLORATION +ó I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +poliglandular I-EXPLORATION +MEN I-EXPLORATION +III I-EXPLORATION +(MEN I-EXPLORATION +IIb) I-EXPLORATION +y I-EXPLORATION +parece I-EXPLORATION +confirmar I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +aisladas I-EXPLORATION +son I-EXPLORATION +independientes I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +síndromes. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +ningún I-EVOLUTION +signo I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +tumoral I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +sucesivas I-EVOLUTION +revisiones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +dolorosa, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lento I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +maxilar I-PRESENT_ILLNESS +superior, I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +premolares I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +15, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +permanecen I-PRESENT_ILLNESS +vitales, I-PRESENT_ILLNESS +desplazando I-PRESENT_ILLNESS +ligeramente I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +raíces. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +hay I-PRESENT_ILLNESS +dolor, I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +tróficas I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inflamación. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +expansión I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +corteza I-EXPLORATION +vestibular, I-EXPLORATION +con I-EXPLORATION +integridad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +existía I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +radiolúcida I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +raíces I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +premolares I-EXPLORATION +superiores. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +nos I-EXPLORATION +dio I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +OKC I-EXPLORATION +con I-EXPLORATION +aisladas I-EXPLORATION +microinclusiones I-EXPLORATION +córneas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +quística I-EXPLORATION +que I-EXPLORATION +ofrece I-EXPLORATION +aislado I-EXPLORATION +componente I-EXPLORATION +cartilaginoso; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +proliferación I-EXPLORATION +celular I-EXPLORATION +ameloblástica. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +raza I-PRESENT_ILLNESS +blanca, I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +induración I-EXPLORATION +eritematosa, I-EXPLORATION +parcialmente I-EXPLORATION +ulcerada, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua I-EXPLORATION +dolorosa I-EXPLORATION +al I-EXPLORATION +tacto. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +objetivó, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +adenomegalias, I-EXPLORATION +ni I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +masas I-EXPLORATION +cervicales. I-EXPLORATION +Se I-EXPLORATION +efectuó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +cuyo I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +evidenció I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +uniforme I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +linfoides I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +linfoma. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +preoperatoria I-EXPLORATION +(hemograma, I-EXPLORATION +bioquímica) I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION +Bajo B-TREATMENT +anestesia I-TREATMENT +local I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +con I-TREATMENT +amplios I-TREATMENT +márgenes I-TREATMENT +de I-TREATMENT +seguridad. I-TREATMENT + I-TREATMENT +Microscópicamente, B-EXPLORATION +el I-EXPLORATION +infiltrado I-EXPLORATION +linfoide I-EXPLORATION +ulceraba I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +epitelial I-EXPLORATION +infiltrando, I-EXPLORATION +en I-EXPLORATION +profundidad, I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +lingual. I-EXPLORATION +Alrededor I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +infiltrado I-EXPLORATION +se I-EXPLORATION +podían I-EXPLORATION +reconocer I-EXPLORATION +múltiples I-EXPLORATION +folículos I-EXPLORATION +linfoides; I-EXPLORATION +algunos I-EXPLORATION +mostraban I-EXPLORATION +centros I-EXPLORATION +germinales I-EXPLORATION +reactivos I-EXPLORATION +con I-EXPLORATION +histiocitos I-EXPLORATION +tipo I-EXPLORATION +cielo I-EXPLORATION +estrellado I-EXPLORATION +(starry-sky); I-EXPLORATION +otros I-EXPLORATION +mostraron I-EXPLORATION +cambios I-EXPLORATION +regresivos I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +centros I-EXPLORATION +germinales I-EXPLORATION +con I-EXPLORATION +depósitos I-EXPLORATION +de I-EXPLORATION +sustancia I-EXPLORATION +eosinófila I-EXPLORATION +homogénea. I-EXPLORATION +Todos I-EXPLORATION +estaban I-EXPLORATION +rodeados I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +importante I-EXPLORATION +infiltrado I-EXPLORATION +perifolicular I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +pequeñas I-EXPLORATION +células I-EXPLORATION +linfoides I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +ligeramente I-EXPLORATION +irregulares I-EXPLORATION +y I-EXPLORATION +acúmulos I-EXPLORATION +de I-EXPLORATION +cromatina I-EXPLORATION +moderadamente I-EXPLORATION +densos I-EXPLORATION +similares I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +centrocitos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +marginal. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +pudo I-EXPLORATION +reconocer I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +numerosos I-EXPLORATION +histiocitos I-EXPLORATION +y I-EXPLORATION +eosinófilos. I-EXPLORATION +Ocasionalmente I-EXPLORATION +algunas I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +varios I-EXPLORATION +nucleolos I-EXPLORATION +prominentes, I-EXPLORATION +se I-EXPLORATION +entremezclaban I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +pequeñas I-EXPLORATION +formando I-EXPLORATION +columnas I-EXPLORATION +de I-EXPLORATION +centroblastos I-EXPLORATION +e I-EXPLORATION +inmunoblastos. I-EXPLORATION +También I-EXPLORATION +podía I-EXPLORATION +reconocerse I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +diferenciación I-EXPLORATION +plasmocitoide, I-EXPLORATION +predominante I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +paraseptal I-EXPLORATION +y I-EXPLORATION +subepitelial. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tumoración, I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +lóbulos, I-EXPLORATION +parcialmente I-EXPLORATION +conservados, I-EXPLORATION +de I-EXPLORATION +glándulas I-EXPLORATION +salivales I-EXPLORATION +menores I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +mucoso, I-EXPLORATION +mostrando I-EXPLORATION +una I-EXPLORATION +destacada I-EXPLORATION +infiltración I-EXPLORATION +linfoidea. I-EXPLORATION +Los I-EXPLORATION +conductos I-EXPLORATION +salivales I-EXPLORATION +estaban I-EXPLORATION +dilatados I-EXPLORATION +e I-EXPLORATION +infiltrados I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +B I-EXPLORATION +con I-EXPLORATION +formación I-EXPLORATION +ocasional I-EXPLORATION +de I-EXPLORATION +islas I-EXPLORATION +epimioepiteliales. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +podían I-EXPLORATION +reconocer, I-EXPLORATION +abundantes I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +conductos I-EXPLORATION +glandulares. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +sobre I-EXPLORATION +secciones I-EXPLORATION +congeladas I-EXPLORATION +y I-EXPLORATION +fijadas I-EXPLORATION +en I-EXPLORATION +formalina I-EXPLORATION +y I-EXPLORATION +parafina, I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +método I-EXPLORATION +estreptavidina-biotina. I-EXPLORATION +Se I-EXPLORATION +emplearon I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +anticuerpos: I-EXPLORATION +CD20, I-EXPLORATION +CD3, I-EXPLORATION +CD5, I-EXPLORATION +CD10, I-EXPLORATION +CD23, I-EXPLORATION +CD43, I-EXPLORATION +DBA44, I-EXPLORATION +CD68, I-EXPLORATION +inmunoglobulinas I-EXPLORATION +α, I-EXPLORATION +γ, I-EXPLORATION +µ I-EXPLORATION +de I-EXPLORATION +cadena I-EXPLORATION +pesada I-EXPLORATION +y I-EXPLORATION +κ, I-EXPLORATION +λ I-EXPLORATION +de I-EXPLORATION +cadena I-EXPLORATION +ligera. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +centrocíticas, I-EXPLORATION +mostraron I-EXPLORATION +un I-EXPLORATION +fenotipo I-EXPLORATION +B, I-EXPLORATION +con I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +CD20, I-EXPLORATION +CD5 I-EXPLORATION +y I-EXPLORATION +CD43. I-EXPLORATION +CD10, I-EXPLORATION +CD23 I-EXPLORATION +y I-EXPLORATION +DBA44 I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +proporción I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +T, I-EXPLORATION +con I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +CD3. I-EXPLORATION +Las I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +bandas I-EXPLORATION +paraseptales I-EXPLORATION +y I-EXPLORATION +subepiteliales I-EXPLORATION +y I-EXPLORATION +también I-EXPLORATION +las I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +conductos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +glándulas I-EXPLORATION +mucosas, I-EXPLORATION +mostraron I-EXPLORATION +producción I-EXPLORATION +de I-EXPLORATION +inmunoglobulina I-EXPLORATION +IgG/κ. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +linfoma I-EXPLORATION +MALT. I-EXPLORATION +Las I-EXPLORATION +alteraciones I-EXPLORATION +morfológicas I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +glándulas I-EXPLORATION +salivales I-EXPLORATION +menores I-EXPLORATION +próximas I-EXPLORATION +al I-EXPLORATION +tumor, I-EXPLORATION +se I-EXPLORATION +interpretaron I-EXPLORATION +como I-EXPLORATION +sialoadenitis I-EXPLORATION +mioepitelial. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +sufrió I-EVOLUTION +otras I-EVOLUTION +manifestaciones I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +como I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +Sjögren, I-EVOLUTION +artritis I-EVOLUTION +reumatoide I-EVOLUTION +diseminada, I-EVOLUTION +lupus I-EVOLUTION +eritematoso, I-EVOLUTION +o I-EVOLUTION +tiroiditis I-EVOLUTION +de I-EVOLUTION +Hashimoto. I-EVOLUTION +El I-EVOLUTION +linfoma I-EVOLUTION +se I-EVOLUTION +consideró I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +tanto I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +estadio I-EVOLUTION +IE. I-EVOLUTION +La B-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +ha I-TREATMENT +recibido I-TREATMENT +ningún I-TREATMENT +tratamiento I-TREATMENT +salvo I-TREATMENT +el I-TREATMENT +quirúrgico, I-TREATMENT +sin I-TREATMENT +presentar I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +enfermedad I-TREATMENT +al I-TREATMENT +año I-TREATMENT +del I-TREATMENT +diagnóstico. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +úlcera I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +encía I-PRESENT_ILLNESS +adherida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +molar I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +cedido I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +conservador. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oral I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +úlcera I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +zona I-EXPLORATION +molar I-EXPLORATION +superior I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +fondo I-EXPLORATION +necrótico I-EXPLORATION +y I-EXPLORATION +bordes I-EXPLORATION +sobreelevados I-EXPLORATION +y I-EXPLORATION +eritematosos I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor, I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +abombamiento I-EXPLORATION +en I-EXPLORATION +fondo I-EXPLORATION +vestibular I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +paladar I-EXPLORATION +duro I-EXPLORATION +(lado I-EXPLORATION +izquierdo). I-EXPLORATION +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +bebedor I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esófago I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1/3 I-PAST_MEDICAL_HISTORY +distal I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +trataba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esófago I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +enteroide, I-PAST_MEDICAL_HISTORY +pobremente I-PAST_MEDICAL_HISTORY +diferenciado, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +infiltración I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tejido I-PAST_MEDICAL_HISTORY +adiposo I-PAST_MEDICAL_HISTORY +periesofágico, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +escasa I-PAST_MEDICAL_HISTORY +reacción I-PAST_MEDICAL_HISTORY +fibroblastica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +linfoide I-PAST_MEDICAL_HISTORY +peritumoral, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +metástasis I-PAST_MEDICAL_HISTORY +ganglionar, I-PAST_MEDICAL_HISTORY +presentando I-PAST_MEDICAL_HISTORY +extensión I-PAST_MEDICAL_HISTORY +extracapsular, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +atipias I-PAST_MEDICAL_HISTORY +intensas, I-PAST_MEDICAL_HISTORY +índice I-PAST_MEDICAL_HISTORY +mitótico I-PAST_MEDICAL_HISTORY +elevado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +necrosis I-PAST_MEDICAL_HISTORY +moderada. I-PAST_MEDICAL_HISTORY +El B-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +complementario I-TREATMENT +con I-TREATMENT +quimioterapia I-TREATMENT +ni I-TREATMENT +radioterapia I-TREATMENT +postoperatoria I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +en I-TREATMENT +el I-TREATMENT +postoperatorio I-TREATMENT +inmediato I-TREATMENT +sufrió I-TREATMENT +dehiscencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sutura I-TREATMENT +gastroesofágica I-TREATMENT +y I-TREATMENT +fistula I-TREATMENT +gastrocutánea I-TREATMENT +que I-TREATMENT +cedió I-TREATMENT +tras I-TREATMENT +nutricion I-TREATMENT +parenteral. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +simple I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +ortopantomografía I-EXPLORATION +y I-EXPLORATION +Waters I-EXPLORATION +apreciando I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +osteolisis I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +hueso I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +e I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +ocupación I-EXPLORATION +en I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +izquierdo. I-EXPLORATION +Se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +toma I-EXPLORATION +de I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +intraoral, I-EXPLORATION +informando I-EXPLORATION +el I-EXPLORATION +anatomopatólogo I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +esófago. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +ingresado I-EVOLUTION +para I-EVOLUTION +descartar I-EVOLUTION +que I-EVOLUTION +presentase I-EVOLUTION +más I-EVOLUTION +metástasis I-EVOLUTION +y I-EVOLUTION +delimitar I-EVOLUTION +la I-EVOLUTION +extensión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +metástasis I-EVOLUTION +de I-EVOLUTION +hueso I-EVOLUTION +maxilar. I-EVOLUTION +La B-EXPLORATION +exploración I-EXPLORATION +cervical I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +el I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cadenas I-EXPLORATION +ganglionares I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +orofacial, I-EXPLORATION +apreciando I-EXPLORATION +destrucción I-EXPLORATION +de I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +paladar I-EXPLORATION +duro, I-EXPLORATION +apófisis I-EXPLORATION +pterigoides, I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +rotura I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +izquierdo, I-EXPLORATION +existiendo I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +masticador I-EXPLORATION +izquierdo, I-EXPLORATION +y I-EXPLORATION +estando I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +tumoral I-EXPLORATION +muy I-EXPLORATION +próximo I-EXPLORATION +al I-EXPLORATION +suelo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +órbita I-EXPLORATION +izquierda. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +ecográfico I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +siendo I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +gammagrafía I-EXPLORATION +ósea, I-EXPLORATION +apreciando I-EXPLORATION +lesiones I-EXPLORATION +óseas I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +malignidad I-EXPLORATION +en I-EXPLORATION +hueso I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +izquierdo, I-EXPLORATION +pelvis I-EXPLORATION +derecha, I-EXPLORATION +séptima I-EXPLORATION +vértebra I-EXPLORATION +dorsal I-EXPLORATION +y I-EXPLORATION +parrilla I-EXPLORATION +costal I-EXPLORATION +derecha. I-EXPLORATION +Cuando B-EVOLUTION +se I-EVOLUTION +terminó I-EVOLUTION +de I-EVOLUTION +completar I-EVOLUTION +el I-EVOLUTION +estudio I-EVOLUTION +(dos I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +duración I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +consulta I-EVOLUTION +y I-EVOLUTION +toma I-EVOLUTION +de I-EVOLUTION +biopsia I-EVOLUTION +intraoral), I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +intraoral I-EVOLUTION +había I-EVOLUTION +crecido I-EVOLUTION +enormemente, I-EVOLUTION +presentando I-EVOLUTION +áreas I-EVOLUTION +necróticas I-EVOLUTION +y I-EVOLUTION +afectando I-EVOLUTION +a I-EVOLUTION +todo I-EVOLUTION +el I-EVOLUTION +fondo I-EVOLUTION +vestibular I-EVOLUTION +superior I-EVOLUTION +izquierdo, I-EVOLUTION +encía I-EVOLUTION +y I-EVOLUTION +paladar I-EVOLUTION +duro I-EVOLUTION +izquierdo, I-EVOLUTION +presentando I-EVOLUTION +así I-EVOLUTION +mismo I-EVOLUTION +impotencia I-EVOLUTION +funcional I-EVOLUTION +en I-EVOLUTION +pierna I-EVOLUTION +derecha I-EVOLUTION +que I-EVOLUTION +le I-EVOLUTION +impedía I-EVOLUTION +una I-EVOLUTION +correcta I-EVOLUTION +deambulación. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +murió I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +repentina I-EVOLUTION +tras I-EVOLUTION +presentar I-EVOLUTION +hemorragia I-EVOLUTION +masiva I-EVOLUTION +por I-EVOLUTION +cavidad I-EVOLUTION +oral. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +personal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +células I-PAST_MEDICAL_HISTORY +basales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +piel I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +paranasal I-PAST_MEDICAL_HISTORY +izquierda, I-PAST_MEDICAL_HISTORY +acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ángulo I-PRESENT_ILLNESS +mandibular I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Aportaba B-EXPLORATION +un I-EXPLORATION +informe I-EXPLORATION +citopatológico I-EXPLORATION +procedente I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +punciones-aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF) I-EXPLORATION +efectuada I-EXPLORATION +en I-EXPLORATION +otro I-EXPLORATION +centro, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +frotis I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +epitelial I-EXPLORATION +de I-EXPLORATION +baja I-EXPLORATION +agresividad I-EXPLORATION +citológica. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +observados I-EXPLORATION +eran I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +adenoma I-EXPLORATION +pleomorfo I-EXPLORATION +de I-EXPLORATION +glándula I-EXPLORATION +salivar, I-EXPLORATION +sin I-EXPLORATION +embargo I-EXPLORATION +la I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +estroma I-EXPLORATION +era I-EXPLORATION +mínima, I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +patrón I-EXPLORATION +se I-EXPLORATION +desviaba I-EXPLORATION +de I-EXPLORATION +lo I-EXPLORATION +habitual I-EXPLORATION +en I-EXPLORATION +estos I-EXPLORATION +casos, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +pudieron I-EXPLORATION +descartar I-EXPLORATION +otros I-EXPLORATION +tumores, I-EXPLORATION +incluído I-EXPLORATION +el I-EXPLORATION +carcinoma. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +yugulodigástrica I-EXPLORATION +derecha, I-EXPLORATION +desplazable I-EXPLORATION +sobre I-EXPLORATION +planos I-EXPLORATION +profundos I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +piel. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +otras I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +tumoraciones I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cervicofacial. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +cola I-EXPLORATION +parotídea I-EXPLORATION +derecha, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +cervicofacial I-EXPLORATION +con I-EXPLORATION +contraste, I-EXPLORATION +practicándose I-EXPLORATION +ventana I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +y I-EXPLORATION +ventana I-EXPLORATION +de I-EXPLORATION +hueso. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +superficial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +parotídea I-EXPLORATION +derecha, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cola I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +parótida, I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +nodular, I-EXPLORATION +hipercaptante, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +definidos I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +que, I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +radiológicas I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +lenta I-EXPLORATION +evolución I-EXPLORATION +en I-EXPLORATION +tres I-EXPLORATION +años, I-EXPLORATION +se I-EXPLORATION +interpretó I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +tumoral I-EXPLORATION +benigna, I-EXPLORATION +a I-EXPLORATION +considerar I-EXPLORATION +las I-EXPLORATION +etiologías I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +pleomorfo, I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +Warthin I-EXPLORATION +u I-EXPLORATION +otros I-EXPLORATION +tumores I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +salivar I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +benigna. I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +adenopatías I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +no I-EXPLORATION +significativo I-EXPLORATION +en I-EXPLORATION +sendas I-EXPLORATION +cadenas I-EXPLORATION +submandibulares, I-EXPLORATION +yugulodigástricas I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +triángulos I-EXPLORATION +posteriores. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +clínico-radiológica I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +benigno I-TREATMENT +de I-TREATMENT +glándula I-TREATMENT +parótida I-TREATMENT +derecha, I-TREATMENT +se I-TREATMENT +intervino I-TREATMENT +quirúrgicamente I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +e I-TREATMENT +intubación I-TREATMENT +orotraqueal, I-TREATMENT +realizándose I-TREATMENT +parotidectomía I-TREATMENT +suprafacial I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +un I-TREATMENT +abordaje I-TREATMENT +de I-TREATMENT +ritidectomía, I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +lóbulo I-TREATMENT +parotídeo I-TREATMENT +superficial I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +x I-TREATMENT +3 I-TREATMENT +cm I-TREATMENT +y I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +cierre I-TREATMENT +con I-TREATMENT +colgajo I-TREATMENT +de I-TREATMENT +SMAS. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +bien I-EXPLORATION +delimitada I-EXPLORATION +de I-EXPLORATION +18 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +blanquecino I-EXPLORATION +y I-EXPLORATION +superficie I-EXPLORATION +homogénea, I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +extremo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza. I-EXPLORATION +Al I-EXPLORATION +corte, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +de I-EXPLORATION +textura I-EXPLORATION +homogénea, I-EXPLORATION +y I-EXPLORATION +características I-EXPLORATION +macroscópicas I-EXPLORATION +de I-EXPLORATION +normalidad I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula. I-EXPLORATION +Asimismo, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biosia-exéresis I-EXPLORATION +de I-EXPLORATION +adenopatía I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +proximidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +parótida, I-EXPLORATION +que I-EXPLORATION +al I-EXPLORATION +corte I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +textura I-EXPLORATION +homogénea, I-EXPLORATION +color I-EXPLORATION +blanquecino I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +elástica. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +microscópico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +encapsulada I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +nidos I-EXPLORATION +o I-EXPLORATION +trabéculas I-EXPLORATION +separadas I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +membrana I-EXPLORATION +basal I-EXPLORATION +eosinófila I-EXPLORATION +y I-EXPLORATION +constituidas I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +basalioides I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +disponían I-EXPLORATION +a I-EXPLORATION +modo I-EXPLORATION +de I-EXPLORATION +empalizada I-EXPLORATION +periférica. I-EXPLORATION +La I-EXPLORATION +celularidad I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +citoqueratina I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +peso I-EXPLORATION +molecular I-EXPLORATION +y I-EXPLORATION +focalmente I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +S-100. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +basales I-EXPLORATION +de I-EXPLORATION +glándula I-EXPLORATION +parótida I-EXPLORATION +y I-EXPLORATION +ganglios I-EXPLORATION +linfáticos I-EXPLORATION +con I-EXPLORATION +hiperplasia I-EXPLORATION +folicular. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +complicaciones I-EVOLUTION +importantes, I-EVOLUTION +salvo I-EVOLUTION +ligera I-EVOLUTION +paresia I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +ramas I-EVOLUTION +frontal I-EVOLUTION +y I-EVOLUTION +bucal I-EVOLUTION +del I-EVOLUTION +nervio I-EVOLUTION +facial, I-EVOLUTION +que I-EVOLUTION +experimentó I-EVOLUTION +mejoría I-EVOLUTION +progresiva I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +subsiguientes I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +otica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +craneofacial I-PRESENT_ILLNESS +referida I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +otalgia I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +tinitus I-PRESENT_ILLNESS +bilateral, I-PRESENT_ILLNESS +vértigo, I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +oído I-PRESENT_ILLNESS +tapado I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuello I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +otorrinolaringologico I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +patología I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +oído, I-EXPLORATION +nariz I-EXPLORATION +o I-EXPLORATION +garganta. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +compromiso I-EXPLORATION +músculo-esquelético I-EXPLORATION +con I-EXPLORATION +resentimiento I-EXPLORATION +muscular I-EXPLORATION +local I-EXPLORATION +en I-EXPLORATION +zonas I-EXPLORATION +de: I-EXPLORATION +pterigoideo I-EXPLORATION +externo I-EXPLORATION +bilateral, I-EXPLORATION +temporal I-EXPLORATION +bilateral, I-EXPLORATION +digastrico I-EXPLORATION +vientre I-EXPLORATION +posterior, I-EXPLORATION +esternocleidomastoideo I-EXPLORATION +bilateral, I-EXPLORATION +esplenio I-EXPLORATION +bilateral, I-EXPLORATION +occipitofrontal I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +izquierda. I-EXPLORATION +Se I-EXPLORATION +encuentran I-EXPLORATION +puntos I-EXPLORATION +gatillo I-EXPLORATION +en I-EXPLORATION +músculo I-EXPLORATION +trapecio I-EXPLORATION +bilateralmente. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +reporta I-EXPLORATION +dolor I-EXPLORATION +al I-EXPLORATION +masticar I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +al I-EXPLORATION +tragar I-EXPLORATION +alimentos I-EXPLORATION +duros. I-EXPLORATION +También I-EXPLORATION +relata I-EXPLORATION +odontalgias I-EXPLORATION +fantasmas I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +molares I-EXPLORATION +mandibulares I-EXPLORATION +izquierdos I-EXPLORATION +sin I-EXPLORATION +patología I-EXPLORATION +dental I-EXPLORATION +evidente I-EXPLORATION +al I-EXPLORATION +examen, I-EXPLORATION +igualmente I-EXPLORATION +describe I-EXPLORATION +dolor I-EXPLORATION +tipo I-EXPLORATION +hiperalgesia I-EXPLORATION +secundaria I-EXPLORATION +en I-EXPLORATION +cuero I-EXPLORATION +cabelludo I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +hace I-EXPLORATION +pensar I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +componente I-EXPLORATION +neuropatico I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +queja. I-EXPLORATION +Reporta I-EXPLORATION +sabores I-EXPLORATION +agrio-amargos I-EXPLORATION +periódicamente I-EXPLORATION +con I-EXPLORATION +sensación I-EXPLORATION +de I-EXPLORATION +quemadura I-EXPLORATION +en I-EXPLORATION +paladar. I-EXPLORATION +Se I-EXPLORATION +palpan I-EXPLORATION +los I-EXPLORATION +procesos I-EXPLORATION +hamulares, I-EXPLORATION +encontrando I-EXPLORATION +dolor I-EXPLORATION +intenso I-EXPLORATION +local I-EXPLORATION +del I-EXPLORATION +lado I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +referido I-EXPLORATION +a I-EXPLORATION +oído I-EXPLORATION +y I-EXPLORATION +zona I-EXPLORATION +mandibular I-EXPLORATION +izquierda I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +Se B-TREATMENT +programa I-TREATMENT +la I-TREATMENT +infiltración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +hamular I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +corticoide I-TREATMENT +sintético I-TREATMENT +(Betametasona I-TREATMENT +- I-TREATMENT +suspensión I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +mg) I-TREATMENT +previa I-TREATMENT +anestesia I-TREATMENT +local. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +también I-TREATMENT +fue I-TREATMENT +manejada I-TREATMENT +con I-TREATMENT +dispositivo I-TREATMENT +intraoral I-TREATMENT +para I-TREATMENT +la I-TREATMENT +supresión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +actividad I-TREATMENT +muscular I-TREATMENT +como I-TREATMENT +tratamiento I-TREATMENT +del I-TREATMENT +DTM I-TREATMENT +y I-TREATMENT +la I-TREATMENT +sintomatología I-TREATMENT +otica I-TREATMENT +referida I-TREATMENT +1 I-TREATMENT +mes I-TREATMENT +posterior I-TREATMENT +a I-TREATMENT +la I-TREATMENT +sintomatología I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Bursitis I-TREATMENT +Hamular. I-TREATMENT +Se B-EVOLUTION +ha I-EVOLUTION +controlado I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +durante I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +sin I-EVOLUTION +recurrencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología. I-EVOLUTION +La I-EVOLUTION +presentacion I-EVOLUTION +clinica I-EVOLUTION +del I-EVOLUTION +compromiso I-EVOLUTION +músculo-esqueletico I-EVOLUTION +y I-EVOLUTION +otico, I-EVOLUTION +adicional I-EVOLUTION +al I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +zona I-EVOLUTION +del I-EVOLUTION +proceso I-EVOLUTION +hamular I-EVOLUTION +y I-EVOLUTION +posible I-EVOLUTION +relacion I-EVOLUTION +concomitante I-EVOLUTION +pueden I-EVOLUTION +tener I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +base I-EVOLUTION +fisiopatologica I-EVOLUTION +del I-EVOLUTION +caso I-EVOLUTION +clínico I-EVOLUTION +anterior. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +solicitando I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +solución I-PRESENT_ILLNESS +estética I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +frente I-PRESENT_ILLNESS +anterior. I-PRESENT_ILLNESS +Durante B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +primeros I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +sometido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +intervenciones I-PAST_MEDICAL_HISTORY +quirúrgicas I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +conseguir I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cierre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tejidos I-PAST_MEDICAL_HISTORY +blandos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +labio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +paladar. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +extraoral I-EXPLORATION +se I-EXPLORATION +podía I-EXPLORATION +observar I-EXPLORATION +una I-EXPLORATION +asimetría I-EXPLORATION +del I-EXPLORATION +labio I-EXPLORATION +superior I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +diversas I-EXPLORATION +operaciones I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +sometido I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +infancia. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +intraoral I-EXPLORATION +se I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +evidente I-EXPLORATION +malposición I-EXPLORATION +y I-EXPLORATION +maloclusión I-EXPLORATION +dentaria I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +distintas I-EXPLORATION +agenesias I-EXPLORATION +dentales I-EXPLORATION +(15, I-EXPLORATION +12, I-EXPLORATION +11, I-EXPLORATION +25, I-EXPLORATION +34, I-EXPLORATION +33 I-EXPLORATION +y I-EXPLORATION +44) I-EXPLORATION +y I-EXPLORATION +discrepancia I-EXPLORATION +maxilo-mandibular. I-EXPLORATION +Apreciándose I-EXPLORATION +también I-EXPLORATION +una I-EXPLORATION +gingivitis I-EXPLORATION +moderada I-EXPLORATION +por I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +placa. I-EXPLORATION + I-EXPLORATION +Vemos I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +grave I-EXPLORATION +dismorfosis I-EXPLORATION +maxilo-mandibular I-EXPLORATION +que I-EXPLORATION +aconsejaba I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tratamiento I-EXPLORATION +ortodóncico I-EXPLORATION +previo I-EXPLORATION +a I-EXPLORATION +cualquier I-EXPLORATION +toma I-EXPLORATION +de I-EXPLORATION +decisión I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +prostodóncico. I-EXPLORATION +El I-EXPLORATION +caso I-EXPLORATION +fue I-EXPLORATION +consultado I-EXPLORATION +al I-EXPLORATION +especialista I-EXPLORATION +en I-EXPLORATION +ortodoncia I-EXPLORATION +y I-EXPLORATION +este I-EXPLORATION +planteo I-EXPLORATION +la I-EXPLORATION +necesidad I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +cirugía I-EXPLORATION +ortognática I-EXPLORATION +previa I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +protético. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +explicó I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +y I-EXPLORATION +este I-EXPLORATION +se I-EXPLORATION +opuso I-EXPLORATION +a I-EXPLORATION +someterse I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +quirúrgico. I-EXPLORATION + I-EXPLORATION +Analizado B-TREATMENT +los I-TREATMENT +hábitos I-TREATMENT +higiénicos I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +observando I-TREATMENT +una I-TREATMENT +clara I-TREATMENT +deficiencia I-TREATMENT +en I-TREATMENT +su I-TREATMENT +control I-TREATMENT +de I-TREATMENT +placa, I-TREATMENT +se I-TREATMENT +opta I-TREATMENT +por I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +fija I-TREATMENT +sobre I-TREATMENT +coronas I-TREATMENT +telescópicas, I-TREATMENT +facultativamente I-TREATMENT +removible, I-TREATMENT +lo I-TREATMENT +cual, I-TREATMENT +por I-TREATMENT +un I-TREATMENT +lado I-TREATMENT +mejorará I-TREATMENT +el I-TREATMENT +control I-TREATMENT +de I-TREATMENT +placa I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +cuestión I-TREATMENT +fundamental I-TREATMENT +para I-TREATMENT +el I-TREATMENT +pronóstico I-TREATMENT +del I-TREATMENT +tratamiento, I-TREATMENT +y I-TREATMENT +por I-TREATMENT +otro I-TREATMENT +lado I-TREATMENT +se I-TREATMENT +cumple I-TREATMENT +la I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +ferulización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arcada I-TREATMENT +a I-TREATMENT +ambos I-TREATMENT +lados I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fisura I-TREATMENT +palatina. I-TREATMENT + I-TREATMENT +Las I-TREATMENT +coronas I-TREATMENT +telescópicas I-TREATMENT +como I-TREATMENT +sistema I-TREATMENT +prostodóncico I-TREATMENT +de I-TREATMENT +doble I-TREATMENT +corona I-TREATMENT +permite I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +ferulización I-TREATMENT +cruzada I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arcada I-TREATMENT +dentaria I-TREATMENT +(en I-TREATMENT +nuestro I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +limita I-TREATMENT +a I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +anterior I-TREATMENT +del I-TREATMENT +maxilar), I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +va I-TREATMENT +a I-TREATMENT +permitir I-TREATMENT +una I-TREATMENT +estabilización I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dientes I-TREATMENT +a I-TREATMENT +largo I-TREATMENT +plazo. I-TREATMENT +El I-TREATMENT +concepto I-TREATMENT +de I-TREATMENT +doble I-TREATMENT +corona I-TREATMENT +y I-TREATMENT +el I-TREATMENT +diseño I-TREATMENT +intrínseco I-TREATMENT +de I-TREATMENT +las I-TREATMENT +mismas I-TREATMENT +hace I-TREATMENT +que I-TREATMENT +la I-TREATMENT +transmisión I-TREATMENT +de I-TREATMENT +las I-TREATMENT +fuerzas I-TREATMENT +masticatorias I-TREATMENT +sean I-TREATMENT +lo I-TREATMENT +más I-TREATMENT +favorable I-TREATMENT +al I-TREATMENT +diente I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +estas I-TREATMENT +se I-TREATMENT +van I-TREATMENT +a I-TREATMENT +producir I-TREATMENT +siempre I-TREATMENT +en I-TREATMENT +sentido I-TREATMENT +axial I-TREATMENT +al I-TREATMENT +eje I-TREATMENT +del I-TREATMENT +diente. I-TREATMENT +La I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +pueda I-TREATMENT +retirar I-TREATMENT +la I-TREATMENT +estructura I-TREATMENT +secundaria I-TREATMENT +hace I-TREATMENT +más I-TREATMENT +fácil I-TREATMENT +la I-TREATMENT +higiene I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dientes I-TREATMENT +pilares I-TREATMENT +sobre I-TREATMENT +todo I-TREATMENT +si I-TREATMENT +se I-TREATMENT +compara I-TREATMENT +con I-TREATMENT +la I-TREATMENT +dificultad I-TREATMENT +de I-TREATMENT +limpieza I-TREATMENT +de I-TREATMENT +un I-TREATMENT +puente I-TREATMENT +fijo I-TREATMENT +convencional, I-TREATMENT +esta I-TREATMENT +circunstancia I-TREATMENT +fue I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +principales I-TREATMENT +motivos I-TREATMENT +por I-TREATMENT +el I-TREATMENT +que I-TREATMENT +optamos I-TREATMENT +en I-TREATMENT +nuestro I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +realizar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +coronas I-TREATMENT +telescópicas, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +la I-TREATMENT +higiene I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +era I-TREATMENT +del I-TREATMENT +todo I-TREATMENT +satisfactoria, I-TREATMENT +tal I-TREATMENT +y I-TREATMENT +como I-TREATMENT +hemos I-TREATMENT +mencionado I-TREATMENT +anteriormente. I-TREATMENT + I-TREATMENT +Desde B-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +momento I-EVOLUTION +se I-EVOLUTION +informa I-EVOLUTION +al I-EVOLUTION +paciente I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +resultado I-EVOLUTION +estético I-EVOLUTION +y I-EVOLUTION +funcional I-EVOLUTION +no I-EVOLUTION +va I-EVOLUTION +a I-EVOLUTION +ser I-EVOLUTION +el I-EVOLUTION +idóneo, I-EVOLUTION +cuestión I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +todo I-EVOLUTION +momento I-EVOLUTION +entiende I-EVOLUTION +y I-EVOLUTION +acepta. I-EVOLUTION +Previo B-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +prostodóncico I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +exodoncia I-TREATMENT +del I-TREATMENT +resto I-TREATMENT +radicular I-TREATMENT +del I-TREATMENT +diente I-TREATMENT +13 I-TREATMENT +y I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +cicatrizada I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +definitivo. I-TREATMENT +Este I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +la I-TREATMENT +preparación I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dientes I-TREATMENT +pilares I-TREATMENT +15, I-TREATMENT +21, I-TREATMENT +22, I-TREATMENT +23 I-TREATMENT +y I-TREATMENT +24, I-TREATMENT +realizando I-TREATMENT +tallados I-TREATMENT +convencionales I-TREATMENT +para I-TREATMENT +coronas I-TREATMENT +telescópicas. I-TREATMENT +Cabe I-TREATMENT +resaltar I-TREATMENT +el I-TREATMENT +importante I-TREATMENT +tallado I-TREATMENT +que I-TREATMENT +hubo I-TREATMENT +que I-TREATMENT +realizar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +corona I-TREATMENT +del I-TREATMENT +diente I-TREATMENT +21, I-TREATMENT +para I-TREATMENT +poder I-TREATMENT +conseguir I-TREATMENT +el I-TREATMENT +paralelismo I-TREATMENT +entre I-TREATMENT +pilares, I-TREATMENT +cuestión I-TREATMENT +ésta I-TREATMENT +que I-TREATMENT +es I-TREATMENT +de I-TREATMENT +crucial I-TREATMENT +importancia I-TREATMENT +en I-TREATMENT +todos I-TREATMENT +los I-TREATMENT +trabajos I-TREATMENT +con I-TREATMENT +coronas I-TREATMENT +telescópicas. I-TREATMENT + I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +impresiones I-TREATMENT +y I-TREATMENT +registros I-TREATMENT +intermaxilares I-TREATMENT +para I-TREATMENT +que I-TREATMENT +con I-TREATMENT +los I-TREATMENT +modelos I-TREATMENT +obtenidos I-TREATMENT +se I-TREATMENT +confeccionen I-TREATMENT +en I-TREATMENT +el I-TREATMENT +laboratorio I-TREATMENT +las I-TREATMENT +cofias I-TREATMENT +primarias. I-TREATMENT +Estas I-TREATMENT +son I-TREATMENT +probadas I-TREATMENT +en I-TREATMENT +la I-TREATMENT +boca I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +verifica I-TREATMENT +su I-TREATMENT +correcto I-TREATMENT +ajuste I-TREATMENT +para I-TREATMENT +a I-TREATMENT +continuación I-TREATMENT +tomar I-TREATMENT +una I-TREATMENT +segunda I-TREATMENT +impresión I-TREATMENT +"de I-TREATMENT +arrastre" I-TREATMENT +que I-TREATMENT +nos I-TREATMENT +posiciona I-TREATMENT +las I-TREATMENT +cofias I-TREATMENT +primarias I-TREATMENT +con I-TREATMENT +respecto I-TREATMENT +al I-TREATMENT +resto I-TREATMENT +de I-TREATMENT +estructuras I-TREATMENT +de I-TREATMENT +la I-TREATMENT +boca I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +Obteniéndose I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +modelo I-TREATMENT +donde I-TREATMENT +van I-TREATMENT +a I-TREATMENT +ser I-TREATMENT +confeccionadas I-TREATMENT +las I-TREATMENT +coronas I-TREATMENT +secundarias I-TREATMENT +que I-TREATMENT +conforman I-TREATMENT +la I-TREATMENT +prótesis I-TREATMENT +fija I-TREATMENT +facultativamente I-TREATMENT +removible. I-TREATMENT +Esta I-TREATMENT +estructura I-TREATMENT +secundaria I-TREATMENT +es I-TREATMENT +probada I-TREATMENT +en I-TREATMENT +la I-TREATMENT +boca I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +comprueba I-TREATMENT +tanto I-TREATMENT +el I-TREATMENT +ajuste I-TREATMENT +como I-TREATMENT +la I-TREATMENT +relación I-TREATMENT +oclusal. I-TREATMENT + I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +seleccionado I-TREATMENT +el I-TREATMENT +color I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +su I-TREATMENT +terminación I-TREATMENT +y I-TREATMENT +colocación. I-TREATMENT +El B-EVOLUTION +resultado I-EVOLUTION +final, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +aprecia I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +imagen, I-EVOLUTION +podemos I-EVOLUTION +ver I-EVOLUTION +un I-EVOLUTION +resultado I-EVOLUTION +que I-EVOLUTION +desde I-EVOLUTION +nuestro I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +es I-EVOLUTION +simplemente I-EVOLUTION +aceptable, I-EVOLUTION +pero I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +valoró I-EVOLUTION +como I-EVOLUTION +muy I-EVOLUTION +satisfactorio, I-EVOLUTION +quizás I-EVOLUTION +debido I-EVOLUTION +a, I-EVOLUTION +lógicamente, I-EVOLUTION +al I-EVOLUTION +estado I-EVOLUTION +inicial I-EVOLUTION +que I-EVOLUTION +presentaba I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +y I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +creía I-EVOLUTION +imposible I-EVOLUTION +de I-EVOLUTION +mejorar, I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +predisposición I-EVOLUTION +favorable I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +en I-EVOLUTION +todo I-EVOLUTION +momento. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +caso I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +revisado I-EVOLUTION +a I-EVOLUTION +lo I-EVOLUTION +largo I-EVOLUTION +de I-EVOLUTION +cinco I-EVOLUTION +años I-EVOLUTION +consecutivos I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +del I-EVOLUTION +mal I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +placa I-EVOLUTION +por I-EVOLUTION +parte I-EVOLUTION +del I-EVOLUTION +paciente, I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +hemos I-EVOLUTION +conseguido I-EVOLUTION +que I-EVOLUTION +adquiera I-EVOLUTION +unos I-EVOLUTION +hábitos I-EVOLUTION +adecuados I-EVOLUTION +de I-EVOLUTION +higiene, I-EVOLUTION +los I-EVOLUTION +pilares I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +prótesis I-EVOLUTION +están I-EVOLUTION +en I-EVOLUTION +perfecto I-EVOLUTION +estado I-EVOLUTION +y I-EVOLUTION +tanto I-EVOLUTION +el I-EVOLUTION +confort I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +estética I-EVOLUTION +para I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +siguen I-EVOLUTION +siendo I-EVOLUTION +satisfactorias. I-EVOLUTION +De I-EVOLUTION +esta I-EVOLUTION +manera I-EVOLUTION +se I-EVOLUTION +pone I-EVOLUTION +de I-EVOLUTION +manifiesto I-EVOLUTION +el I-EVOLUTION +correcto I-EVOLUTION +funcionamiento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +tratamientos I-EVOLUTION +con I-EVOLUTION +coronas I-EVOLUTION +telescópicas I-EVOLUTION +a I-EVOLUTION +medio I-EVOLUTION +y I-EVOLUTION +largo I-EVOLUTION +plazo I-EVOLUTION +siendo I-EVOLUTION +una I-EVOLUTION +posibilidad I-EVOLUTION +que I-EVOLUTION +siempre I-EVOLUTION +debemos I-EVOLUTION +tener I-EVOLUTION +en I-EVOLUTION +cuenta I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +hora I-EVOLUTION +de I-EVOLUTION +planificar I-EVOLUTION +nuestros I-EVOLUTION +tratamientos, I-EVOLUTION +sobre I-EVOLUTION +todo I-EVOLUTION +en I-EVOLUTION +pacientes I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +mal I-EVOLUTION +pronóstico I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +dientes I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +comportamiento I-EVOLUTION +biomecánico I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +coronas I-EVOLUTION +telescópicas I-EVOLUTION +hace I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +supervivencia I-EVOLUTION +a I-EVOLUTION +largo I-EVOLUTION +plazo I-EVOLUTION +de I-EVOLUTION +estos I-EVOLUTION +dientes I-EVOLUTION +sea I-EVOLUTION +prolongada. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +19 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +refiere B-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +acudido I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +dentista I-PAST_MEDICAL_HISTORY +particular I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +nódulo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +dorso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +lengua, I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +color I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mucosa I-PAST_MEDICAL_HISTORY +adyacente, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consistencia I-PAST_MEDICAL_HISTORY +firme, I-PAST_MEDICAL_HISTORY +asintomático, I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cm. I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diámetro, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +realiza I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +excisional I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +histopatológico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +adenoma I-PAST_MEDICAL_HISTORY +monomorfo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +canalicular; I-PAST_MEDICAL_HISTORY +tres B-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +nuevamente I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +dentista I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +recidiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lesión, I-PRESENT_ILLNESS +a B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +intraoral I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +localización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +lesión, I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +leve I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +linfadenopatía I-EXPLORATION +cervical, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +biometría I-EXPLORATION +hemática I-EXPLORATION +y I-EXPLORATION +química I-EXPLORATION +sanguínea, I-EXPLORATION +con I-EXPLORATION +resultados I-EXPLORATION +normales, I-EXPLORATION +decidiendo I-EXPLORATION +realizar I-EXPLORATION +segunda I-EXPLORATION +biopsia I-EXPLORATION +excisional. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +pieza I-EXPLORATION +macroscópica I-EXPLORATION +presenta I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +forma I-EXPLORATION +y I-EXPLORATION +superficie I-EXPLORATION +irregular, I-EXPLORATION +color I-EXPLORATION +marrón I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +5 I-EXPLORATION +mm.. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +se I-EXPLORATION +podía I-EXPLORATION +observar I-EXPLORATION +múltiples I-EXPLORATION +cavidades I-EXPLORATION +pseudoquísticas I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +variable I-EXPLORATION +compuestos I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +cúbicas I-EXPLORATION +de I-EXPLORATION +citoplasma I-EXPLORATION +escaso, I-EXPLORATION +núcleos I-EXPLORATION +ovales I-EXPLORATION +con I-EXPLORATION +contenido I-EXPLORATION +eosinófilo, I-EXPLORATION +rodeado I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +banda I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +conjuntivo I-EXPLORATION +fibroso I-EXPLORATION +denso, I-EXPLORATION +bien I-EXPLORATION +vascularizado, I-EXPLORATION +e I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +crónico I-EXPLORATION +moderado I-EXPLORATION +y I-EXPLORATION +difuso, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +fibroso I-EXPLORATION +que I-EXPLORATION +rodea I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +principal I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +cordones I-EXPLORATION +alineados I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +cúbicas I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +hipercromáticos, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +periferia I-EXPLORATION +presenta I-EXPLORATION +infiltración I-EXPLORATION +perineural I-EXPLORATION +con I-EXPLORATION +tejido I-EXPLORATION +muscular I-EXPLORATION +estriado.. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +estas I-EXPLORATION +características I-EXPLORATION +se I-EXPLORATION +da I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +adenoideo I-EXPLORATION +quístico I-EXPLORATION +siendo I-EXPLORATION +diferente I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +previo I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +canalicular, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +solicitar I-EXPLORATION +el I-EXPLORATION +corte I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +biopsia, I-EXPLORATION +observándose I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +CAQ I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +tomados. I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +panel I-EXPLORATION +de I-EXPLORATION +inmunohistoquímica I-EXPLORATION +recomendado, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +es I-EXPLORATION +el I-EXPLORATION +siguiente: I-EXPLORATION +proteína I-EXPLORATION +S-100, I-EXPLORATION +Actina I-EXPLORATION +para I-EXPLORATION +músculo I-EXPLORATION +liso I-EXPLORATION +específica, I-EXPLORATION +CALPONINA, I-EXPLORATION +CEA, I-EXPLORATION +Antígeno I-EXPLORATION +Epitelial I-EXPLORATION +de I-EXPLORATION +Membrana, I-EXPLORATION +PAGF, I-EXPLORATION +Ki67. I-EXPLORATION +(7-8) I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +marcadores I-EXPLORATION +fueron: I-EXPLORATION +CEA I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +citoplasma I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +luminares I-EXPLORATION +(normalmente I-EXPLORATION +encontrado I-EXPLORATION +en I-EXPLORATION +conductos I-EXPLORATION +estriados I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +glándulas I-EXPLORATION +salivales I-EXPLORATION +menores), I-EXPLORATION +EMA I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +citoplasma I-EXPLORATION +de I-EXPLORATION +conductos I-EXPLORATION +intercalados I-EXPLORATION +y I-EXPLORATION +estriados I-EXPLORATION +(abundante I-EXPLORATION +en I-EXPLORATION +células I-EXPLORATION +mioepiteliales I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +acinos), I-EXPLORATION +S-100 I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +mioepiteliales, I-EXPLORATION +conductos I-EXPLORATION +intercalados I-EXPLORATION +y I-EXPLORATION +estriados. I-EXPLORATION +La I-EXPLORATION +CALP I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +mioepiteliales, I-EXPLORATION +también I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +Ki-67 I-EXPLORATION +demostró I-EXPLORATION +áreas I-EXPLORATION +focales I-EXPLORATION +escasas I-EXPLORATION +con I-EXPLORATION +aproximadamente I-EXPLORATION +el I-EXPLORATION +15 I-EXPLORATION +al I-EXPLORATION +20% I-EXPLORATION +de I-EXPLORATION +tinción I-EXPLORATION +nuclear, I-EXPLORATION +que I-EXPLORATION +al I-EXPLORATION +correlacionar I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +clínica I-EXPLORATION +nos I-EXPLORATION +indica I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado, I-EXPLORATION +corroborado B-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnostico I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +envía I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +oncológico I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +seguimiento I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +largo I-DERIVED_FROM/TO +plazo, I-DERIVED_FROM/TO +después B-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +presenta I-EVOLUTION +recurrencia I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +realiza I-EVOLUTION +glosectomia I-EVOLUTION +parcial, I-EVOLUTION +con I-EVOLUTION +seguimiento I-EVOLUTION +a I-EVOLUTION +largo I-EVOLUTION +plazo. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +extracción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +resto I-PRESENT_ILLNESS +radicular. I-PRESENT_ILLNESS +Durante B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +se I-EXPLORATION +descubren I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +papulares I-EXPLORATION +en I-EXPLORATION +encías, I-EXPLORATION +con I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +confluir, I-EXPLORATION +que I-EXPLORATION +adquieren I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +empedrado. I-EXPLORATION +La I-EXPLORATION +mucosa I-EXPLORATION +labial I-EXPLORATION +inferior I-EXPLORATION +tiene I-EXPLORATION +una I-EXPLORATION +disposición I-EXPLORATION +coarrugada I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +lengua I-EXPLORATION +aparecen I-EXPLORATION +gran I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +pápulas I-EXPLORATION +que I-EXPLORATION +confieren I-EXPLORATION +a I-EXPLORATION +ésta, I-EXPLORATION +aspecto I-EXPLORATION +moriforme. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +yugal I-EXPLORATION +aparece I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +polipoide I-EXPLORATION +que I-EXPLORATION +extirpamos I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vez I-EXPLORATION +que I-EXPLORATION +realizamos I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +encía I-EXPLORATION +cuyo I-EXPLORATION +resultado I-EXPLORATION +es I-EXPLORATION +hiperplasia I-EXPLORATION +inflamatoria I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +yugal, I-EXPLORATION +pólipo I-EXPLORATION +fibroepitelial. I-EXPLORATION + I-EXPLORATION +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +operada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bocio I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +ocasiones, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +quistes I-PRESENT_ILLNESS +mamarios I-PRESENT_ILLNESS +bilaterales. I-PRESENT_ILLNESS +Padece I-PRESENT_ILLNESS +ulcera I-PRESENT_ILLNESS +gástrica, I-PRESENT_ILLNESS +esofagitis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pólipos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +colon. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +han I-PRESENT_ILLNESS +extirpado I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +cutáneas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +brazos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +plantas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +pies. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Ante B-PAST_MEDICAL_HISTORY +esta I-PAST_MEDICAL_HISTORY +patología I-PAST_MEDICAL_HISTORY +tan I-PAST_MEDICAL_HISTORY +florida I-PAST_MEDICAL_HISTORY +solicitamos I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +archivo I-PAST_MEDICAL_HISTORY +central I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +hospital I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +referencia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +realizando I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +resumen I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ésta, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +enferma I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +han I-PAST_MEDICAL_HISTORY +extirpado I-PAST_MEDICAL_HISTORY +nódulos I-PAST_MEDICAL_HISTORY +coloides I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tiroides, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +fibroquística I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mama, I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +ulcus I-PAST_MEDICAL_HISTORY +gástrico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +han I-PAST_MEDICAL_HISTORY +extirpado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +endoscópica I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +gástricos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colon. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Las I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +extirpadas I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +brazo I-PAST_MEDICAL_HISTORY +resultaron I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +hiperplasias I-PAST_MEDICAL_HISTORY +reactivas I-PAST_MEDICAL_HISTORY +inflamatorias I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Ackerman, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +pies I-PAST_MEDICAL_HISTORY +verrugas I-PAST_MEDICAL_HISTORY +plantares. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ante B-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +realizamos I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +oral I-EXPLORATION +de I-EXPLORATION +Síndrome I-EXPLORATION +de I-EXPLORATION +Cowden. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +raza I-PRESENT_ILLNESS +blanca, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +lento, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +localizada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +glándula I-PRESENT_ILLNESS +parótida I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +existían I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +y B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +motivó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +asintomática. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +permitió I-EXPLORATION +detectar I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +insensible I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +y I-EXPLORATION +cubierta I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +piel I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +normal, I-EXPLORATION +desplazable I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +tejidos I-EXPLORATION +profundos. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +cervicocefálica I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +no I-EXPLORATION +habiéndose I-EXPLORATION +detectado I-EXPLORATION +adenomegalias I-EXPLORATION +cervicales. I-EXPLORATION +Se I-EXPLORATION +practicaron I-EXPLORATION +estudios I-EXPLORATION +rutinarios I-EXPLORATION +(radiografías I-EXPLORATION +torácicas I-EXPLORATION +y I-EXPLORATION +analítica I-EXPLORATION +sistemática) I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +La B-TREATMENT +tumoración I-TREATMENT +fue I-TREATMENT +extirpada I-TREATMENT +mediante I-TREATMENT +una I-TREATMENT +parotidectomía I-TREATMENT +extrafacial, I-TREATMENT +observándose, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +transcurso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma, I-TREATMENT +que I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +mostraba I-TREATMENT +un I-TREATMENT +aspecto I-TREATMENT +bien I-TREATMENT +delimitado, I-TREATMENT +un I-TREATMENT +color I-TREATMENT +amarillento I-TREATMENT +grisáceo I-TREATMENT +y I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +un I-TREATMENT +tejido I-TREATMENT +salival I-TREATMENT +circundante I-TREATMENT +de I-TREATMENT +apariencia I-TREATMENT +normal. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +procesamiento I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +fue I-EXPLORATION +rutinario, I-EXPLORATION +practicándose I-EXPLORATION +secciones I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +espesor I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +teñidas I-EXPLORATION +con I-EXPLORATION +hematoxilina-eosina. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mismas I-EXPLORATION +permitió I-EXPLORATION +constatar I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +lesión, I-EXPLORATION +que I-EXPLORATION +estaba I-EXPLORATION +rodeada I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +cápsula I-EXPLORATION +incompletamente I-EXPLORATION +formada, I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +masas I-EXPLORATION +sólidas I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +estrechamente I-EXPLORATION +asociadas I-EXPLORATION +a I-EXPLORATION +conductos I-EXPLORATION +tapizados I-EXPLORATION +por I-EXPLORATION +dos I-EXPLORATION +capas I-EXPLORATION +de I-EXPLORATION +células, I-EXPLORATION +y I-EXPLORATION +amplias I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +diferenciación I-EXPLORATION +sebácea. I-EXPLORATION +En I-EXPLORATION +ocasiones, I-EXPLORATION +las I-EXPLORATION +estructuras I-EXPLORATION +ductales I-EXPLORATION +mostraban I-EXPLORATION +proliferaciones I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +quística I-EXPLORATION +cuyas I-EXPLORATION +luces I-EXPLORATION +estaban I-EXPLORATION +ocupadas I-EXPLORATION +por I-EXPLORATION +material I-EXPLORATION +sebáceo I-EXPLORATION +y I-EXPLORATION +ocasionales I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +metaplasia I-EXPLORATION +oncocítica. I-EXPLORATION +Tras B-EVOLUTION +cinco I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +producido I-EVOLUTION +una I-EVOLUTION +recidiva I-EVOLUTION +lesional. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Estomatología I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Oral I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Universidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cartagena I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +odontólogo I-DERIVED_FROM/TO +rehabilitador, I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +descubrió I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +imagen I-DERIVED_FROM/TO +radiolúcida I-DERIVED_FROM/TO +circunscrita I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +zona I-DERIVED_FROM/TO +periapical I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +órgano I-DERIVED_FROM/TO +dentario I-DERIVED_FROM/TO +21 I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +radiografía I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +propósito I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +rehabilitación. I-DERIVED_FROM/TO +Durante B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +anamnesis I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +reportó I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trauma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +superior I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +relata I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +malestar I-PAST_MEDICAL_HISTORY +relacionados I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +caso. I-PAST_MEDICAL_HISTORY +Radiográficamente B-EXPLORATION +muestra I-EXPLORATION +imagen I-EXPLORATION +radiolúcida I-EXPLORATION +ovalada I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +vidrio I-EXPLORATION +esmerilado, I-EXPLORATION +bien I-EXPLORATION +circunscrita I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +radiopacos, I-EXPLORATION +perirradicular I-EXPLORATION +al I-EXPLORATION +órgano I-EXPLORATION +dentario I-EXPLORATION +21. I-EXPLORATION +Los I-EXPLORATION +diagnósticos I-EXPLORATION +presuntivos I-EXPLORATION +fueron I-EXPLORATION +quiste I-EXPLORATION +óseo I-EXPLORATION +traumático I-EXPLORATION +y I-EXPLORATION +KCOT. I-EXPLORATION +Bajo I-EXPLORATION +anestesia I-EXPLORATION +local I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +incisión I-EXPLORATION +intraoral I-EXPLORATION +exponiendo I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +involucrada, I-EXPLORATION +encontrando I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +encapsulada I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +rompe I-EXPLORATION +haciendo I-EXPLORATION +evidente I-EXPLORATION +el I-EXPLORATION +contenido I-EXPLORATION +quístico I-EXPLORATION +color I-EXPLORATION +achocolatado; I-EXPLORATION +luego I-EXPLORATION +se I-EXPLORATION +separa I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +curetaje I-EXPLORATION +cuidadoso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad. I-EXPLORATION +El I-EXPLORATION +material I-EXPLORATION +extraído I-EXPLORATION +fue I-EXPLORATION +enviado I-EXPLORATION +para I-EXPLORATION +análisis I-EXPLORATION +anatomohistopatológico. I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +reportó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +benigna I-EXPLORATION +tapizada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +epitelio I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +escamosa, I-EXPLORATION +descansando I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +estroma I-EXPLORATION +fibroconectivo I-EXPLORATION +con I-EXPLORATION +escasas I-EXPLORATION +células I-EXPLORATION +inflamatorias I-EXPLORATION +tipo I-EXPLORATION +linfocitos, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +KCTO. I-EXPLORATION + I-EXPLORATION + +Comentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +torácico I-PAST_MEDICAL_HISTORY +atípico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cuyo I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +cardiovascular I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +(HTA), I-PAST_MEDICAL_HISTORY +dislipemia I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +índice I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +masa I-PAST_MEDICAL_HISTORY +corporal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +31 I-PAST_MEDICAL_HISTORY +(no I-PAST_MEDICAL_HISTORY +fumador, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +diabético, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +bebedor); I-PAST_MEDICAL_HISTORY +además, I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +depresión. I-PAST_MEDICAL_HISTORY +Seguía I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +simvastatina I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg, I-PAST_MEDICAL_HISTORY +bisoprolol I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg, I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg, I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +acetilsalicílico I-PAST_MEDICAL_HISTORY +(AAS) I-PAST_MEDICAL_HISTORY +100 I-PAST_MEDICAL_HISTORY +mg, I-PAST_MEDICAL_HISTORY +alprazolam I-PAST_MEDICAL_HISTORY +0, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ketazolam I-PAST_MEDICAL_HISTORY +45 I-PAST_MEDICAL_HISTORY +mg. I-PAST_MEDICAL_HISTORY +Acudió I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +urgencias I-PAST_MEDICAL_HISTORY +hospitalarias I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +numerosas I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +presentando I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +torácico I-PAST_MEDICAL_HISTORY +atípico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +electrocardiogramas I-PAST_MEDICAL_HISTORY +normales, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +constatar I-PAST_MEDICAL_HISTORY +cambios I-PAST_MEDICAL_HISTORY +eléctricos I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +elevación I-PAST_MEDICAL_HISTORY +enzimática. I-PAST_MEDICAL_HISTORY +Hace I-PAST_MEDICAL_HISTORY +unos I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +valorado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cardiología, I-PAST_MEDICAL_HISTORY +presentando I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ecocardiografía I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +anomalías, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ergometría I-PAST_MEDICAL_HISTORY +positiva I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +carga I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tomografía I-PAST_MEDICAL_HISTORY +computerizada I-PAST_MEDICAL_HISTORY +coronaria I-PAST_MEDICAL_HISTORY +informada I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +aterosclerosis I-PAST_MEDICAL_HISTORY +coronaria I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +obstructiva. I-PAST_MEDICAL_HISTORY +Tras B-PRESENT_ILLNESS +numerosos I-PRESENT_ILLNESS +episodios, I-PRESENT_ILLNESS +finalmente I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +posible I-PRESENT_ILLNESS +angina I-PRESENT_ILLNESS +inestable. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +cateterismo, I-EXPLORATION +visualizando I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +severa I-EXPLORATION +de I-EXPLORATION +monovaso I-EXPLORATION +(en I-EXPLORATION +concreto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +circunfleja I-EXPLORATION +derecha I-EXPLORATION +media), I-EXPLORATION +precisando B-TREATMENT +angioplastia I-TREATMENT +coronaria I-TREATMENT +transluminal I-TREATMENT +percutánea I-TREATMENT +e I-TREATMENT +implantación I-TREATMENT +de I-TREATMENT +stent I-TREATMENT +farmacoactivo. I-TREATMENT +En I-TREATMENT +tratamiento I-TREATMENT +actual I-TREATMENT +con I-TREATMENT +nitroglicerina I-TREATMENT +sl I-TREATMENT +si I-TREATMENT +dolor I-TREATMENT +precordial, I-TREATMENT +ramipril I-TREATMENT +2, I-TREATMENT +5 I-TREATMENT +mg, I-TREATMENT +clopidogrel I-TREATMENT +75 I-TREATMENT +mg, I-TREATMENT +AAS I-TREATMENT +100 I-TREATMENT +mg, I-TREATMENT +simvastatina I-TREATMENT +40 I-TREATMENT +mg, I-TREATMENT +bisoprolol I-TREATMENT +2, I-TREATMENT +5 I-TREATMENT +mg, I-TREATMENT +ranitidina I-TREATMENT +150 I-TREATMENT +mg, I-TREATMENT +ketazolam I-TREATMENT +45 I-TREATMENT +mg I-TREATMENT +y I-TREATMENT +alprazolam I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +mg. I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +colocación I-EVOLUTION +del I-EVOLUTION +stent, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +mejoría I-EVOLUTION +clínica. I-EVOLUTION + I-EVOLUTION +Posteriormente, I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +valoración I-EVOLUTION +de I-EVOLUTION +consulta I-EVOLUTION +de I-EVOLUTION +crónicos I-EVOLUTION +de I-EVOLUTION +enfermería I-EVOLUTION +se I-EVOLUTION +aprecia I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +casual I-EVOLUTION +una I-EVOLUTION +hendidura I-EVOLUTION +diagonal I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +lóbulo I-EVOLUTION +del I-EVOLUTION +pabellón I-EVOLUTION +auricular I-EVOLUTION +que I-EVOLUTION +discurre I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +porción I-EVOLUTION +anterior I-EVOLUTION +y I-EVOLUTION +cercano I-EVOLUTION +al I-EVOLUTION +trago I-EVOLUTION +en I-EVOLUTION +45o I-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +cara I-EVOLUTION +posterior I-EVOLUTION +del I-EVOLUTION +pabellón I-EVOLUTION +auricular, I-EVOLUTION +bilateral, I-EVOLUTION +conocido I-EVOLUTION +como I-EVOLUTION +signo I-EVOLUTION +de I-EVOLUTION +Frank. I-EVOLUTION +Este I-EVOLUTION +hallazgo I-EVOLUTION +nos I-EVOLUTION +hizo I-EVOLUTION +pensar I-EVOLUTION +que I-EVOLUTION +pueda I-EVOLUTION +existir I-EVOLUTION +una I-EVOLUTION +interrelación I-EVOLUTION +entre I-EVOLUTION +este I-EVOLUTION +surco I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +cardiopatía I-EVOLUTION +diagnosticada. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ansiedad, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +sigue I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +escitalopram I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alprazolam I-PAST_MEDICAL_HISTORY +0, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg. I-PAST_MEDICAL_HISTORY +Exfumador I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Atención I-PRESENT_ILLNESS +Primaria I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +"asfixia", I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +falta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aire I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +extraño I-PRESENT_ILLNESS +faríngeo. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presenta I-EXPLORATION +buen I-EXPLORATION +murmullo I-EXPLORATION +vesicular I-EXPLORATION +sin I-EXPLORATION +ruidos I-EXPLORATION +sobreañadidos, I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +98 I-EXPLORATION +%. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +faringe I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +úvula I-EXPLORATION +con I-EXPLORATION +prolongación I-EXPLORATION +filiforme I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +base I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +papilomatosa I-EXPLORATION +engrosada. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +tranquiliza I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +explica I-EXPLORATION +la I-EXPLORATION +patología. I-EXPLORATION +Se B-DERIVED_FROM/TO +aconseja I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +médico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +familia, I-DERIVED_FROM/TO +quien I-DERIVED_FROM/TO +deriva I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +otorrinolaringólogo I-DERIVED_FROM/TO +(ORL). I-DERIVED_FROM/TO +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +cribado I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +patologías I-EXPLORATION +de I-EXPLORATION +transmisión I-EXPLORATION +sexual I-EXPLORATION +con I-EXPLORATION +resultados I-EXPLORATION +negativos I-EXPLORATION +para I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +sífilis, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana, I-EXPLORATION +herpes I-EXPLORATION +y I-EXPLORATION +hepatitis. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +ORL I-EXPLORATION +le I-EXPLORATION +diagnostica I-EXPLORATION +de I-EXPLORATION +poliposis I-EXPLORATION +senonasal I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +remodelación I-EXPLORATION +ósea, I-EXPLORATION +desviación I-EXPLORATION +del I-EXPLORATION +tabique I-EXPLORATION +nasal, I-EXPLORATION +ensanchamiento I-EXPLORATION +del I-EXPLORATION +infundíbulo I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +y I-EXPLORATION +úvula I-EXPLORATION +con I-EXPLORATION +formación I-EXPLORATION +papilomatosa I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +base I-EXPLORATION +y I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION +Se B-TREATMENT +interviene I-TREATMENT +y B-EXPLORATION +desde I-EXPLORATION +Anatomía I-EXPLORATION +Patológica I-EXPLORATION +informan I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +papiloma I-EXPLORATION +invertido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +nasal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +en I-EXPLORATION +úvula I-EXPLORATION +como I-EXPLORATION +papiloma I-EXPLORATION +escamoso. I-EXPLORATION + I-EXPLORATION +Actualmente B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +mejorado I-EVOLUTION +notablemente I-EVOLUTION +tanto I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +nasal I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +hizo I-EVOLUTION +referencia I-EVOLUTION +hasta I-EVOLUTION +llegar I-EVOLUTION +al I-EVOLUTION +ORL I-EVOLUTION +como I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +sensación I-EVOLUTION +de I-EVOLUTION +cuerpo I-EVOLUTION +extraño. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +este I-EXPLORATION +caso I-EXPLORATION +en I-EXPLORATION +particular I-EXPLORATION +sería I-EXPLORATION +interesante I-EXPLORATION +poner I-EXPLORATION +en I-EXPLORATION +conocimiento I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +mantiene I-EXPLORATION +buena I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +su I-EXPLORATION +médico I-EXPLORATION +de I-EXPLORATION +familia I-EXPLORATION +porque I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +opinión I-EXPLORATION +no I-EXPLORATION +le I-EXPLORATION +trata I-EXPLORATION +bien I-EXPLORATION +su I-EXPLORATION +clínica I-EXPLORATION +ansioso-depresiva. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +suele I-EXPLORATION +acudir I-EXPLORATION +a I-EXPLORATION +consulta I-EXPLORATION +cuando I-EXPLORATION +su I-EXPLORATION +médico I-EXPLORATION +esta I-EXPLORATION +saliente I-EXPLORATION +de I-EXPLORATION +guardia I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +vacaciones; I-EXPLORATION +de B-TREATMENT +hecho I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antidepresivo I-TREATMENT +y I-TREATMENT +ansiolítico I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +instaurado I-TREATMENT +por I-TREATMENT +su I-TREATMENT +médico, I-TREATMENT +haciendo I-TREATMENT +complicado I-TREATMENT +el I-TREATMENT +seguimiento I-TREATMENT +de I-TREATMENT +su I-TREATMENT +patología. I-TREATMENT +El B-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +comentó I-EXPLORATION +nada I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +congestión I-EXPLORATION +que I-EXPLORATION +le I-EXPLORATION +provocaba I-EXPLORATION +la I-EXPLORATION +poliposis I-EXPLORATION +nasal I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +motivo. I-EXPLORATION +La I-EXPLORATION +relación I-EXPLORATION +que I-EXPLORATION +tiene I-EXPLORATION +con I-EXPLORATION +su I-EXPLORATION +médico I-EXPLORATION +de I-EXPLORATION +familia I-EXPLORATION +también I-EXPLORATION +ayuda I-EXPLORATION +a I-EXPLORATION +explicar I-EXPLORATION +por I-EXPLORATION +qué I-EXPLORATION +acude I-EXPLORATION +a I-EXPLORATION +urgencias I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +consulta I-EXPLORATION +que I-EXPLORATION +realmente I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +aguda. I-EXPLORATION +Tampoco I-EXPLORATION +podemos I-EXPLORATION +descartar I-EXPLORATION +que I-EXPLORATION +sus I-EXPLORATION +síntomas I-EXPLORATION +hayan I-EXPLORATION +pasado I-EXPLORATION +desapercibidos I-EXPLORATION +por I-EXPLORATION +los I-EXPLORATION +facultativos I-EXPLORATION +relacionándolos I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +ansiedad. I-EXPLORATION + I-EXPLORATION + +El B-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agosto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Role I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +informa I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Medical I-PRESENT_ILLNESS +Advisor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Operación I-PRESENT_ILLNESS +European I-PRESENT_ILLNESS +Union I-PRESENT_ILLNESS +Training I-PRESENT_ILLNESS +Mission I-PRESENT_ILLNESS +(EUTM) I-PRESENT_ILLNESS +Somalia I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +prueba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +"quick I-PRESENT_ILLNESS +test" I-PRESENT_ILLNESS +realizada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +enfermeras I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Role I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +resultado I-PRESENT_ILLNESS +positiva. I-PRESENT_ILLNESS +Por B-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +va I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +proceder I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +traslado I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +forma I-DERIVED_FROM/TO +urgente I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Nakasero I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +Kampala I-DERIVED_FROM/TO +situado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +400 I-DERIVED_FROM/TO +km I-DERIVED_FROM/TO +aproximadamente I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +carreteras I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +muy I-DERIVED_FROM/TO +malas I-DERIVED_FROM/TO +condiciones. I-DERIVED_FROM/TO +La I-DERIVED_FROM/TO +decisión I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cómo I-DERIVED_FROM/TO +realizar I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +traslado I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +depende I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +EUTM-Somalia, I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Role I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +puede I-DERIVED_FROM/TO +decidir I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +forma I-DERIVED_FROM/TO +independiente I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +estar I-DERIVED_FROM/TO +éste I-DERIVED_FROM/TO +contratado I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +EUTM-Somalia. I-DERIVED_FROM/TO +El I-DERIVED_FROM/TO +personal I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Role-2 I-DERIVED_FROM/TO +tiene I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +propio I-DERIVED_FROM/TO +seguro I-DERIVED_FROM/TO +sanitario. I-DERIVED_FROM/TO +Quiere I-DERIVED_FROM/TO +decir I-DERIVED_FROM/TO +que, I-DERIVED_FROM/TO +pueden I-DERIVED_FROM/TO +gestionarse I-DERIVED_FROM/TO +sus I-DERIVED_FROM/TO +propias I-DERIVED_FROM/TO +evacuaciones I-DERIVED_FROM/TO +e I-DERIVED_FROM/TO +ingresos I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +hospitales. I-DERIVED_FROM/TO +Al I-DERIVED_FROM/TO +igual I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +cuentan I-DERIVED_FROM/TO +siempre I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +ayuda I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +colaboración I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Cuartel I-DERIVED_FROM/TO +General I-DERIVED_FROM/TO +EUTM-Somalia. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Los B-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +alarmantes I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +llevan I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +compañeros I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Quik I-PRESENT_ILLNESS +test I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +pseudo-confusional, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +cansancio, I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38oC. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +parecer, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +posteriores I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +confirmación I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +suman I-PRESENT_ILLNESS +antecedentes I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +revelado I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +momento: I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +quince I-PRESENT_ILLNESS +días, I-PRESENT_ILLNESS +cefaleas, I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +aparentemente I-PRESENT_ILLNESS +infeccioso I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +comenzado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +automedicarse I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antibiótico I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +amoxicilina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ácido I-PRESENT_ILLNESS +clavulánico. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +sufría I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +migrañas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +personal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +Role I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +permanecía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +periodos I-PAST_MEDICAL_HISTORY +largos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +(con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +mes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +descanso I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estancia I-PAST_MEDICAL_HISTORY +aproximadamente), I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +llevado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +muchos I-PAST_MEDICAL_HISTORY +casos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +abandono I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +voluntaria I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +quimioprofilaxis I-PAST_MEDICAL_HISTORY +(Lariam®, I-PAST_MEDICAL_HISTORY +Malarone® I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +Doxiciclina). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Se B-EVOLUTION +decide I-EVOLUTION +realizar I-EVOLUTION +el I-EVOLUTION +traslado I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +por I-EVOLUTION +carretera I-EVOLUTION +con I-EVOLUTION +ambulancia I-EVOLUTION +procedente I-EVOLUTION +de I-EVOLUTION +Kampala I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +informa I-EVOLUTION +al I-EVOLUTION +Medical I-EVOLUTION +Advisor I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +ingreso I-EVOLUTION +será I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hospital I-EVOLUTION +Nakasero I-EVOLUTION +de I-EVOLUTION +Kampala. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +12 I-EVOLUTION +horas I-EVOLUTION +aproximadamente I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +ingresa I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +citado I-EVOLUTION +Hospital I-EVOLUTION +y I-EVOLUTION +pocas I-EVOLUTION +horas I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +entra I-EVOLUTION +en I-EVOLUTION +coma. I-EVOLUTION +Ya I-EVOLUTION +entonces I-EVOLUTION +se I-EVOLUTION +estaba I-EVOLUTION +gestionando I-EVOLUTION +la I-EVOLUTION +aeroevacuación I-EVOLUTION +a I-EVOLUTION +Italia. I-EVOLUTION +Dado I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +avanzado I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +aeroevacuada I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +compañía I-EVOLUTION +de I-EVOLUTION +"Flying I-EVOLUTION +Doctors" I-EVOLUTION +a I-EVOLUTION +Nairobi I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +más I-EVOLUTION +tarde. I-EVOLUTION +Tras I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hospital I-EVOLUTION +de I-EVOLUTION +Nairobi I-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +persiste I-EVOLUTION +muy I-EVOLUTION +desfavorablemente I-EVOLUTION +falleciendo I-EVOLUTION +pocas I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +al I-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +diagnóstico I-EVOLUTION +inicial. I-EVOLUTION + I-EVOLUTION +Se I-EVOLUTION +puede I-EVOLUTION +pensar I-EVOLUTION +que I-EVOLUTION +una I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +causas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +rápida I-EVOLUTION +y I-EVOLUTION +mala I-EVOLUTION +evolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +de I-EVOLUTION +nuestra I-EVOLUTION +compañera I-EVOLUTION +fue I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +diagnóstico I-EVOLUTION +e I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +tardíos, I-EVOLUTION +la I-EVOLUTION +falta I-EVOLUTION +de I-EVOLUTION +inmunidad I-EVOLUTION +adquirida I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +abandono I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +quimioprofilaxis I-EVOLUTION +que I-EVOLUTION +pudo I-EVOLUTION +ayudar I-EVOLUTION +al I-EVOLUTION +plasmodium I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +reproducción I-EVOLUTION +e I-EVOLUTION +invasión I-EVOLUTION +rápida. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +Medical I-EVOLUTION +Advisor I-EVOLUTION + I-EVOLUTION +Durante I-EVOLUTION +todo I-EVOLUTION +este I-EVOLUTION +proceso I-EVOLUTION +y I-EVOLUTION +como I-EVOLUTION +es I-EVOLUTION +habitual, I-EVOLUTION +el I-EVOLUTION +Medical I-EVOLUTION +Advisor I-EVOLUTION +informa I-EVOLUTION +en I-EVOLUTION +cada I-EVOLUTION +momento I-EVOLUTION +al I-EVOLUTION +Jefe I-EVOLUTION +de I-EVOLUTION +Estado I-EVOLUTION +Mayor I-EVOLUTION +y I-EVOLUTION +éste I-EVOLUTION +mantiene I-EVOLUTION +informado I-EVOLUTION +al I-EVOLUTION +Jefe I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +Mision, I-EVOLUTION +quien I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +vez I-EVOLUTION +transmite I-EVOLUTION +todo I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +acontece I-EVOLUTION +en I-EVOLUTION +nuestra I-EVOLUTION +Misión I-EVOLUTION +en I-EVOLUTION +Uganda I-EVOLUTION +al I-EVOLUTION +Cuartel I-EVOLUTION +General I-EVOLUTION +en I-EVOLUTION +Bruselas. I-EVOLUTION +La I-EVOLUTION +preocupación I-EVOLUTION +de I-EVOLUTION +Bruselas I-EVOLUTION +se I-EVOLUTION +hace I-EVOLUTION +evidente. I-EVOLUTION +Asimismo I-EVOLUTION +el I-EVOLUTION +Medical I-EVOLUTION +Advisor I-EVOLUTION +informa I-EVOLUTION +al I-EVOLUTION +Mando I-EVOLUTION +de I-EVOLUTION +Operaciones I-EVOLUTION +(CMOPS) I-EVOLUTION +y I-EVOLUTION +al I-EVOLUTION +Instituto I-EVOLUTION +de I-EVOLUTION +Medicina I-EVOLUTION +Preventiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +Defensa I-EVOLUTION +(IMPDEF) I-EVOLUTION +para I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +informe I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +mayor I-EVOLUTION +brevedad I-EVOLUTION +posible I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Inspección I-EVOLUTION +General I-EVOLUTION +de I-EVOLUTION +Sanidad. I-EVOLUTION + I-EVOLUTION +Tras I-EVOLUTION +esta I-EVOLUTION +amarga I-EVOLUTION +experiencia, I-EVOLUTION +cobra I-EVOLUTION +mayor I-EVOLUTION +relieve I-EVOLUTION +la I-EVOLUTION +figura I-EVOLUTION +del I-EVOLUTION +Medical I-EVOLUTION +Advisor I-EVOLUTION +en I-EVOLUTION +Uganda, I-EVOLUTION +una I-EVOLUTION +de I-EVOLUTION +cuyas I-EVOLUTION +funciones I-EVOLUTION +es I-EVOLUTION +la I-EVOLUTION +de I-EVOLUTION +recordar I-EVOLUTION +a I-EVOLUTION +todo I-EVOLUTION +el I-EVOLUTION +contingente I-EVOLUTION +desplegado I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +misión I-EVOLUTION +las I-EVOLUTION +enfermedades I-EVOLUTION +de I-EVOLUTION +riesgo I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona, I-EVOLUTION +les I-EVOLUTION +aconseja I-EVOLUTION +e I-EVOLUTION +instruye I-EVOLUTION +sobre I-EVOLUTION +la I-EVOLUTION +prevención I-EVOLUTION +de I-EVOLUTION +dichas I-EVOLUTION +enfermedades I-EVOLUTION +y I-EVOLUTION +sobre I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +higiénico-sanitarias I-EVOLUTION +a I-EVOLUTION +tomar I-EVOLUTION +para I-EVOLUTION +prevenirlas. I-EVOLUTION +En B-TREATMENT +relación I-TREATMENT +a I-TREATMENT +la I-TREATMENT +Malaria I-TREATMENT +se I-TREATMENT +remarca I-TREATMENT +lo I-TREATMENT +importante I-TREATMENT +que I-TREATMENT +es I-TREATMENT +tomar I-TREATMENT +la I-TREATMENT +quimioprofilaxis, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +medidas I-TREATMENT +defensivas I-TREATMENT +que I-TREATMENT +todos I-TREATMENT +conocemos I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +la I-TREATMENT +picadura I-TREATMENT +del I-TREATMENT +mosquito I-TREATMENT +como: I-TREATMENT + I-TREATMENT +1. I-TREATMENT +Utilizar I-TREATMENT +repelente I-TREATMENT +de I-TREATMENT +insectos I-TREATMENT +de I-TREATMENT +tipo I-TREATMENT +dietiltoluamida, I-TREATMENT +de I-TREATMENT +aplicación I-TREATMENT +en I-TREATMENT +zonas I-TREATMENT +expuestas I-TREATMENT +sobre I-TREATMENT +todo I-TREATMENT +desde I-TREATMENT +las I-TREATMENT +18 I-TREATMENT +p.m. I-TREATMENT +a I-TREATMENT +las I-TREATMENT +05 I-TREATMENT +a.m. I-TREATMENT + I-TREATMENT +2. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +exterior I-TREATMENT +utilizar I-TREATMENT +ropa I-TREATMENT +de I-TREATMENT +manga I-TREATMENT +larga I-TREATMENT +y I-TREATMENT +pantalón I-TREATMENT +largo. I-TREATMENT +Incluso I-TREATMENT +impregnar I-TREATMENT +el I-TREATMENT +uniforme I-TREATMENT +con I-TREATMENT +permetrina. I-TREATMENT + I-TREATMENT +3. I-TREATMENT +Disponer I-TREATMENT +de I-TREATMENT +mosquiteras I-TREATMENT +en I-TREATMENT +las I-TREATMENT +ventanas I-TREATMENT +de I-TREATMENT +las I-TREATMENT +habitaciones. I-TREATMENT +Malla I-TREATMENT +mosquitera I-TREATMENT +impregnada I-TREATMENT +en I-TREATMENT +permetrina I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cama, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantenga I-TREATMENT +bien I-TREATMENT +tensada I-TREATMENT +y I-TREATMENT +metida I-TREATMENT +por I-TREATMENT +debajo I-TREATMENT +del I-TREATMENT +colchón, I-TREATMENT +y I-TREATMENT +que I-TREATMENT +nunca I-TREATMENT +se I-TREATMENT +apoye I-TREATMENT +en I-TREATMENT +el I-TREATMENT +suelo. I-TREATMENT + I-TREATMENT +4. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +interior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +habitación I-TREATMENT +utilizar I-TREATMENT +insecticidas I-TREATMENT +para I-TREATMENT +el I-TREATMENT +cuarto. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +les I-TREATMENT +informa I-TREATMENT +y I-TREATMENT +recuerda I-TREATMENT +continuamente I-TREATMENT +que I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +un I-TREATMENT +desenlace I-TREATMENT +fatal I-TREATMENT +con I-TREATMENT +la I-TREATMENT +malaria I-TREATMENT +es I-TREATMENT +fundamental I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +precoz I-TREATMENT +y, I-TREATMENT +para I-TREATMENT +ello I-TREATMENT +es I-TREATMENT +fundamental I-TREATMENT +que I-TREATMENT +adviertan I-TREATMENT +al I-TREATMENT +médico I-TREATMENT +del I-TREATMENT +Role I-TREATMENT +1 I-TREATMENT +(en I-TREATMENT +Bihanga I-TREATMENT +o I-TREATMENT +Kampala) I-TREATMENT +de I-TREATMENT +cualquier I-TREATMENT +síntoma I-TREATMENT +que I-TREATMENT +se I-TREATMENT +presente, I-TREATMENT +en I-TREATMENT +general I-TREATMENT +"cuando I-TREATMENT +uno I-TREATMENT +se I-TREATMENT +encuentre I-TREATMENT +mal". I-TREATMENT +Se I-TREATMENT +dice I-TREATMENT +que I-TREATMENT +cuando I-TREATMENT +aparece I-TREATMENT +fiebre I-TREATMENT +en I-TREATMENT +zona I-TREATMENT +endémica I-TREATMENT +de I-TREATMENT +malaria I-TREATMENT +"hay I-TREATMENT +que I-TREATMENT +pensar I-TREATMENT +como I-TREATMENT +primera I-TREATMENT +opción I-TREATMENT +en I-TREATMENT +esta I-TREATMENT +enfermedad". I-TREATMENT +Es I-TREATMENT +muy I-TREATMENT +importante I-TREATMENT +tener I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +este I-TREATMENT +principio I-TREATMENT +pero, I-TREATMENT +no I-TREATMENT +hay I-TREATMENT +que I-TREATMENT +olvidar I-TREATMENT +además, I-TREATMENT +todos I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +que I-TREATMENT +pueden I-TREATMENT +aparecer I-TREATMENT +en I-TREATMENT +la I-TREATMENT +malaria: I-TREATMENT +cefalea, I-TREATMENT +dolor I-TREATMENT +de I-TREATMENT +garganta, I-TREATMENT +astenia I-TREATMENT +intensa, I-TREATMENT +escalofríos, I-TREATMENT +sudoración, I-TREATMENT +náuseas, I-TREATMENT +diarrea I-TREATMENT +y I-TREATMENT +vómitos. I-TREATMENT +Estos, I-TREATMENT +son I-TREATMENT +síntomas I-TREATMENT +comunes I-TREATMENT +a I-TREATMENT +otras I-TREATMENT +afecciones I-TREATMENT +frecuentes I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +como I-TREATMENT +es I-TREATMENT +el I-TREATMENT +caso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +gastroenteritis, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +puede I-TREATMENT +no I-TREATMENT +darles I-TREATMENT +importancia. I-TREATMENT +Se I-TREATMENT +debe I-TREATMENT +insistir I-TREATMENT +en I-TREATMENT +la I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +consultar I-TREATMENT +con I-TREATMENT +el I-TREATMENT +médico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +cualquiera I-TREATMENT +de I-TREATMENT +ellos. I-TREATMENT + I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +misión, I-TREATMENT +el I-TREATMENT +Medical I-TREATMENT +Advisor I-TREATMENT +viaja I-TREATMENT +a I-TREATMENT +la I-TREATMENT +capital I-TREATMENT +de I-TREATMENT +Kenya I-TREATMENT +para I-TREATMENT +informarse I-TREATMENT +de I-TREATMENT +las I-TREATMENT +prestaciones I-TREATMENT +y I-TREATMENT +servicios I-TREATMENT +de I-TREATMENT +los I-TREATMENT +hospitales I-TREATMENT +que I-TREATMENT +allí I-TREATMENT +se I-TREATMENT +encuentran. I-TREATMENT +Así I-TREATMENT +mismo I-TREATMENT +se I-TREATMENT +informa I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +protocolo I-TREATMENT +que I-TREATMENT +siguen I-TREATMENT +para I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +malaria. I-TREATMENT +Todos I-TREATMENT +ellos I-TREATMENT +coinciden I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +precoz I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad, I-TREATMENT +siendo I-TREATMENT +suficiente I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +síntomas I-TREATMENT +clínicos I-TREATMENT +aunque I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +microscópico I-TREATMENT +sea I-TREATMENT +negativo. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +mayoría I-TREATMENT +de I-TREATMENT +los I-TREATMENT +casos I-TREATMENT +se I-TREATMENT +utiliza I-TREATMENT +Artemether I-TREATMENT +20mg/Lumefantrine I-TREATMENT +120mg I-TREATMENT +cuatro I-TREATMENT +unidades I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +durante I-TREATMENT +3 I-TREATMENT +días. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +Cuartel I-TREATMENT +General I-TREATMENT +de I-TREATMENT +Kampala, I-TREATMENT +se I-TREATMENT +trataron I-TREATMENT +dos I-TREATMENT +casos I-TREATMENT +sospechosos I-TREATMENT +de I-TREATMENT +malaria, I-TREATMENT +sin I-TREATMENT +diagnóstico I-TREATMENT +evidente I-TREATMENT +al I-TREATMENT +microscopio. I-TREATMENT +La I-TREATMENT +evolución I-TREATMENT +fue I-TREATMENT +muy I-TREATMENT +buena. I-TREATMENT + I-TREATMENT +Otra I-TREATMENT +medida I-TREATMENT +de I-TREATMENT +prevención I-TREATMENT +que I-TREATMENT +se I-TREATMENT +tuvo I-TREATMENT +en I-TREATMENT +cuenta, I-TREATMENT +fue I-TREATMENT +luchar I-TREATMENT +contra I-TREATMENT +el I-TREATMENT +vector. I-TREATMENT +Se I-TREATMENT +visitaron I-TREATMENT +varias I-TREATMENT +compañías I-TREATMENT +expertas I-TREATMENT +en I-TREATMENT +la I-TREATMENT +lucha I-TREATMENT +contra I-TREATMENT +el I-TREATMENT +vector I-TREATMENT +de I-TREATMENT +la I-TREATMENT +malaria I-TREATMENT +y I-TREATMENT +se I-TREATMENT +pidió I-TREATMENT +estudio I-TREATMENT +para I-TREATMENT +la I-TREATMENT +desinfección I-TREATMENT +del I-TREATMENT +Campamento I-TREATMENT +de I-TREATMENT +Bihanga. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +Cuartel I-TREATMENT +General I-TREATMENT +de I-TREATMENT +Kampala I-TREATMENT +se I-TREATMENT +desinfecta I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +al I-TREATMENT +mes I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +las I-TREATMENT +habitaciones I-TREATMENT +y I-TREATMENT +en I-TREATMENT +el I-TREATMENT +exterior I-TREATMENT +más I-TREATMENT +próximo, I-TREATMENT +incluyendo I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +vegetación I-TREATMENT +que I-TREATMENT +allí I-TREATMENT +se I-TREATMENT +encuentra. I-TREATMENT + I-TREATMENT +La I-TREATMENT +desinfección I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +Campamento I-TREATMENT +de I-TREATMENT +Bihanga I-TREATMENT +es I-TREATMENT +más I-TREATMENT +complicada, I-TREATMENT +al I-TREATMENT +estar I-TREATMENT +rodeado I-TREATMENT +de I-TREATMENT +zonas I-TREATMENT +verdes I-TREATMENT +muy I-TREATMENT +extensas I-TREATMENT +y I-TREATMENT +de I-TREATMENT +una I-TREATMENT +zona I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +de I-TREATMENT +los I-TREATMENT +militares I-TREATMENT +de I-TREATMENT +Uganda I-TREATMENT +y I-TREATMENT +sus I-TREATMENT +familias I-TREATMENT +que I-TREATMENT +no I-TREATMENT +reúnen I-TREATMENT +las I-TREATMENT +condiciones I-TREATMENT +higiénico I-TREATMENT +sanitarias I-TREATMENT +suficientes I-TREATMENT +para I-TREATMENT +la I-TREATMENT +lucha I-TREATMENT +contra I-TREATMENT +el I-TREATMENT +vector, I-TREATMENT +y I-TREATMENT +el I-TREATMENT +plan I-TREATMENT +de I-TREATMENT +desinfección I-TREATMENT +implicarían I-TREATMENT +medidas I-TREATMENT +que I-TREATMENT +precisaría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +autorización I-TREATMENT +de I-TREATMENT +los I-TREATMENT +militares I-TREATMENT +Ugandeses. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +estudio I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +la I-TREATMENT +compañía I-TREATMENT +experta I-TREATMENT +para I-TREATMENT +la I-TREATMENT +desinfección I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +las I-TREATMENT +viviendas, I-TREATMENT +medidas I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +que I-TREATMENT +entren I-TREATMENT +mosquitos I-TREATMENT +en I-TREATMENT +el I-TREATMENT +interior, I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +charcas I-TREATMENT +y I-TREATMENT +desecación I-TREATMENT +de I-TREATMENT +colecciones I-TREATMENT +de I-TREATMENT +agua I-TREATMENT +estancada, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +eliminación I-TREATMENT +de I-TREATMENT +vegetación I-TREATMENT +que I-TREATMENT +pueda I-TREATMENT +favorecer I-TREATMENT +el I-TREATMENT +desarrollo I-TREATMENT +de I-TREATMENT +larvas. I-TREATMENT +Todo I-TREATMENT +ello I-TREATMENT +en I-TREATMENT +un I-TREATMENT +radio I-TREATMENT +mínimo I-TREATMENT +de I-TREATMENT +un I-TREATMENT +kilómetro. I-TREATMENT + I-TREATMENT +La I-TREATMENT +misión I-TREATMENT +del I-TREATMENT +Medical I-TREATMENT +Advisor I-TREATMENT +en I-TREATMENT +Uganda I-TREATMENT +terminó I-TREATMENT +sin I-TREATMENT +haberse I-TREATMENT +decidido I-TREATMENT +sobre I-TREATMENT +muchas I-TREATMENT +de I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +anteriores. I-TREATMENT +Al I-TREATMENT +no I-TREATMENT +poner I-TREATMENT +ningún I-TREATMENT +país I-TREATMENT +Europeo I-TREATMENT +un I-TREATMENT +Medical I-TREATMENT +Advisor I-TREATMENT +que I-TREATMENT +reemplace I-TREATMENT +al I-TREATMENT +anterior, I-TREATMENT +todos I-TREATMENT +estos I-TREATMENT +temas I-TREATMENT +quedan I-TREATMENT +abiertos I-TREATMENT +y I-TREATMENT +pendientes I-TREATMENT +de I-TREATMENT +que I-TREATMENT +se I-TREATMENT +tome I-TREATMENT +una I-TREATMENT +decisión I-TREATMENT +por I-TREATMENT +el I-TREATMENT +nuevo I-TREATMENT +Jefe I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Mision, I-TREATMENT +asesorado I-TREATMENT +por I-TREATMENT +el I-TREATMENT +Jefe I-TREATMENT +de I-TREATMENT +Estado I-TREATMENT +Mayor I-TREATMENT +y I-TREATMENT +los I-TREATMENT +estudios I-TREATMENT +realizados. I-TREATMENT + I-TREATMENT +En I-TREATMENT +las I-TREATMENT +Figuras I-TREATMENT +1 I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +se I-TREATMENT +observan I-TREATMENT +las I-TREATMENT +condiciones I-TREATMENT +de I-TREATMENT +las I-TREATMENT +viviendas I-TREATMENT +de I-TREATMENT +las I-TREATMENT +familias I-TREATMENT +de I-TREATMENT +militares I-TREATMENT +Ugandeses I-TREATMENT +muy I-TREATMENT +próximas I-TREATMENT +a I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +de I-TREATMENT +los I-TREATMENT +europeos. I-TREATMENT +Debieran I-TREATMENT +tratarse I-TREATMENT +y I-TREATMENT +cerrar I-TREATMENT +ventanas I-TREATMENT +y I-TREATMENT +puertas I-TREATMENT +con I-TREATMENT +mosquiteras I-TREATMENT +para I-TREATMENT +una I-TREATMENT +correcta I-TREATMENT +desinfección I-TREATMENT +y I-TREATMENT +eliminación I-TREATMENT +del I-TREATMENT +vector. I-TREATMENT + I-TREATMENT +La I-TREATMENT +Figura I-TREATMENT +3, I-TREATMENT +nos I-TREATMENT +da I-TREATMENT +clara I-TREATMENT +idea I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cercanía I-TREATMENT +de I-TREATMENT +las I-TREATMENT +viviendas I-TREATMENT +de I-TREATMENT +militares I-TREATMENT +europeos I-TREATMENT +(con I-TREATMENT +tejados I-TREATMENT +azules) I-TREATMENT +y I-TREATMENT +las I-TREATMENT +viviendas I-TREATMENT +de I-TREATMENT +militares I-TREATMENT +ugandeses I-TREATMENT +(construcciones I-TREATMENT +propias I-TREATMENT +de I-TREATMENT +la I-TREATMENT +zona). I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +(178 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +Kg), I-PRESENT_ILLNESS +varón, B-PAST_MEDICAL_HISTORY +militar I-PAST_MEDICAL_HISTORY +afgano, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +quemadura I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +grado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +interna I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +antebrazo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +brazo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +(7% I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +superficie I-PRESENT_ILLNESS +corporal I-PRESENT_ILLNESS +quemada) I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +explosión I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +horas. I-PRESENT_ILLNESS +Se B-TREATMENT +aplicó I-TREATMENT +tratamiento I-TREATMENT +tópico I-TREATMENT +que I-TREATMENT +resultó I-TREATMENT +ineficaz. I-TREATMENT +Debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +tórpida I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +desbridamiento I-TREATMENT +mecánico I-TREATMENT +local I-TREATMENT +y I-TREATMENT +aplicación I-TREATMENT +de I-TREATMENT +sulfadiacina I-TREATMENT +argéntica I-TREATMENT +y I-TREATMENT +apósito I-TREATMENT +Tulgrasum® I-TREATMENT +cicatrizante I-TREATMENT +impregnado I-TREATMENT +de I-TREATMENT +antibiótico I-TREATMENT +(bacitracina-zinc, I-TREATMENT +neomicina, I-TREATMENT +sulfato I-TREATMENT +de I-TREATMENT +polimixina I-TREATMENT +B). I-TREATMENT +Para I-TREATMENT +permitir I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +previa I-TREATMENT +midazolam I-TREATMENT +(3 I-TREATMENT +mg I-TREATMENT +i.m) I-TREATMENT +y I-TREATMENT +a I-TREATMENT +los I-TREATMENT +5 I-TREATMENT +minutos I-TREATMENT +ketamina I-TREATMENT +(200 I-TREATMENT +mg I-TREATMENT +i.m). I-TREATMENT +Se I-TREATMENT +consiguió I-TREATMENT +analgesia I-TREATMENT +(grado I-TREATMENT +1 I-TREATMENT +según I-TREATMENT +la I-TREATMENT +escala I-TREATMENT +verbal I-TREATMENT +del I-TREATMENT +dolor) I-TREATMENT +y I-TREATMENT +sedación I-TREATMENT +a I-TREATMENT +los I-TREATMENT +12 I-TREATMENT +minutos I-TREATMENT +(puntuación I-TREATMENT +3 I-TREATMENT +en I-TREATMENT +escala I-TREATMENT +Ramsay), I-TREATMENT +permitiendo I-TREATMENT +realizar I-TREATMENT +la I-TREATMENT +cura I-TREATMENT +sin I-TREATMENT +incidencias I-TREATMENT +durante I-TREATMENT +16 I-TREATMENT +minutos. I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +recuperó I-TREATMENT +sensibilidad I-TREATMENT +y I-TREATMENT +vigilia I-TREATMENT +a I-TREATMENT +los I-TREATMENT +55 I-TREATMENT +minutos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +del I-TREATMENT +tratamiento. I-TREATMENT +El I-TREATMENT +grado I-TREATMENT +de I-TREATMENT +amnesia I-TREATMENT +del I-TREATMENT +procedimiento I-TREATMENT +quirúrgico I-TREATMENT +valorado I-TREATMENT +por I-TREATMENT +la I-TREATMENT +escala I-TREATMENT +de I-TREATMENT +Korttila I-TREATMENT +y I-TREATMENT +Linnolia I-TREATMENT +fue I-TREATMENT +total. I-TREATMENT + I-TREATMENT +Ambos I-TREATMENT +casos I-TREATMENT +presentaron I-TREATMENT +una I-TREATMENT +evolución I-TREATMENT +favorable I-TREATMENT +sin I-TREATMENT +efectos I-TREATMENT +adversos I-TREATMENT +durante I-TREATMENT +curas I-TREATMENT +posteriores. I-TREATMENT + I-TREATMENT +En I-TREATMENT +zona I-TREATMENT +de I-TREATMENT +combate, I-TREATMENT +es I-TREATMENT +frecuente I-TREATMENT +encontrar I-TREATMENT +heridos I-TREATMENT +que I-TREATMENT +presentan I-TREATMENT +quemaduras I-TREATMENT +de I-TREATMENT +distinto I-TREATMENT +grado I-TREATMENT +y I-TREATMENT +extensión I-TREATMENT +debido I-TREATMENT +principalmente I-TREATMENT +al I-TREATMENT +empleo I-TREATMENT +de I-TREATMENT +artefactos I-TREATMENT +explosivos I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +los I-TREATMENT +contendientes. I-TREATMENT +En I-TREATMENT +un I-TREATMENT +estudio I-TREATMENT +realizado I-TREATMENT +sobre I-TREATMENT +256 I-TREATMENT +heridos I-TREATMENT +por I-TREATMENT +arma I-TREATMENT +de I-TREATMENT +fuego I-TREATMENT +o I-TREATMENT +por I-TREATMENT +artefacto I-TREATMENT +explosivo I-TREATMENT +improvisado I-TREATMENT +atendidos I-TREATMENT +en I-TREATMENT +el I-TREATMENT +hospital I-TREATMENT +militar I-TREATMENT +español I-TREATMENT +de I-TREATMENT +Herat I-TREATMENT +(Afganistán) I-TREATMENT +entre I-TREATMENT +2005 I-TREATMENT +y I-TREATMENT +2008, I-TREATMENT +se I-TREATMENT +describe I-TREATMENT +que I-TREATMENT +23 I-TREATMENT +(9%) I-TREATMENT +sufrieron I-TREATMENT +quemaduras5. I-TREATMENT + I-TREATMENT +A I-TREATMENT +dosis I-TREATMENT +adecuadas I-TREATMENT +el I-TREATMENT +empleo I-TREATMENT +de I-TREATMENT +ketamina I-TREATMENT +y I-TREATMENT +midazolam I-TREATMENT +consigue I-TREATMENT +un I-TREATMENT +adecuado I-TREATMENT +estado I-TREATMENT +analgésico, I-TREATMENT +hipnótico I-TREATMENT +y I-TREATMENT +ansiolítico I-TREATMENT +con I-TREATMENT +una I-TREATMENT +estabilidad I-TREATMENT +hemodinámica I-TREATMENT +notable I-TREATMENT +y I-TREATMENT +un I-TREATMENT +mantenimiento I-TREATMENT +espontáneo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +respiratoria. I-TREATMENT +Además, I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +emplear I-TREATMENT +ambos I-TREATMENT +fármacos I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +intramuscular I-TREATMENT +minimiza I-TREATMENT +ostensiblemente I-TREATMENT +los I-TREATMENT +requerimientos I-TREATMENT +logísticos I-TREATMENT +necesarios I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +paciente. I-TREATMENT +La I-TREATMENT +sedación I-TREATMENT +con I-TREATMENT +midazolam I-TREATMENT +debe I-TREATMENT +ser I-TREATMENT +previa I-TREATMENT +a I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ketamina, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +en I-TREATMENT +caso I-TREATMENT +contrario I-TREATMENT +podría I-TREATMENT +producirse I-TREATMENT +una I-TREATMENT +marcada I-TREATMENT +estimulación I-TREATMENT +cardiovascular I-TREATMENT +y I-TREATMENT +presentarse I-TREATMENT +desagradables I-TREATMENT +reacciones I-TREATMENT +psicomiméticas I-TREATMENT +al I-TREATMENT +despertar. I-TREATMENT +Así I-TREATMENT +mismo I-TREATMENT +se I-TREATMENT +podría I-TREATMENT +añadir I-TREATMENT +atropina I-TREATMENT +para I-TREATMENT +minimizar I-TREATMENT +la I-TREATMENT +posible I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +sialorrea, I-TREATMENT +aunque I-TREATMENT +en I-TREATMENT +ninguno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +casos I-TREATMENT +fue I-TREATMENT +administrada I-TREATMENT +ni I-TREATMENT +apareció I-TREATMENT +un I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +secreciones I-TREATMENT +en I-TREATMENT +estos I-TREATMENT +pacientes. I-TREATMENT +Dichas I-TREATMENT +características I-TREATMENT +hacen I-TREATMENT +estos I-TREATMENT +fármacos I-TREATMENT +de I-TREATMENT +elección I-TREATMENT +para I-TREATMENT +la I-TREATMENT +anestesia I-TREATMENT +en I-TREATMENT +ambientes I-TREATMENT +austeros, I-TREATMENT +como I-TREATMENT +es I-TREATMENT +el I-TREATMENT +de I-TREATMENT +la I-TREATMENT +guerra I-TREATMENT +de I-TREATMENT +Afganistán. I-TREATMENT + I-TREATMENT +Ricardo I-TREATMENT +Navarro I-TREATMENT +Suay1, I-TREATMENT +Sergio I-TREATMENT +Castillejo I-TREATMENT +Pérez2, I-TREATMENT +Javier I-TREATMENT +de I-TREATMENT +las I-TREATMENT +Heras I-TREATMENT +Díez3 I-TREATMENT +y I-TREATMENT +Rafael I-TREATMENT +Tamburri I-TREATMENT +Bariain4 I-TREATMENT +1Cte. I-TREATMENT +Médico. I-TREATMENT +2Cap. I-TREATMENT +Médico. I-TREATMENT +3Cap. I-TREATMENT +Médico. I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Anestesiología I-TREATMENT +y I-TREATMENT +Reanimación I-TREATMENT +4Cte. I-TREATMENT +Médico. I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Traumatología. I-TREATMENT +Hospital I-TREATMENT +Central I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Defensa I-TREATMENT +«Gómez I-TREATMENT +Ulla». I-TREATMENT +Madrid I-TREATMENT + I-TREATMENT + +Un B-PRESENT_ILLNESS +soldado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +fue B-PRESENT_ILLNESS +evacuado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ROLE I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +base I-PRESENT_ILLNESS +Miguel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cervantes I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +posición I-PRESENT_ILLNESS +cercana I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +sufrir I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +picaduras I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +escorpión, I-PRESENT_ILLNESS +localizadas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pierna I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +menos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +llegada. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +estaba I-PRESENT_ILLNESS +localizada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tercio I-PRESENT_ILLNESS +medio I-PRESENT_ILLNESS +tibial. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +segunda, I-PRESENT_ILLNESS +prácticamente I-PRESENT_ILLNESS +indetectable, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +hallaba I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +misma I-PRESENT_ILLNESS +altura I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +posterior. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refirió I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +única I-PRESENT_ILLNESS +manifestación, I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +acentuado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +segunda I-PRESENT_ILLNESS +picadura. I-PRESENT_ILLNESS +Durante B-EXPLORATION +la I-EXPLORATION +asistencia I-EXPLORATION +inicial, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentó I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +(PA) I-EXPLORATION +de I-EXPLORATION +130/ I-EXPLORATION +60, I-EXPLORATION +una I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +de I-EXPLORATION +62 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +una I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +inicial I-EXPLORATION +del I-EXPLORATION +96% I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +36oC. I-EXPLORATION +El I-EXPLORATION +electrocardiograma I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +otras I-EXPLORATION +manifestaciones I-EXPLORATION +sistémicas. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +2 I-TREATMENT +gramos I-TREATMENT +de I-TREATMENT +dipirona I-TREATMENT +intravenosa I-TREATMENT +y I-TREATMENT +la I-TREATMENT +vacuna I-TREATMENT +antitetánica. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +local I-TREATMENT +incluyó I-TREATMENT +una I-TREATMENT +exhaustiva I-TREATMENT +irrigación I-TREATMENT +con I-TREATMENT +povidona I-TREATMENT +diluida I-TREATMENT +para I-TREATMENT +su I-TREATMENT +limpieza. I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +una I-TREATMENT +reacción I-TREATMENT +edematosa I-TREATMENT +localizada I-TREATMENT +en I-TREATMENT +la I-TREATMENT +pierna I-TREATMENT +derecha I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +única I-TREATMENT +de I-TREATMENT +corticoterapia I-TREATMENT +intravenosa. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +ingreso I-EVOLUTION +la I-EVOLUTION +PA I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +entre I-EVOLUTION +100 I-EVOLUTION +y I-EVOLUTION +130 I-EVOLUTION +(sistólica) I-EVOLUTION +y I-EVOLUTION +55 I-EVOLUTION +y I-EVOLUTION +70 I-EVOLUTION +(diastólica). I-EVOLUTION +La I-EVOLUTION +temperatura I-EVOLUTION +corporal I-EVOLUTION +nunca I-EVOLUTION +superó I-EVOLUTION +los I-EVOLUTION +36´5oC. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +abandonó I-EVOLUTION +el I-EVOLUTION +ROLE I-EVOLUTION +1 I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +sin I-EVOLUTION +requerir I-EVOLUTION +ningún I-EVOLUTION +tipo I-EVOLUTION +de I-EVOLUTION +medicación I-EVOLUTION +(sólo I-EVOLUTION +analgesia I-EVOLUTION +convencional I-EVOLUTION +a I-EVOLUTION +demanda). I-EVOLUTION +Las I-EVOLUTION +heridas I-EVOLUTION +cicatrizaron I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +ejemplar I-EVOLUTION +fue I-EVOLUTION +capturado I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +mismo I-EVOLUTION +lugar I-EVOLUTION +donde I-EVOLUTION +se I-EVOLUTION +produjo I-EVOLUTION +la I-EVOLUTION +picadura. I-EVOLUTION +Se I-EVOLUTION +trataba I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +escorpión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +familia I-EVOLUTION +Buthidae, I-EVOLUTION +muy I-EVOLUTION +común I-EVOLUTION +en I-EVOLUTION +Líbano, I-EVOLUTION +aunque I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +precisar I-EVOLUTION +la I-EVOLUTION +especie. I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +oficial I-PRESENT_ILLNESS +afgano I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +evacuado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ROLE I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Herat I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ROLE I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Farah I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +herida I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +arma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuego I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +inguinal I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +estenosis I-PAST_MEDICAL_HISTORY +traqueal I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +disparo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +arma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fuego I-PAST_MEDICAL_HISTORY +sufrido I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +ROLE I-EXPLORATION +1 I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +herida I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +shunt I-TREATMENT +de I-TREATMENT +Argyle I-TREATMENT +de I-TREATMENT +10F I-TREATMENT +en I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +femoral, I-TREATMENT +tras I-TREATMENT +constatar I-TREATMENT +una I-TREATMENT +pérdida I-TREATMENT +de I-TREATMENT +substancia I-TREATMENT +que I-TREATMENT +afectaba I-TREATMENT +al I-TREATMENT +80 I-TREATMENT +% I-TREATMENT +de I-TREATMENT +su I-TREATMENT +circunferencia, I-TREATMENT +10 I-TREATMENT +centímetros I-TREATMENT +por I-TREATMENT +debajo I-TREATMENT +del I-TREATMENT +pliegue I-TREATMENT +inguinal, I-TREATMENT +con B-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +consiguió I-EVOLUTION +revascularizar I-EVOLUTION +el I-EVOLUTION +miembro I-EVOLUTION +y I-EVOLUTION +cohibir I-EVOLUTION +la I-EVOLUTION +hemorragia. I-EVOLUTION +Durante B-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +requirió I-TREATMENT +8 I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes, I-TREATMENT +9 I-TREATMENT +de I-TREATMENT +plaquetas I-TREATMENT +y I-TREATMENT +1 I-TREATMENT +de I-TREATMENT +factores I-TREATMENT +de I-TREATMENT +coagulación. I-TREATMENT +A I-TREATMENT +su I-TREATMENT +llegada I-TREATMENT +a I-TREATMENT +ROLE I-TREATMENT +2 I-TREATMENT +estaba I-TREATMENT +intubado. I-TREATMENT +Los B-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +fueron I-EXPLORATION +13/7, I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +74 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +fiebre. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destacaron I-EXPLORATION +una I-EXPLORATION +plaquetopenia I-EXPLORATION +de I-EXPLORATION +67.000 I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +INR I-EXPLORATION +de I-EXPLORATION +1´4, I-EXPLORATION +aunque I-EXPLORATION +no I-EXPLORATION +existía I-EXPLORATION +acidosis I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +lactato I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +extremidad I-EXPLORATION +estaba I-EXPLORATION +caliente I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +palidez I-EXPLORATION +ni I-EXPLORATION +cianosis, I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +pulsos I-EXPLORATION +distales. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +fracturas. I-EXPLORATION +Por I-EXPLORATION +ello, I-EXPLORATION +y I-EXPLORATION +dada I-EXPLORATION +la I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +trasladar I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +centro I-EXPLORATION +de I-EXPLORATION +referencia, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +herida. I-EXPLORATION +El I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +entrada, I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +se I-EXPLORATION +hallaba I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +externa I-EXPLORATION +del I-EXPLORATION +muslo, I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +salida, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +interna, I-EXPLORATION +cerca I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +aductores. I-EXPLORATION +El I-EXPLORATION +lecho I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +herida I-EXPLORATION +estaba I-EXPLORATION +exangüe I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +compromiso I-EXPLORATION +venoso. I-EXPLORATION +La I-EXPLORATION +arteria I-EXPLORATION +femoral I-EXPLORATION +se I-EXPLORATION +hallaba I-EXPLORATION +seccionada I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +80% I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +circunferencia. I-EXPLORATION +Seguidamente, B-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +interna I-TREATMENT +del I-TREATMENT +muslo I-TREATMENT +contralateral I-TREATMENT +hasta I-TREATMENT +disecar I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +safena I-TREATMENT +mediante I-TREATMENT +disección I-TREATMENT +roma I-TREATMENT +y I-TREATMENT +electrocoagulación. I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +ligadura I-TREATMENT +de I-TREATMENT +las I-TREATMENT +colaterales I-TREATMENT +y I-TREATMENT +de I-TREATMENT +ambos I-TREATMENT +extremos I-TREATMENT +se I-TREATMENT +obtuvo I-TREATMENT +un I-TREATMENT +injerto I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +cm, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +fue I-TREATMENT +irrigado I-TREATMENT +con I-TREATMENT +una I-TREATMENT +solución I-TREATMENT +de I-TREATMENT +suero I-TREATMENT +salino I-TREATMENT +heparinizado I-TREATMENT +para I-TREATMENT +evidenciar I-TREATMENT +la I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +fugas. I-TREATMENT +Tras I-TREATMENT +ello, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +y I-TREATMENT +exposición I-TREATMENT +del I-TREATMENT +tramo I-TREATMENT +arterial I-TREATMENT +afectado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +la I-TREATMENT +anticoagulación I-TREATMENT +sistémica I-TREATMENT +con I-TREATMENT +3.000 I-TREATMENT +UI I-TREATMENT +de I-TREATMENT +heparina, I-TREATMENT +teniendo I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +el I-TREATMENT +valor I-TREATMENT +elevado I-TREATMENT +del I-TREATMENT +INR I-TREATMENT +y I-TREATMENT +la I-TREATMENT +plaquetopenia. I-TREATMENT +Se I-TREATMENT +liberó I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +controlada I-TREATMENT +el I-TREATMENT +clampaje I-TREATMENT +de I-TREATMENT +los I-TREATMENT +cabos I-TREATMENT +arteriales I-TREATMENT +para I-TREATMENT +evacuar I-TREATMENT +los I-TREATMENT +posibles I-TREATMENT +trombos I-TREATMENT +neoformados I-TREATMENT +y I-TREATMENT +se I-TREATMENT +aplicó I-TREATMENT +suero I-TREATMENT +heparinizado. I-TREATMENT +Se I-TREATMENT +colocó I-TREATMENT +el I-TREATMENT +injerto I-TREATMENT +venoso I-TREATMENT +de I-TREATMENT +modo I-TREATMENT +invertido I-TREATMENT +y I-TREATMENT +se I-TREATMENT +suturó I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +continua I-TREATMENT +con I-TREATMENT +Prolene I-TREATMENT +de I-TREATMENT +5/0. I-TREATMENT +Se I-TREATMENT +comprobó I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +pulso I-TREATMENT +distal I-TREATMENT +pedio I-TREATMENT +y I-TREATMENT +tibial I-TREATMENT +posterior I-TREATMENT +con I-TREATMENT +ultrasonidos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +lavó I-TREATMENT +copiosamente I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +con I-TREATMENT +suero I-TREATMENT +salino. I-TREATMENT +El I-TREATMENT +tejido I-TREATMENT +subcutáneo I-TREATMENT +se I-TREATMENT +cerró I-TREATMENT +con I-TREATMENT +Vicryl I-TREATMENT +de I-TREATMENT +3/0 I-TREATMENT +recubriendo I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +reconstruida. I-TREATMENT +Durante B-EVOLUTION +su I-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cuidados I-EVOLUTION +Intensivos I-EVOLUTION +se I-EVOLUTION +comprobó I-EVOLUTION +cada I-EVOLUTION +hora I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +pulsos I-EVOLUTION +distales I-EVOLUTION +con I-EVOLUTION +ultrasonidos, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +temperatura I-EVOLUTION +y I-EVOLUTION +aspecto I-EVOLUTION +del I-EVOLUTION +miembro, I-EVOLUTION +sin I-EVOLUTION +observarse I-EVOLUTION +ninguna I-EVOLUTION +anomalía I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +traslado I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso. I-EVOLUTION +La B-TREATMENT +analgesia I-TREATMENT +se I-TREATMENT +controló I-TREATMENT +con I-TREATMENT +fentanilo I-TREATMENT +y I-TREATMENT +dipirona. I-TREATMENT +Se I-TREATMENT +administró I-TREATMENT +cefazolina I-TREATMENT +1 I-TREATMENT +gr I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +anticoagulación I-TREATMENT +con I-TREATMENT +25.000 I-TREATMENT +UI I-TREATMENT +de I-TREATMENT +heparina I-TREATMENT +en I-TREATMENT +500 I-TREATMENT +cc I-TREATMENT +de I-TREATMENT +suero I-TREATMENT +a I-TREATMENT +500 I-TREATMENT +unidades I-TREATMENT +por I-TREATMENT +hora. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +42 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +conocidas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +desprendimiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +retina I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +paladar I-PAST_MEDICAL_HISTORY +hendido. I-PAST_MEDICAL_HISTORY +Valorado B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Traumatología I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +casual I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +tumefacción I-EXPLORATION +en I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +mano I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +4o I-EXPLORATION +metacarpiano, I-EXPLORATION +dolor I-EXPLORATION +leve I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +estructuras I-EXPLORATION +óseas I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +marcada I-EXPLORATION +limitación I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +metacarpofalángica I-EXPLORATION +de I-EXPLORATION +3o I-EXPLORATION +y I-EXPLORATION +4o I-EXPLORATION +dedos. I-EXPLORATION +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +manifiesta I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +dicha I-PAST_MEDICAL_HISTORY +limitación I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Presenta B-EXPLORATION +similar I-EXPLORATION +limitación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +contralateral I-EXPLORATION +que I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +mismos I-EXPLORATION +dedos, I-EXPLORATION +3o I-EXPLORATION +y I-EXPLORATION +4o. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +manos, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +lesión I-EXPLORATION +traumática I-EXPLORATION +ósea I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +contusión, I-EXPLORATION +y I-EXPLORATION +como I-EXPLORATION +hallazgo I-EXPLORATION +radiológico, I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +aplanamiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cabezas I-EXPLORATION +metacarpianas I-EXPLORATION +3a I-EXPLORATION +y I-EXPLORATION +4a I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +manos, I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +espejo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +falanges I-EXPLORATION +correspondientes, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +da I-EXPLORATION +un I-EXPLORATION +aspecto I-EXPLORATION +«cuadrado» I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +articulación. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +pauta I-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +la I-TREATMENT +contusión I-TREATMENT +(reposo, I-TREATMENT +crioterapia I-TREATMENT +y I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +AINEs) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +cita I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +para I-TREATMENT +una I-TREATMENT +exploración I-TREATMENT +funcional I-TREATMENT +no I-TREATMENT +alterada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +dolor. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +mejoría I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +proceso I-EVOLUTION +traumático. I-EVOLUTION +Se I-EVOLUTION +observa I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +arco I-EVOLUTION +de I-EVOLUTION +movilidad I-EVOLUTION +metacarpofalángico I-EVOLUTION +en I-EVOLUTION +ambas I-EVOLUTION +manos I-EVOLUTION +(valores I-EVOLUTION +normales: I-EVOLUTION +extensión I-EVOLUTION +0-20o I-EVOLUTION +y I-EVOLUTION +flexión I-EVOLUTION +0-90o) I-EVOLUTION +consistente I-EVOLUTION +en I-EVOLUTION +pérdida I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +mano I-EVOLUTION +derecha I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +30o I-EVOLUTION +de I-EVOLUTION +flexión I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +3o I-EVOLUTION +dedo I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +25o I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +4o. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +mano I-EVOLUTION +izquierda I-EVOLUTION +tan I-EVOLUTION +solo I-EVOLUTION +se I-EVOLUTION +aprecia I-EVOLUTION +la I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +20o I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +flexión I-EVOLUTION +del I-EVOLUTION +3o I-EVOLUTION +y I-EVOLUTION +4o I-EVOLUTION +dedos I-EVOLUTION +(coincidente I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +menor I-EVOLUTION +afectación I-EVOLUTION +radiológica I-EVOLUTION +en I-EVOLUTION +esa I-EVOLUTION +mano). I-EVOLUTION +Pese I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +afectación I-EVOLUTION +radiológica I-EVOLUTION +de I-EVOLUTION +más I-EVOLUTION +articulaciones, I-EVOLUTION +no I-EVOLUTION +objetivamos I-EVOLUTION +déficit I-EVOLUTION +de I-EVOLUTION +movilidad I-EVOLUTION +en I-EVOLUTION +ninguna I-EVOLUTION +otra. I-EVOLUTION + I-EVOLUTION +No I-EVOLUTION +tiene I-EVOLUTION +dolor I-EVOLUTION +actualmente, I-EVOLUTION +ni I-EVOLUTION +lo I-EVOLUTION +ha I-EVOLUTION +sufrido I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +pasado, I-EVOLUTION +siendo I-EVOLUTION +su I-EVOLUTION +queja I-EVOLUTION +principal I-EVOLUTION +la I-EVOLUTION +limitación I-EVOLUTION +que I-EVOLUTION +presenta I-EVOLUTION +en I-EVOLUTION +actividades I-EVOLUTION +que I-EVOLUTION +requieren I-EVOLUTION +formar I-EVOLUTION +un I-EVOLUTION +puño I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +mano. I-EVOLUTION + I-EVOLUTION +Diagnóstico: I-EVOLUTION +enfermedad I-EVOLUTION +de I-EVOLUTION +dieterich I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +no B-PAST_MEDICAL_HISTORY +fumador, I-PAST_MEDICAL_HISTORY +originario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Perú, I-PAST_MEDICAL_HISTORY +residente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +España I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +presentaba B-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tumefacción I-PRESENT_ILLNESS +dolorosa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +color I-PRESENT_ILLNESS +violáceo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +progresó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pierna I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +mínimo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +mejoró I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pesar I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +antibiótico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +antiinflamatorio. I-PRESENT_ILLNESS +Una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +mismos I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +añadiéndose I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +termometrada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39oC. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +afebril, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +adenopatías, I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +cardíaca I-EXPLORATION +eran I-EXPLORATION +normales, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +borde I-EXPLORATION +no I-EXPLORATION +definido I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +miembros I-EXPLORATION +hasta I-EXPLORATION +las I-EXPLORATION +rodillas, I-EXPLORATION +más I-EXPLORATION +evidente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +izquierdo, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +inflamación I-EXPLORATION +articular. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +21.000 I-EXPLORATION +/ I-EXPLORATION +ml I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +y I-EXPLORATION +linfopenia, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación: I-EXPLORATION +67 I-EXPLORATION +mm I-EXPLORATION +/ I-EXPLORATION +h, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva: I-EXPLORATION +24, I-EXPLORATION +48 I-EXPLORATION +mg I-EXPLORATION +/ I-EXPLORATION +dl I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +postero-anterior I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +revelaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +nodular I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +hilio I-EXPLORATION +izquierdo, I-EXPLORATION +sugestiva I-EXPLORATION +de I-EXPLORATION +adenopatía I-EXPLORATION +hiliar. I-EXPLORATION +Los I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +urocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +a I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Hepatitis I-EXPLORATION +A, I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +borrelia, I-EXPLORATION +rickettsia I-EXPLORATION +conorii, I-EXPLORATION +coxiella, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein I-EXPLORATION +Barr, I-EXPLORATION +y I-EXPLORATION +citomegalovirus I-EXPLORATION +no I-EXPLORATION +aportaba I-EXPLORATION +datos I-EXPLORATION +concordantes I-EXPLORATION +con I-EXPLORATION +infección I-EXPLORATION +aguda. I-EXPLORATION +Los I-EXPLORATION +BAAR I-EXPLORATION +y I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +esputo I-EXPLORATION +en I-EXPLORATION +medios I-EXPLORATION +habituales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +Mantoux I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +TC I-EXPLORATION +toraco-abdomino-pélvico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +pusieron I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +adenopatías I-EXPLORATION +mediastínicas I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +significativo I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +paratraqueal I-EXPLORATION +derecho, I-EXPLORATION +pretraqueal I-EXPLORATION +y I-EXPLORATION +perivascular I-EXPLORATION +e I-EXPLORATION +hiliar I-EXPLORATION +bilateral I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +indeterminada. I-EXPLORATION +Adyacente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cúpula I-EXPLORATION +diafragmática I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +basales I-EXPLORATION +del I-EXPLORATION +LII, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +pseudonodular I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +2, I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +anteroposterior, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +inflamatorio, I-EXPLORATION +sin I-EXPLORATION +poderse I-EXPLORATION +descartar I-EXPLORATION +otras I-EXPLORATION +posibilidades. I-EXPLORATION +Ambas I-EXPLORATION +cisuras I-EXPLORATION +mayores I-EXPLORATION +presentaban I-EXPLORATION +aspecto I-EXPLORATION +engrosado I-EXPLORATION +con I-EXPLORATION +pequeña I-EXPLORATION +cuña I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +fibroboncoscopia I-EXPLORATION +con I-EXPLORATION +toma I-EXPLORATION +de I-EXPLORATION +broncoaspirado I-EXPLORATION +(BAS), I-EXPLORATION +lavado I-EXPLORATION +broncoalveolar I-EXPLORATION +(LBA), I-EXPLORATION +biopsia I-EXPLORATION +bronquial I-EXPLORATION +y I-EXPLORATION +transbronquial. I-EXPLORATION +El I-EXPLORATION +LBA I-EXPLORATION +revelo I-EXPLORATION +una I-EXPLORATION +celularidad I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +linfocitario I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +cociente I-EXPLORATION +CD4/CD8 I-EXPLORATION +> I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +bronquial I-EXPLORATION +y I-EXPLORATION +transbronquial I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +epitelio I-EXPLORATION +respiratorio I-EXPLORATION +maduro, I-EXPLORATION +con I-EXPLORATION +glándulas I-EXPLORATION +mucosas I-EXPLORATION +y I-EXPLORATION +acúmulos I-EXPLORATION +linfoides I-EXPLORATION +aislados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +lámina I-EXPLORATION +propia. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +elementos I-EXPLORATION +granulomatosos I-EXPLORATION +ni I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +malignidad. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +mediastinoscopia I-EXPLORATION +con I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +paratraqueal I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +glanglio I-EXPLORATION +linfático I-EXPLORATION +ocupado I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +mayor I-EXPLORATION +parte I-EXPLORATION +por I-EXPLORATION +granulomas I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +sarcoideo, I-EXPLORATION +pequeños I-EXPLORATION +y I-EXPLORATION +coalescentes, I-EXPLORATION +con I-EXPLORATION +densa I-EXPLORATION +corona I-EXPLORATION +linfocitaria I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +necrosis I-EXPLORATION +central, I-EXPLORATION +no I-EXPLORATION +objetivándose I-EXPLORATION +estructuras I-EXPLORATION +bacilares, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +linfadenitis I-EXPLORATION +granulomatosa, I-EXPLORATION +sarcoidosis. I-EXPLORATION +Se I-EXPLORATION +tomó I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +piel, I-EXPLORATION +cuya I-EXPLORATION +histología I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +inflamatorio I-EXPLORATION +en I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +constituido I-EXPLORATION +por I-EXPLORATION +histiocitos, I-EXPLORATION +algunos I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +epitelioide, I-EXPLORATION +polimorfonucleares, I-EXPLORATION +neutrófilos I-EXPLORATION +y I-EXPLORATION +linfocitos I-EXPLORATION +aislados, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +eritema I-EXPLORATION +nodoso. I-EXPLORATION +La I-EXPLORATION +espirometría I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +difusión I-EXPLORATION +pulmonar I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +los I-TREATMENT +hallazgos I-TREATMENT +clínicos I-TREATMENT +y I-TREATMENT +la I-TREATMENT +biopsia I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +granuloma I-TREATMENT +sarcoideo I-TREATMENT +se I-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +corticoides. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +desemboca I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +eritematosa, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bordes I-PRESENT_ILLNESS +vesiculosos I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +irregulares I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +superficie I-PRESENT_ILLNESS +ligeramente I-PRESENT_ILLNESS +escamosa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +brazo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +aparecen I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +semejantes I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +resto I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +incluyendo I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara. I-PRESENT_ILLNESS +Unos B-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +135mg I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interferón I-PAST_MEDICAL_HISTORY +alfa-2a I-PAST_MEDICAL_HISTORY +semanalmente, I-PAST_MEDICAL_HISTORY +administrado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +subcutánea I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ribavirina, I-PAST_MEDICAL_HISTORY +1.200 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +oral. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +placa I-EXPLORATION +eccematosa, I-EXPLORATION +pruriginosa, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +brazo I-EXPLORATION +izquierdo. I-EXPLORATION +Ver I-EXPLORATION +figura. I-EXPLORATION +Se I-EXPLORATION +observan I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +semejantes, I-EXPLORATION +de I-EXPLORATION +diversos I-EXPLORATION +tamaños I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +distribuyen I-EXPLORATION +por I-EXPLORATION +los I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +superiores, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +tórax, I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +y I-EXPLORATION +pabellones I-EXPLORATION +auriculares. I-EXPLORATION +El I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +bueno, I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +sanguínea I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +practica I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +del I-EXPLORATION +borde I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +ubicada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +brazo I-EXPLORATION +izquierdo. I-EXPLORATION +El I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informa I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trata I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +dermatitis I-EXPLORATION +psoriasiforme I-EXPLORATION +y I-EXPLORATION +espongiótica I-EXPLORATION +con I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +ampolla I-EXPLORATION +intracórnea I-EXPLORATION +con I-EXPLORATION +neutrófilos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +establece I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +eccema I-EXPLORATION +nummular I-EXPLORATION +generalizado I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +ingesta I-EXPLORATION +de I-EXPLORATION +interferón I-EXPLORATION +alfa-2a I-EXPLORATION +y I-EXPLORATION +ribavirina I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +hepatitis I-EXPLORATION +C. I-EXPLORATION +Tras B-TREATMENT +consultar I-TREATMENT +con I-TREATMENT +el I-TREATMENT +especialista I-TREATMENT +de I-TREATMENT +Digestivo I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +retirar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +hidroxicina I-TREATMENT +25 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +beclometasona I-TREATMENT +dipropionato I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +025% I-TREATMENT +tópico I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +sobre I-TREATMENT +las I-TREATMENT +lesiones. I-TREATMENT +El B-EVOLUTION +cuadro I-EVOLUTION +cutáneo I-EVOLUTION +se I-EVOLUTION +resuelve I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION +Diagnóstico: B-EXPLORATION +Eccema I-EXPLORATION +nummular I-EXPLORATION +generalizado I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +interferón I-EXPLORATION +alfa-2a I-EXPLORATION +y I-EXPLORATION +ribavirina I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +conocidas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Valorada B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Traumatología I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hombro I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +profesión I-PAST_MEDICAL_HISTORY +realiza I-PAST_MEDICAL_HISTORY +esfuerzos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición I-PAST_MEDICAL_HISTORY +y B-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +limitación I-PRESENT_ILLNESS +funcional I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +actividades I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +diaria I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +espacio I-EXPLORATION +subacromial, I-EXPLORATION +con I-EXPLORATION +movilidad I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +hombro, I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Yocum I-EXPLORATION +positivo I-EXPLORATION +y I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Jobe I-EXPLORATION +positivo. I-EXPLORATION +Además, I-EXPLORATION +el I-EXPLORATION +antebrazo I-EXPLORATION +izquierdo I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +bloqueo I-EXPLORATION +en I-EXPLORATION +pronación I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +50o, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +limitación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +movimientos I-EXPLORATION +de I-EXPLORATION +pronación I-EXPLORATION +y I-EXPLORATION +supinación, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +compensaban I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +movilización I-EXPLORATION +del I-EXPLORATION +hombro, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +flexoextensión I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +codo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +radiográfico I-EXPLORATION +del I-EXPLORATION +codo I-EXPLORATION +mostró I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +imágenes. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +articulaciones I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +deformidades I-EXPLORATION +óseas, I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +exploración I-EXPLORATION +por I-EXPLORATION +aparatos I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Diagnóstico: B-EVOLUTION +sinostosis I-EVOLUTION +radiocubital I-EVOLUTION +proximal I-EVOLUTION +congénita I-EVOLUTION +"enfermedad I-EVOLUTION +de I-EVOLUTION +lennoire" I-EVOLUTION + I-EVOLUTION + +Varón, B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +(172 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +Kg), I-PRESENT_ILLNESS +ASA I-PRESENT_ILLNESS +I I-PRESENT_ILLNESS +U, I-PRESENT_ILLNESS +que B-PAST_MEDICAL_HISTORY +procedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +buque I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Armada I-PAST_MEDICAL_HISTORY +española I-PAST_MEDICAL_HISTORY +es B-PRESENT_ILLNESS +evacuado I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +bimaleolar I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +subsidiaria I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +osteosíntesis. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +monitorizó I-EXPLORATION +la I-EXPLORATION +SaO2, I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca, I-EXPLORATION +la I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +no I-EXPLORATION +invasiva, I-EXPLORATION +la I-EXPLORATION +temperatura, I-EXPLORATION +la I-EXPLORATION +capnografía I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +hipnosis I-EXPLORATION +mediante I-EXPLORATION +el I-EXPLORATION +monitor I-EXPLORATION +BIS®. I-EXPLORATION +Tras B-TREATMENT +administración I-TREATMENT +de I-TREATMENT +250 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +coloide I-TREATMENT +en I-TREATMENT +bolo I-TREATMENT +iv, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +anestesia I-TREATMENT +intradural I-TREATMENT +empleando I-TREATMENT +bupivacaína I-TREATMENT +0, I-TREATMENT +5% I-TREATMENT +hiperbara I-TREATMENT +10 I-TREATMENT +mg I-TREATMENT +y I-TREATMENT +fentanilo I-TREATMENT +10 I-TREATMENT +µg. I-TREATMENT +Como I-TREATMENT +medicación I-TREATMENT +coadyuvante I-TREATMENT +se I-TREATMENT +empleó I-TREATMENT +midazolam I-TREATMENT +(3 I-TREATMENT +mg I-TREATMENT +en I-TREATMENT +bolo I-TREATMENT +iv) I-TREATMENT +y I-TREATMENT +propofol I-TREATMENT +(1, I-TREATMENT +5 I-TREATMENT +mg/Kg/h). I-TREATMENT +La I-TREATMENT +profilaxis I-TREATMENT +antibiótica I-TREATMENT +fue I-TREATMENT +cefazolina I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +iv. I-TREATMENT +Asimismo I-TREATMENT +se I-TREATMENT +pautó I-TREATMENT +omeprazol I-TREATMENT +40 I-TREATMENT +mg I-TREATMENT +iv, I-TREATMENT +granisetron I-TREATMENT +3 I-TREATMENT +mg I-TREATMENT +iv I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +tranexámico I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +iv. I-TREATMENT +Al I-TREATMENT +final I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +desketoprofeno I-TREATMENT +(50 I-TREATMENT +mg I-TREATMENT +iv) I-TREATMENT +y I-TREATMENT +dexametasona I-TREATMENT +(4 I-TREATMENT +mg I-TREATMENT +iv). I-TREATMENT +Se I-TREATMENT +finalizó I-TREATMENT +la I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +propofol I-TREATMENT +aproximadamente I-TREATMENT +5 I-TREATMENT +minutos I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +finalización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +ingresó I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +reanimación I-EVOLUTION +postquirúrgica I-EVOLUTION +y I-EVOLUTION +posteriormente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +sala I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +monitorización I-EXPLORATION +mediante I-EXPLORATION +BIS® I-EXPLORATION +mostró I-EXPLORATION +unos I-EXPLORATION +valores I-EXPLORATION +comprendidos I-EXPLORATION +entre I-EXPLORATION +98 I-EXPLORATION +y I-EXPLORATION +47, I-EXPLORATION +la I-EXPLORATION +curva I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +capnografía I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +(onda I-EXPLORATION +cuadrada I-EXPLORATION +con I-EXPLORATION +valores I-EXPLORATION +comprendidos I-EXPLORATION +entre I-EXPLORATION +35 I-EXPLORATION +y I-EXPLORATION +45 I-EXPLORATION +mmHg) I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +acto I-EXPLORATION +quirúrgico I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sedación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +unidad I-EXPLORATION +de I-EXPLORATION +reanimación I-EXPLORATION +postquirúrgica I-EXPLORATION +fue I-EXPLORATION +máxima: I-EXPLORATION +10 I-EXPLORATION +puntos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Escala I-EXPLORATION +de I-EXPLORATION +Aldrete I-EXPLORATION +(actividad I-EXPLORATION +muscular: I-EXPLORATION +0-2, I-EXPLORATION +respiración: I-EXPLORATION +0-2, I-EXPLORATION +hemodinámica: I-EXPLORATION +0-2, I-EXPLORATION +conciencia: I-EXPLORATION +0-2 I-EXPLORATION +y I-EXPLORATION +coloración I-EXPLORATION +de I-EXPLORATION +piel: I-EXPLORATION +0-2). I-EXPLORATION + I-EXPLORATION + +Varón, B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +(170 I-PRESENT_ILLNESS +cm, I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +Kg), I-PRESENT_ILLNESS +ASA I-PRESENT_ILLNESS +I I-PRESENT_ILLNESS +U, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +evacuado I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fractura I-PRESENT_ILLNESS +conminuta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fémur I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +arma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuego I-PRESENT_ILLNESS +subsidiaria I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +quirúrgico. I-PRESENT_ILLNESS +Al B-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +monitorizó I-EXPLORATION +de I-EXPLORATION +igual I-EXPLORATION +forma I-EXPLORATION +que I-EXPLORATION +al I-EXPLORATION +primer I-EXPLORATION +caso I-EXPLORATION +clínico: I-EXPLORATION +SaO2, I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca, I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +no I-EXPLORATION +invasiva, I-EXPLORATION +temperatura, I-EXPLORATION +capnografía I-EXPLORATION +y I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +hipnosis I-EXPLORATION +mediante I-EXPLORATION +el I-EXPLORATION +monitor I-EXPLORATION +BIS®. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +administración I-TREATMENT +de I-TREATMENT +250 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +coloide I-TREATMENT +en I-TREATMENT +bolo I-TREATMENT +iv, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +anestesia I-TREATMENT +intradural I-TREATMENT +empleando I-TREATMENT +bupivacaína I-TREATMENT +0, I-TREATMENT +5% I-TREATMENT +hiperbara I-TREATMENT +10 I-TREATMENT +mg I-TREATMENT +y I-TREATMENT +fentanilo I-TREATMENT +10 I-TREATMENT +µg. I-TREATMENT +La I-TREATMENT +medicación I-TREATMENT +coadyuvante I-TREATMENT +fue I-TREATMENT +midazolam I-TREATMENT +(3 I-TREATMENT +mg I-TREATMENT +en I-TREATMENT +bolo I-TREATMENT +iv) I-TREATMENT +y I-TREATMENT +propofol I-TREATMENT +(1, I-TREATMENT +5 I-TREATMENT +mg/Kg/h). I-TREATMENT +La I-TREATMENT +profilaxis I-TREATMENT +antibiótica I-TREATMENT +fue I-TREATMENT +cefazolina I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +iv. I-TREATMENT +Asimismo I-TREATMENT +también I-TREATMENT +se I-TREATMENT +pautó I-TREATMENT +omeprazol I-TREATMENT +40 I-TREATMENT +mg I-TREATMENT +iv, I-TREATMENT +granisetron I-TREATMENT +3 I-TREATMENT +mg I-TREATMENT +iv I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +tranexámico I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +iv. I-TREATMENT +Al I-TREATMENT +de I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +desketoprofeno I-TREATMENT +(50 I-TREATMENT +mg I-TREATMENT +iv), I-TREATMENT +se I-TREATMENT +finalizó I-TREATMENT +la I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +propofol I-TREATMENT +y I-TREATMENT +se I-TREATMENT +infiltró I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +con I-TREATMENT +mepivacaína I-TREATMENT +2% I-TREATMENT +200 I-TREATMENT +mg. I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +ingresó I-TREATMENT +en I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +de I-TREATMENT +reanimación I-TREATMENT +postquirúrgica, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +un I-TREATMENT +bloqueo I-TREATMENT +nervioso I-TREATMENT +ecoguiado I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +femoral I-TREATMENT +con I-TREATMENT +bupivacaína I-TREATMENT +0, I-TREATMENT +25% I-TREATMENT +25 I-TREATMENT +mg I-TREATMENT +y I-TREATMENT +tras I-TREATMENT +recobrar I-TREATMENT +la I-TREATMENT +sensibilidad I-TREATMENT +y I-TREATMENT +motricidad I-TREATMENT +en I-TREATMENT +miembros I-TREATMENT +inferiores I-TREATMENT +fue I-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +a I-TREATMENT +sala I-TREATMENT +de I-TREATMENT +hospitalización I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +monitorización I-EVOLUTION +mediante I-EVOLUTION +BIS® I-EVOLUTION +mostró I-EVOLUTION +unos I-EVOLUTION +valores I-EVOLUTION +comprendidos I-EVOLUTION +entre I-EVOLUTION +97 I-EVOLUTION +y I-EVOLUTION +30. I-EVOLUTION +La I-EVOLUTION +curva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +capnografía I-EVOLUTION +fue I-EVOLUTION +normal I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +valoración I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sedación I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +reanimación I-EVOLUTION +postquirúrgica I-EVOLUTION +fue I-EVOLUTION +máxima I-EVOLUTION +(10 I-EVOLUTION +puntos I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Escala I-EVOLUTION +de I-EVOLUTION +Aldrete). I-EVOLUTION + I-EVOLUTION + +Exponemos B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +efectos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +programa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ejercicio I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +(55 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +kg, I-PRESENT_ILLNESS +158 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +22, I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +kg/m2), I-PRESENT_ILLNESS +jubilada I-PRESENT_ILLNESS +por B-PAST_MEDICAL_HISTORY +incapacidad I-PAST_MEDICAL_HISTORY +física, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +MG I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +III I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +marcada I-PAST_MEDICAL_HISTORY +debilidad I-PAST_MEDICAL_HISTORY +muscular, I-PAST_MEDICAL_HISTORY +especialmente I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +(necesitaba I-PAST_MEDICAL_HISTORY +sujetar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +manos I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +cabeza I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +comía I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +iba I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tumbar) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +que, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +dorsal, I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +causaba I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +actitud I-PAST_MEDICAL_HISTORY +cifótica. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +plasmaféresis, I-PAST_MEDICAL_HISTORY +Prograf® I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +Inmurel® I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ejercicio I-PAST_MEDICAL_HISTORY +tomaba I-PAST_MEDICAL_HISTORY +Ciclosporina® I-PAST_MEDICAL_HISTORY +(500 I-PAST_MEDICAL_HISTORY +mg/15días), I-PAST_MEDICAL_HISTORY +Dacortin® I-PAST_MEDICAL_HISTORY +(5 I-PAST_MEDICAL_HISTORY +mg/24 I-PAST_MEDICAL_HISTORY +h), I-PAST_MEDICAL_HISTORY +Escitalopram® I-PAST_MEDICAL_HISTORY +(10 I-PAST_MEDICAL_HISTORY +mg/24 I-PAST_MEDICAL_HISTORY +h), I-PAST_MEDICAL_HISTORY +Mestinon® I-PAST_MEDICAL_HISTORY +(60 I-PAST_MEDICAL_HISTORY +mg/8 I-PAST_MEDICAL_HISTORY +h), I-PAST_MEDICAL_HISTORY +Lanzoprazol® I-PAST_MEDICAL_HISTORY +(30 I-PAST_MEDICAL_HISTORY +mg/24 I-PAST_MEDICAL_HISTORY +h), I-PAST_MEDICAL_HISTORY +Lexatin® I-PAST_MEDICAL_HISTORY +(1, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg/24 I-PAST_MEDICAL_HISTORY +h) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Calcium I-PAST_MEDICAL_HISTORY +Sandoz I-PAST_MEDICAL_HISTORY +D® I-PAST_MEDICAL_HISTORY +(1.000 I-PAST_MEDICAL_HISTORY +mg/880 I-PAST_MEDICAL_HISTORY +UI/24 I-PAST_MEDICAL_HISTORY +h). I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +practicado I-PAST_MEDICAL_HISTORY +timectomía I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +situación I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +eutiroidismo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nódulos I-PAST_MEDICAL_HISTORY +tiroideos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +padecía I-PAST_MEDICAL_HISTORY +osteoporosis. I-PAST_MEDICAL_HISTORY +Tras B-TREATMENT +ser I-TREATMENT +informada I-TREATMENT +dio I-TREATMENT +su I-TREATMENT +consentimiento I-TREATMENT +por I-TREATMENT +escrito I-TREATMENT +para I-TREATMENT +su I-TREATMENT +participación I-TREATMENT +en I-TREATMENT +el I-TREATMENT +estudio. I-TREATMENT +El I-TREATMENT +diseño I-TREATMENT +y I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +esta I-TREATMENT +investigación I-TREATMENT +respetaron I-TREATMENT +las I-TREATMENT +recomendaciones I-TREATMENT +éticas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Asociación I-TREATMENT +Médica I-TREATMENT +Mundial I-TREATMENT +y I-TREATMENT +la I-TREATMENT +Declaración I-TREATMENT +de I-TREATMENT +Helsinki I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +aprobado I-TREATMENT +por I-TREATMENT +el I-TREATMENT +comité I-TREATMENT +de I-TREATMENT +Ética I-TREATMENT +de I-TREATMENT +Asociación I-TREATMENT +Miastenia I-TREATMENT +de I-TREATMENT +España I-TREATMENT +(AMES). I-TREATMENT + I-TREATMENT +Programa I-TREATMENT +de I-TREATMENT +ejercicio I-TREATMENT +y I-TREATMENT +valoraciones I-TREATMENT +efectuadas I-TREATMENT + I-TREATMENT +El I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +ejercicio I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +el I-TREATMENT +20 I-TREATMENT +de I-TREATMENT +junio I-TREATMENT +de I-TREATMENT +2012 I-TREATMENT +y I-TREATMENT +concluyó I-TREATMENT +el I-TREATMENT +17 I-TREATMENT +de I-TREATMENT +julio I-TREATMENT +de I-TREATMENT +2012 I-TREATMENT +y I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +sesiones I-TREATMENT +matinales I-TREATMENT +semanales. I-TREATMENT +Los I-TREATMENT +componentes I-TREATMENT +de I-TREATMENT +cada I-TREATMENT +sesión I-TREATMENT +consistían I-TREATMENT +en I-TREATMENT +ejercicios I-TREATMENT +de I-TREATMENT +Pilates I-TREATMENT +suelo, I-TREATMENT +ejercicios I-TREATMENT +de I-TREATMENT +fuerza I-TREATMENT +para I-TREATMENT +los I-TREATMENT +grupos I-TREATMENT +musculares I-TREATMENT +de I-TREATMENT +bíceps, I-TREATMENT +tríceps, I-TREATMENT +pectoral I-TREATMENT +y I-TREATMENT +dorsal I-TREATMENT +ancho, I-TREATMENT +mediante I-TREATMENT +contracciones I-TREATMENT +auxotónicas, I-TREATMENT +con I-TREATMENT +banda I-TREATMENT +elástica I-TREATMENT +de I-TREATMENT +dureza I-TREATMENT +baja I-TREATMENT +(Domyos® I-TREATMENT +Villeneuve I-TREATMENT +D'Ascq. I-TREATMENT +Francia), I-TREATMENT +ejercicios I-TREATMENT +de I-TREATMENT +propiocepción I-TREATMENT +de I-TREATMENT +tobillo I-TREATMENT +con I-TREATMENT +pelota I-TREATMENT +100% I-TREATMENT +de I-TREATMENT +FOAM I-TREATMENT +de I-TREATMENT +16 I-TREATMENT +cm I-TREATMENT +(Gui-an I-TREATMENT +S.L. I-TREATMENT +Servicios I-TREATMENT +Deportivos®, I-TREATMENT +San I-TREATMENT +Sebastián I-TREATMENT +de I-TREATMENT +los I-TREATMENT +Reyes, I-TREATMENT +Madrid), I-TREATMENT +ejercicios I-TREATMENT +de I-TREATMENT +flexibilidad I-TREATMENT +(ejercicios I-TREATMENT +pasivos I-TREATMENT +asistidos I-TREATMENT +de I-TREATMENT +cuádriceps, I-TREATMENT +isquiotibiliales, I-TREATMENT +sóleo, I-TREATMENT +cuadrado I-TREATMENT +lumbar, I-TREATMENT +dorsal I-TREATMENT +ancho, I-TREATMENT +trapecios, I-TREATMENT +esternocleidomastoideo, I-TREATMENT +tríceps, I-TREATMENT +deltoides I-TREATMENT +y I-TREATMENT +pectoral) I-TREATMENT +y I-TREATMENT +ejercicios I-TREATMENT +de I-TREATMENT +facilitación I-TREATMENT +neuromuscular I-TREATMENT +propioceptiva I-TREATMENT +(PNF) I-TREATMENT +asistidos I-TREATMENT +por I-TREATMENT +un I-TREATMENT +fisioterapeuta I-TREATMENT +profesional I-TREATMENT +(isquiotibiales, I-TREATMENT +cuádriceps, I-TREATMENT +cuadrado I-TREATMENT +lumbar, I-TREATMENT +dorsal I-TREATMENT +y I-TREATMENT +trapecios). I-TREATMENT +Durante B-EXPLORATION +las I-EXPLORATION +sesiones I-EXPLORATION +de I-EXPLORATION +ejercicio I-EXPLORATION +se I-EXPLORATION +monitorizó I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +(FC) I-EXPLORATION +para I-EXPLORATION +evitar I-EXPLORATION +que I-EXPLORATION +esta I-EXPLORATION +aumentase I-EXPLORATION +más I-EXPLORATION +de I-EXPLORATION +30 I-EXPLORATION +pulsaciones I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +(ppm). I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +inicio I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +final I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +midieron: I-EXPLORATION +peso I-EXPLORATION +(kg), I-EXPLORATION +talla I-EXPLORATION +(cm) I-EXPLORATION +mediante I-EXPLORATION +báscula I-EXPLORATION +con I-EXPLORATION +tallímetro I-EXPLORATION +(modelo I-EXPLORATION +PS10®DINA, I-EXPLORATION +Derio, I-EXPLORATION +España), I-EXPLORATION +FC I-EXPLORATION +en I-EXPLORATION +reposo, I-EXPLORATION +en I-EXPLORATION +ejercicio I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +minutos I-EXPLORATION +de I-EXPLORATION +recuperación I-EXPLORATION +mediante I-EXPLORATION +pulsímetro I-EXPLORATION +(modelo I-EXPLORATION +M22 I-EXPLORATION +Polar®, I-EXPLORATION +Helsinki, I-EXPLORATION +Finlandia) I-EXPLORATION +y I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +(PA, I-EXPLORATION +en I-EXPLORATION +mmHg) I-EXPLORATION +mediante I-EXPLORATION +tensiómetro I-EXPLORATION +(modelo I-EXPLORATION +M2 I-EXPLORATION +BASIC I-EXPLORATION +OMRON I-EXPLORATION +HEALTHCARE®, I-EXPLORATION +Hoofddorp, I-EXPLORATION +Holanda). I-EXPLORATION +En I-EXPLORATION +cada I-EXPLORATION +sesión I-EXPLORATION +de I-EXPLORATION +ejercicio I-EXPLORATION +se I-EXPLORATION +determinaron I-EXPLORATION +la I-EXPLORATION +temperatura I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +humedad I-EXPLORATION +ambientales I-EXPLORATION +mediante I-EXPLORATION +un I-EXPLORATION +termómetro-higrómetro-barómetro-altímetro-cronómetro I-EXPLORATION +digital I-EXPLORATION +modelo I-EXPLORATION +AT701-H® I-EXPLORATION +(Atech I-EXPLORATION +Navigator, I-EXPLORATION +Hirschau, I-EXPLORATION +Alemania). I-EXPLORATION +Para I-EXPLORATION +valorar I-EXPLORATION +el I-EXPLORATION +ejercicio I-EXPLORATION +realizado I-EXPLORATION +se I-EXPLORATION +midió I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +ejercicio I-EXPLORATION +completado. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +practicaron, I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +final I-EXPLORATION +del I-EXPLORATION +programa, I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +test: I-EXPLORATION + I-EXPLORATION +-Caminata I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +minutos I-EXPLORATION +(Six-minute I-EXPLORATION +Walk I-EXPLORATION +Test, I-EXPLORATION +6MWT) I-EXPLORATION +11, I-EXPLORATION +la I-EXPLORATION +distancia I-EXPLORATION +recorrida I-EXPLORATION +se I-EXPLORATION +midió I-EXPLORATION +mediante I-EXPLORATION +un I-EXPLORATION +podómetro I-EXPLORATION +modelo I-EXPLORATION +Dista I-EXPLORATION +Newfeel I-EXPLORATION +100® I-EXPLORATION +(Oxylane, I-EXPLORATION +Madrid, I-EXPLORATION +España) I-EXPLORATION + I-EXPLORATION +-Dinamometría I-EXPLORATION +manual: I-EXPLORATION +se I-EXPLORATION +midió I-EXPLORATION +la I-EXPLORATION +fuerza I-EXPLORATION +máxima I-EXPLORATION +ejercida I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +al I-EXPLORATION +instante I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +fuerza I-EXPLORATION +resistencia I-EXPLORATION +(aquella I-EXPLORATION +que I-EXPLORATION +aplica I-EXPLORATION +el I-EXPLORATION +sujeto I-EXPLORATION +durante I-EXPLORATION +10" I-EXPLORATION +con I-EXPLORATION +cada I-EXPLORATION +mano, I-EXPLORATION +manteniendo I-EXPLORATION +el I-EXPLORATION +brazo I-EXPLORATION +estirado I-EXPLORATION +y I-EXPLORATION +presionando I-EXPLORATION +la I-EXPLORATION +perilla I-EXPLORATION +del I-EXPLORATION +dinamómetro I-EXPLORATION +tanto I-EXPLORATION +como I-EXPLORATION +se I-EXPLORATION +pueda) I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +miembros I-EXPLORATION +superiores12, I-EXPLORATION +13. I-EXPLORATION +Para I-EXPLORATION +evitar I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +fatiga I-EXPLORATION +alterase I-EXPLORATION +los I-EXPLORATION +resultados, I-EXPLORATION +se I-EXPLORATION +instruyó I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +un I-EXPLORATION +día I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +prueba I-EXPLORATION +al I-EXPLORATION +siguiente. I-EXPLORATION +Ambas I-EXPLORATION +variables I-EXPLORATION +se I-EXPLORATION +midieron I-EXPLORATION +en I-EXPLORATION +kg I-EXPLORATION +mediante I-EXPLORATION +un I-EXPLORATION +dinamómetro I-EXPLORATION +de I-EXPLORATION +precisión I-EXPLORATION +100 I-EXPLORATION +g I-EXPLORATION +(modelo I-EXPLORATION +SH50008 I-EXPLORATION +Squeeze I-EXPLORATION +Saehan I-EXPLORATION +Corporation®, I-EXPLORATION +North I-EXPLORATION +Lincolnshire, I-EXPLORATION +Inglaterra). I-EXPLORATION + I-EXPLORATION +-Flexibilidad I-EXPLORATION +de I-EXPLORATION +tronco, I-EXPLORATION +extremidades I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores14: I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +sentó I-EXPLORATION +al I-EXPLORATION +borde I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +silla I-EXPLORATION +de I-EXPLORATION +44 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +altura. I-EXPLORATION +Una I-EXPLORATION +pierna I-EXPLORATION +permanecía I-EXPLORATION +flexionada I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +planta I-EXPLORATION +del I-EXPLORATION +pie I-EXPLORATION +apoyada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +suelo. I-EXPLORATION +La I-EXPLORATION +otra I-EXPLORATION +estirada I-EXPLORATION +lo I-EXPLORATION +máximo I-EXPLORATION +posible, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +talón I-EXPLORATION +en I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +suelo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +pie I-EXPLORATION +en I-EXPLORATION +flexión I-EXPLORATION +de I-EXPLORATION +90o. I-EXPLORATION +Espalda I-EXPLORATION +y I-EXPLORATION +cabeza I-EXPLORATION +erectas. I-EXPLORATION +La I-EXPLORATION +mano I-EXPLORATION +derecha I-EXPLORATION +colocada I-EXPLORATION +encima I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +terceros I-EXPLORATION +dedos I-EXPLORATION +superpuestos. I-EXPLORATION +Se I-EXPLORATION +invitó I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +a I-EXPLORATION +alcanzar I-EXPLORATION +la I-EXPLORATION +punta I-EXPLORATION +del I-EXPLORATION +pie I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +manos I-EXPLORATION +mientras I-EXPLORATION +se I-EXPLORATION +expulsa I-EXPLORATION +el I-EXPLORATION +aire. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +intento I-EXPLORATION +con I-EXPLORATION +cada I-EXPLORATION +pierna. I-EXPLORATION +Se I-EXPLORATION +permitió I-EXPLORATION +una I-EXPLORATION +familiarización I-EXPLORATION +previa I-EXPLORATION +al I-EXPLORATION +test. I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +máxima I-EXPLORATION +distancia I-EXPLORATION +alcanzada I-EXPLORATION +(cm), I-EXPLORATION +mantenida I-EXPLORATION +durante I-EXPLORATION +2", I-EXPLORATION +medida I-EXPLORATION +con I-EXPLORATION +cinta I-EXPLORATION +antropométrica I-EXPLORATION +(Clase I-EXPLORATION +I I-EXPLORATION +modelo I-EXPLORATION +CM040 I-EXPLORATION +Gisibérica®, I-EXPLORATION +Cáceres, I-EXPLORATION +España). I-EXPLORATION + I-EXPLORATION +-Flexibilidad I-EXPLORATION +de I-EXPLORATION +extremidades I-EXPLORATION +superiores14: I-EXPLORATION +la I-EXPLORATION +participante I-EXPLORATION +se I-EXPLORATION +colocó I-EXPLORATION +en I-EXPLORATION +bipedestación, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +manos I-EXPLORATION +por I-EXPLORATION +encima I-EXPLORATION +del I-EXPLORATION +hombro, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +codo I-EXPLORATION +apuntando I-EXPLORATION +hacia I-EXPLORATION +arriba, I-EXPLORATION +los I-EXPLORATION +dedos I-EXPLORATION +extendidos I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +palma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +escápula I-EXPLORATION +e I-EXPLORATION +intentando I-EXPLORATION +deslizar I-EXPLORATION +esta I-EXPLORATION +lo I-EXPLORATION +máximo I-EXPLORATION +posible I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +espalda. I-EXPLORATION +Al I-EXPLORATION +mismo I-EXPLORATION +tiempo, I-EXPLORATION +se I-EXPLORATION +colocaba I-EXPLORATION +la I-EXPLORATION +otra I-EXPLORATION +mano I-EXPLORATION +detrás I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +espalda, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +dorsal, I-EXPLORATION +intentando I-EXPLORATION +alcanzar I-EXPLORATION +o I-EXPLORATION +sobrepasar I-EXPLORATION +la I-EXPLORATION +otra I-EXPLORATION +mano. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +intento I-EXPLORATION +con I-EXPLORATION +cada I-EXPLORATION +brazo. I-EXPLORATION +Hubo I-EXPLORATION +una I-EXPLORATION +familiarización I-EXPLORATION +previa I-EXPLORATION +al I-EXPLORATION +test. I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +mínima I-EXPLORATION +distancia I-EXPLORATION +(cm) I-EXPLORATION +alcanzada I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +terceros I-EXPLORATION +dedos I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +manos, I-EXPLORATION +mantenida I-EXPLORATION +durante I-EXPLORATION +2", I-EXPLORATION +medida I-EXPLORATION +mediante I-EXPLORATION +cinta I-EXPLORATION +antropométrica I-EXPLORATION +(Clase I-EXPLORATION +I I-EXPLORATION +modelo I-EXPLORATION +CM040 I-EXPLORATION +Gisibérica®, I-EXPLORATION +Cáceres, I-EXPLORATION +España). I-EXPLORATION + I-EXPLORATION +-Fuerza I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +inferiores: I-EXPLORATION +se I-EXPLORATION +midió I-EXPLORATION +el I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +sentadillas I-EXPLORATION +realizadas I-EXPLORATION +en I-EXPLORATION +30" I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +manos I-EXPLORATION +cruzadas I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +pecho14. I-EXPLORATION +Se I-EXPLORATION +ha I-EXPLORATION +utilizado I-EXPLORATION +una I-EXPLORATION +silla I-EXPLORATION +de I-EXPLORATION +44 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +altura I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cronómetro I-EXPLORATION +(modelo I-EXPLORATION +AT701-H® I-EXPLORATION +Atech, I-EXPLORATION +Hirschau, I-EXPLORATION +Alemania). I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +percepción I-EXPLORATION +del I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +salud I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +aplicó I-EXPLORATION +el I-EXPLORATION +cuestionario I-EXPLORATION +de I-EXPLORATION +Percepción I-EXPLORATION +del I-EXPLORATION +Estado I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +y I-EXPLORATION +Calidad I-EXPLORATION +de I-EXPLORATION +Vida I-EXPLORATION +SF-36 I-EXPLORATION +validada I-EXPLORATION +para I-EXPLORATION +español I-EXPLORATION +por I-EXPLORATION +Alonso I-EXPLORATION +et I-EXPLORATION +al.15. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +test I-EXPLORATION +funcionales I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Percepción I-EXPLORATION +del I-EXPLORATION +Estado I-EXPLORATION +de I-EXPLORATION +Salud, I-EXPLORATION +SF-36, I-EXPLORATION +obtenidos I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +y I-EXPLORATION +tras I-EXPLORATION +realizar I-EXPLORATION +el I-EXPLORATION +programa I-EXPLORATION +de I-EXPLORATION +ejercicios, I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +tablas I-EXPLORATION +2 I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +respectivamente. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +conocidas I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +fármacos, I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +enfermedades I-PAST_MEDICAL_HISTORY +médicas I-PAST_MEDICAL_HISTORY +relevantes. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +enero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2010 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tobillo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +aumentaba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +carga I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acompañaba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +flogóticos. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +RMN I-EXPLORATION +que I-EXPLORATION +objetivó I-EXPLORATION +un I-EXPLORATION +intenso I-EXPLORATION +edema I-EXPLORATION +óseo I-EXPLORATION +con I-EXPLORATION +severa I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +mineral, I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +osteonecrosis I-EXPLORATION +del I-EXPLORATION +astrágalo I-EXPLORATION +con I-EXPLORATION +derrame I-EXPLORATION +articular I-EXPLORATION +asociado. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +pamidronato I-TREATMENT +intravenoso, I-TREATMENT +pero I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +presentó I-TREATMENT +fiebre I-TREATMENT +alta I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +infusión I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +su I-TREATMENT +administración. I-TREATMENT +Se I-TREATMENT +pautó I-TREATMENT +tramadol, I-TREATMENT +diclofenaco I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +rehabilitador, I-TREATMENT +sin I-TREATMENT +evidente I-TREATMENT +mejoría I-TREATMENT +del I-TREATMENT +dolor. I-TREATMENT +En B-EVOLUTION +septiembre I-EVOLUTION +de I-EVOLUTION +2010 I-EVOLUTION +refiere I-EVOLUTION +dolor I-EVOLUTION +intenso I-EVOLUTION +en I-EVOLUTION +región I-EVOLUTION +inguinal I-EVOLUTION +derecha, I-EVOLUTION +que I-EVOLUTION +aumentaba I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +deambulación. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +RMN I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +caderas I-EXPLORATION +observándose I-EXPLORATION +una I-EXPLORATION +necrosis I-EXPLORATION +avascular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +femoral I-EXPLORATION +derecha, I-EXPLORATION +estadío I-EXPLORATION +I-II I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +clasificación I-EXPLORATION +de I-EXPLORATION +FICAT. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +gabapentina I-TREATMENT +oral I-TREATMENT +(600 I-TREATMENT +mg/8 I-TREATMENT +horas), I-TREATMENT +y B-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +remitió I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +metabolismo I-DERIVED_FROM/TO +óseo. I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +en I-EXPLORATION +nuestra I-EXPLORATION +consulta I-EXPLORATION +llamaba I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +escleras I-EXPLORATION +azuladas. I-EXPLORATION +Reinterrogada B-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente, I-FAMILY_HISTORY +señalaba I-FAMILY_HISTORY +que I-FAMILY_HISTORY +su I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +había I-FAMILY_HISTORY +presentado I-FAMILY_HISTORY +múltiples I-FAMILY_HISTORY +fracturas I-FAMILY_HISTORY +desde I-FAMILY_HISTORY +los I-FAMILY_HISTORY +49 I-FAMILY_HISTORY +años, I-FAMILY_HISTORY +que I-FAMILY_HISTORY +la I-FAMILY_HISTORY +mantenían I-FAMILY_HISTORY +inmovilizada. I-FAMILY_HISTORY +Un I-FAMILY_HISTORY +hermano I-FAMILY_HISTORY +y I-FAMILY_HISTORY +dos I-FAMILY_HISTORY +tías I-FAMILY_HISTORY +maternas I-FAMILY_HISTORY +también I-FAMILY_HISTORY +habían I-FAMILY_HISTORY +padecido I-FAMILY_HISTORY +fracturas I-FAMILY_HISTORY +de I-FAMILY_HISTORY +cadera I-FAMILY_HISTORY +precoces. I-FAMILY_HISTORY +La B-EXPLORATION +densitometría I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +osteoporosis I-EXPLORATION +grave I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +tres I-EXPLORATION +localizaciones I-EXPLORATION +habituales I-EXPLORATION +(columna I-EXPLORATION +lumbar: I-EXPLORATION +T-score=-3, I-EXPLORATION +Z-score=-1, I-EXPLORATION +8; I-EXPLORATION +cuello I-EXPLORATION +femoral: I-EXPLORATION +T-score=-3, I-EXPLORATION +1, I-EXPLORATION +Z-score=-2, I-EXPLORATION +3 I-EXPLORATION +y I-EXPLORATION +cadera I-EXPLORATION +total: I-EXPLORATION +T-score=-2, I-EXPLORATION +7, I-EXPLORATION +Z-score= I-EXPLORATION +-2, I-EXPLORATION +0). I-EXPLORATION +La I-EXPLORATION +calciuria I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +336 I-EXPLORATION +mg/dl, I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +25 I-EXPLORATION +(OH) I-EXPLORATION +vitamina I-EXPLORATION +D I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +ng/ml I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +PTH I-EXPLORATION +intacta, I-EXPLORATION +de I-EXPLORATION +49 I-EXPLORATION +pg/ml. I-EXPLORATION +Los I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +remodelado I-EXPLORATION +óseo I-EXPLORATION +estaban I-EXPLORATION +elevados I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +franca I-EXPLORATION +(CTX: I-EXPLORATION +1, I-EXPLORATION +036 I-EXPLORATION +ng/ml). I-EXPLORATION +Dados I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +clínicos I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +antecedentes I-EXPLORATION +familiares, I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +osteogénesis I-EXPLORATION +imperfecta I-EXPLORATION +tipo I-EXPLORATION +I. I-EXPLORATION +La I-EXPLORATION +audiometría I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +mínima I-EXPLORATION +caída I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +tonos I-EXPLORATION +agudos. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +calcio I-TREATMENT +(1.000 I-TREATMENT +mg/día), I-TREATMENT +vitamina I-TREATMENT +D I-TREATMENT +(800 I-TREATMENT +UI/día) I-TREATMENT +y I-TREATMENT +risedronato I-TREATMENT +(35 I-TREATMENT +mg/semana), I-TREATMENT +en I-TREATMENT +enero I-TREATMENT +de I-TREATMENT +2011. I-TREATMENT +En I-TREATMENT +marzo I-TREATMENT +de I-TREATMENT +ese I-TREATMENT +año, I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +el I-TREATMENT +risedronato I-TREATMENT +por I-TREATMENT +teriparatida I-TREATMENT +subcutánea I-TREATMENT +(20 I-TREATMENT +mcg/día) I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +intolerancia I-TREATMENT +digestiva. I-TREATMENT +En B-EXPLORATION +mayo I-EXPLORATION +de I-EXPLORATION +2011, I-EXPLORATION +una I-EXPLORATION +RMN I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +franca I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +edema I-EXPLORATION +óseo I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +derrame I-EXPLORATION +articular I-EXPLORATION +del I-EXPLORATION +tobillo I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +del I-EXPLORATION +edema I-EXPLORATION +medular I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cadera I-EXPLORATION +derecha. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +cumplió I-EVOLUTION +24 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +teriparatida I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +progresiva I-EVOLUTION +mejoría I-EVOLUTION +clínica. I-EVOLUTION +Los I-EVOLUTION +marcadores I-EVOLUTION +de I-EVOLUTION +formación I-EVOLUTION +se I-EVOLUTION +mantuvieron I-EVOLUTION +elevados I-EVOLUTION +durante I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +(propéptido I-EVOLUTION +aminoterminal I-EVOLUTION +del I-EVOLUTION +procolágeno I-EVOLUTION +tipo I-EVOLUTION +1 I-EVOLUTION +-PINP-: I-EVOLUTION +45 I-EVOLUTION +ng/ml; I-EVOLUTION +osteocalcina: I-EVOLUTION +>100 I-EVOLUTION +ng/ml), I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +los I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +25 I-EVOLUTION +(OH) I-EVOLUTION +vitamina I-EVOLUTION +D. I-EVOLUTION +En B-TREATMENT +marzo I-TREATMENT +de I-TREATMENT +2013 I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +denosumab I-TREATMENT +(60 I-TREATMENT +mg/6 I-TREATMENT +meses), I-TREATMENT +presentando B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +radiológica I-EVOLUTION +satisfactoria. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +última I-EXPLORATION +consulta, I-EXPLORATION +en I-EXPLORATION +enero I-EXPLORATION +de I-EXPLORATION +2015, I-EXPLORATION +los I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +remodelado I-EXPLORATION +estaban I-EXPLORATION +suprimidos I-EXPLORATION +(PINP: I-EXPLORATION +5, I-EXPLORATION +8 I-EXPLORATION +ng/ml; I-EXPLORATION +telopéptido I-EXPLORATION +carboxiterminal I-EXPLORATION +del I-EXPLORATION +colágeno I-EXPLORATION +tipo I-EXPLORATION +1 I-EXPLORATION +-CTX-: I-EXPLORATION +<0, I-EXPLORATION +030 I-EXPLORATION +ng/ml) I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +25 I-EXPLORATION +(OH) I-EXPLORATION +vitamina I-EXPLORATION +D I-EXPLORATION +son I-EXPLORATION +de I-EXPLORATION +31 I-EXPLORATION +ng/ml. I-EXPLORATION +La I-EXPLORATION +densidad I-EXPLORATION +mineral I-EXPLORATION +ósea I-EXPLORATION +(DMO) I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +redujo I-EXPLORATION +significativamente I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +basal I-EXPLORATION +(columna I-EXPLORATION +lumbar: I-EXPLORATION +T-score=-3, I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +Z-score=-1, I-EXPLORATION +5; I-EXPLORATION +cuello I-EXPLORATION +femoral: I-EXPLORATION +T-score=-3, I-EXPLORATION +2 I-EXPLORATION +y I-EXPLORATION +Z-score=-2; I-EXPLORATION +cadera I-EXPLORATION +total: I-EXPLORATION +T-score=-3 I-EXPLORATION +y I-EXPLORATION +Z-score=-2), I-EXPLORATION +pero I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +sufrido I-EXPLORATION +ninguna I-EXPLORATION +fractura I-EXPLORATION +ni I-EXPLORATION +osteonecrosis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +seguimiento. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +mujer, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +repetidos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +rodillas, I-PRESENT_ILLNESS +atribuido I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +entonces I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +proceso I-PRESENT_ILLNESS +degenerativo, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +mejoraban I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antiinflamatorios I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +esteroideos. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +también I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +muñecas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +raquis I-PRESENT_ILLNESS +cervical, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +mecánicas. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +padecido I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +consumía I-PRESENT_ILLNESS +diuréticos I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +ningún I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fármacos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +mostraba I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +normohidratada, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +120/80 I-EXPLORATION +mmHg. I-EXPLORATION +Del I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destacaba I-EXPLORATION +el I-EXPLORATION +dolor I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +limitación I-EXPLORATION +a I-EXPLORATION +flexo-extensión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rodilla I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +maniobras I-EXPLORATION +meniscales I-EXPLORATION +positivas, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +derrame I-EXPLORATION +articular. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +manos I-EXPLORATION +mostraba I-EXPLORATION +signos I-EXPLORATION +degenerativos I-EXPLORATION +en I-EXPLORATION +articulaciones I-EXPLORATION +interfalángicas I-EXPLORATION +distales I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +nódulos I-EXPLORATION +de I-EXPLORATION +Heberden. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica, I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +fórmula I-EXPLORATION +fueron I-EXPLORATION +normales; I-EXPLORATION +los I-EXPLORATION +análisis I-EXPLORATION +bioquímicos I-EXPLORATION +mostraron I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +resultados: I-EXPLORATION +urea, I-EXPLORATION +37 I-EXPLORATION +mg/dl; I-EXPLORATION +creatinina, I-EXPLORATION +0, I-EXPLORATION +71 I-EXPLORATION +mg/dl; I-EXPLORATION +filtrado I-EXPLORATION +glomerular, I-EXPLORATION +>60 I-EXPLORATION +mL/min/1, I-EXPLORATION +73m2; I-EXPLORATION +calcio I-EXPLORATION +total, I-EXPLORATION +9, I-EXPLORATION +45 I-EXPLORATION +mg/dl; I-EXPLORATION +fosfato I-EXPLORATION +inorgánico, I-EXPLORATION +3, I-EXPLORATION +51 I-EXPLORATION +mg/dl; I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina, I-EXPLORATION +56 I-EXPLORATION +U/L; I-EXPLORATION +sodio I-EXPLORATION +(Na), I-EXPLORATION +140 I-EXPLORATION +mEq/l; I-EXPLORATION +potasio I-EXPLORATION +(K), I-EXPLORATION +3, I-EXPLORATION +4 I-EXPLORATION +mEq/l; I-EXPLORATION +TSH, I-EXPLORATION +3, I-EXPLORATION +45 I-EXPLORATION +mUL; I-EXPLORATION +PTH I-EXPLORATION +plasma, I-EXPLORATION +2, I-EXPLORATION +9 I-EXPLORATION +pmol/L I-EXPLORATION +(1,6-6,9); I-EXPLORATION +25-hidroxicolecalciferol, I-EXPLORATION +30, I-EXPLORATION +9 I-EXPLORATION +ng/ml I-EXPLORATION +(30-100); I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +ósea, I-EXPLORATION +9, I-EXPLORATION +7 I-EXPLORATION +ug/L; I-EXPLORATION +magnesio I-EXPLORATION +(Mg), I-EXPLORATION +0, I-EXPLORATION +54 I-EXPLORATION +mmol/L I-EXPLORATION +(0,66-0,99). I-EXPLORATION +En I-EXPLORATION +orina I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas: I-EXPLORATION +proteinuria I-EXPLORATION +negativa; I-EXPLORATION +calciuria, I-EXPLORATION +69, I-EXPLORATION +56 I-EXPLORATION +mg I-EXPLORATION +(100-250); I-EXPLORATION +fosfaturia, I-EXPLORATION +588, I-EXPLORATION +30 I-EXPLORATION +mg; I-EXPLORATION +Mg, I-EXPLORATION +1, I-EXPLORATION +31 I-EXPLORATION +mg/dL I-EXPLORATION +(1,7-5,7); I-EXPLORATION +fosfato I-EXPLORATION +en I-EXPLORATION +primera I-EXPLORATION +orina I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mañana, I-EXPLORATION +15, I-EXPLORATION +9 I-EXPLORATION +mg/dL I-EXPLORATION +(40-136). I-EXPLORATION +Los I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda, I-EXPLORATION +factor I-EXPLORATION +reumatoide, I-EXPLORATION +anticuerpo I-EXPLORATION +anticitrulinado I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(ANA, I-EXPLORATION +anti-ENA) I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +o I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +mostró I-EXPLORATION +calcificaciones I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +meniscos I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +rodillas I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +degenerativos I-EXPLORATION +añadidos, I-EXPLORATION +de I-EXPLORATION +sínfisis I-EXPLORATION +púbica, I-EXPLORATION +ambos I-EXPLORATION +carpos, I-EXPLORATION +en I-EXPLORATION +cartílago I-EXPLORATION +hialino I-EXPLORATION +de I-EXPLORATION +coxofemorales I-EXPLORATION +y I-EXPLORATION +también I-EXPLORATION +en I-EXPLORATION +metatarsofalángicas I-EXPLORATION +de I-EXPLORATION +primer I-EXPLORATION +dedo I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +pies. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnérico I-EXPLORATION +nuclear I-EXPLORATION +(RM) I-EXPLORATION +de I-EXPLORATION +rodilla I-EXPLORATION +derecha I-EXPLORATION +mostraba I-EXPLORATION +severos I-EXPLORATION +signos I-EXPLORATION +degenerativos I-EXPLORATION +de I-EXPLORATION +artrosis I-EXPLORATION +fémoro-rotuliana, I-EXPLORATION +fémoro-tibial I-EXPLORATION +interna I-EXPLORATION +y I-EXPLORATION +externa, I-EXPLORATION +con I-EXPLORATION +rotura I-EXPLORATION +degenerativa I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +meniscos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +molecular I-EXPLORATION +mediante I-EXPLORATION +amplificación I-EXPLORATION +PCR I-EXPLORATION +y I-EXPLORATION +secuenciación I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +SCL112A3, I-EXPLORATION +detectando I-EXPLORATION +homozigosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +c2576T>C I-EXPLORATION +(p. I-EXPLORATION +L859P) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +exón I-EXPLORATION +del I-EXPLORATION +citado I-EXPLORATION +gen I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +confirmaba I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Gitelman. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +suplementos I-TREATMENT +orales I-TREATMENT +de I-TREATMENT +magnesio I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +variables I-TREATMENT +según I-TREATMENT +resultados I-TREATMENT +analíticos I-TREATMENT +de I-TREATMENT +seguimiento, I-TREATMENT +y I-TREATMENT +colchicina I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +los I-TREATMENT +episodios I-TREATMENT +de I-TREATMENT +pseudogota I-TREATMENT +que I-TREATMENT +venía I-TREATMENT +padeciendo I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hija B-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +anterior, I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +OI I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +raíz I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tibia I-PAST_MEDICAL_HISTORY +desplazada I-PAST_MEDICAL_HISTORY +seguida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +clavícula I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +traumatismos I-PAST_MEDICAL_HISTORY +leves. I-PAST_MEDICAL_HISTORY +Posteriormente I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +nuevas I-PAST_MEDICAL_HISTORY +fracturas, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +última I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +precisando I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ellas I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +quirúrgico I-PAST_MEDICAL_HISTORY +(olécranon). I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +destacaban I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +esguinces I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tobillo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +estapedectomía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +oído I-PAST_MEDICAL_HISTORY +derecho. I-PAST_MEDICAL_HISTORY +Nunca I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +asintomática. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +deseaba I-PRESENT_ILLNESS +conocer I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +opciones I-PRESENT_ILLNESS +reproductivas I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +tener I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hijo I-PRESENT_ILLNESS +libre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +enfermedad. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +talla I-EXPLORATION +de I-EXPLORATION +153 I-EXPLORATION +cm, I-EXPLORATION +escleras I-EXPLORATION +azules I-EXPLORATION +y I-EXPLORATION +dientes I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +deformidades I-EXPLORATION +a I-EXPLORATION +ningún I-EXPLORATION +nivel. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +resultaron I-EXPLORATION +normales, I-EXPLORATION +salvo I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +25OHCC: I-EXPLORATION +23 I-EXPLORATION +ng/ml, I-EXPLORATION +y I-EXPLORATION +también I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +realizado I-EXPLORATION +(radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +cervical, I-EXPLORATION +ecocardiograma, I-EXPLORATION +espirometría, I-EXPLORATION +ecografía I-EXPLORATION +abdominal). I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +densitometría I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +densidad I-EXPLORATION +mineral I-EXPLORATION +ósea I-EXPLORATION +normal: I-EXPLORATION +T-scores I-EXPLORATION +de I-EXPLORATION +-0, I-EXPLORATION +9 I-EXPLORATION +en I-EXPLORATION +columna I-EXPLORATION +lumbar I-EXPLORATION +(L1-L4), I-EXPLORATION +0, I-EXPLORATION +0 I-EXPLORATION +en I-EXPLORATION +cuello I-EXPLORATION +femoral I-EXPLORATION +y I-EXPLORATION +-0, I-EXPLORATION +1 I-EXPLORATION +en I-EXPLORATION +fémur I-EXPLORATION +total. I-EXPLORATION +Se B-TREATMENT +recomendó I-TREATMENT +suplementación I-TREATMENT +con I-TREATMENT +vitamina I-TREATMENT +D. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +dirigido I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +búsqueda I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +identificada I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +padre, I-EXPLORATION +confirmando I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +hija I-EXPLORATION +es I-EXPLORATION +portadora I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +deleción I-EXPLORATION +en I-EXPLORATION +heterocigosis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +COL1A1 I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +su I-EXPLORATION +padre. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +asesoramiento I-EXPLORATION +genético I-EXPLORATION +para I-EXPLORATION +informar I-EXPLORATION +sobre I-EXPLORATION +las I-EXPLORATION +posibles I-EXPLORATION +consecuencias I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +afecto I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +descendencia, I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +y I-EXPLORATION +sus I-EXPLORATION +ventajas I-EXPLORATION +y I-EXPLORATION +riesgos, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +informarle I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +posibles I-EXPLORATION +alternativas I-EXPLORATION +derivadas I-EXPLORATION +del I-EXPLORATION +análisis. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +ERC I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +glomerulonefritis I-PAST_MEDICAL_HISTORY +proliferativa I-PAST_MEDICAL_HISTORY +extracapilar I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +I. I-PAST_MEDICAL_HISTORY +Fumadora I-PAST_MEDICAL_HISTORY +activa, I-PAST_MEDICAL_HISTORY +Hipertensa I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +precisa I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +farmacológico I-PAST_MEDICAL_HISTORY +actualmente. I-PAST_MEDICAL_HISTORY +Presenta I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Darier I-PAST_MEDICAL_HISTORY +cutánea. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Recibió I-PAST_MEDICAL_HISTORY +14 I-PAST_MEDICAL_HISTORY +sesiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +plasmaféresis I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2006. I-PAST_MEDICAL_HISTORY +Posteriormente I-PAST_MEDICAL_HISTORY +abandonó I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +revisiones I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +finalmente I-PAST_MEDICAL_HISTORY +acudió I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +urgencias I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +situación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +uremia I-PAST_MEDICAL_HISTORY +terminal I-PAST_MEDICAL_HISTORY +iniciando I-PAST_MEDICAL_HISTORY +diálisis. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +da I-PRESENT_ILLNESS +consentimiento I-PRESENT_ILLNESS +expreso I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +exposición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +caso. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Historia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +acceso I-PRESENT_ILLNESS +vascular I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +• B-TREATMENT +Varios I-TREATMENT +intentos I-TREATMENT +de I-TREATMENT +Fístula I-TREATMENT +Arteriovenosa I-TREATMENT +(FAV), I-TREATMENT +todos I-TREATMENT +ellos I-TREATMENT +infructuosos: I-TREATMENT +FAV I-TREATMENT +radio-cefálica I-TREATMENT +izquierda I-TREATMENT +en I-TREATMENT +01-2009, I-TREATMENT +húmero-cefálica I-TREATMENT +izquierda I-TREATMENT +en I-TREATMENT +03-09, I-TREATMENT +radio-cefálica I-TREATMENT +derecha I-TREATMENT +en I-TREATMENT +04-09 I-TREATMENT +y I-TREATMENT +húmero-cefálica I-TREATMENT +derecha I-TREATMENT +en I-TREATMENT +05-11. I-TREATMENT +Se B-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +mapa I-EXPLORATION +vascular I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +ninguna I-EXPLORATION +vena I-EXPLORATION +apta I-EXPLORATION +en I-EXPLORATION +MMSS. I-EXPLORATION + I-EXPLORATION +• B-TREATMENT +Catéter I-TREATMENT +venoso I-TREATMENT +permanente I-TREATMENT +yugular I-TREATMENT +derecho, I-TREATMENT +implantado I-TREATMENT +el I-TREATMENT +14/01/09 I-TREATMENT +y I-TREATMENT +retirado I-TREATMENT +el I-TREATMENT +05/11/09 I-TREATMENT +por I-TREATMENT +Endocarditis I-TREATMENT +Tricuspídea I-TREATMENT +secundaria I-TREATMENT +a I-TREATMENT +MARS. I-TREATMENT + I-TREATMENT +• I-TREATMENT +Varios I-TREATMENT +catéteres I-TREATMENT +temporales I-TREATMENT +en I-TREATMENT +ambas I-TREATMENT +venas I-TREATMENT +femorales I-TREATMENT +retirados I-TREATMENT +por I-TREATMENT +trombosis I-TREATMENT +o I-TREATMENT +disfunción. I-TREATMENT + I-TREATMENT +• I-TREATMENT +Catéter I-TREATMENT +permanente I-TREATMENT +yugular I-TREATMENT +izquierdo I-TREATMENT +colocado I-TREATMENT +el I-TREATMENT +16/11/09 I-TREATMENT +y I-TREATMENT +retirado I-TREATMENT +el I-TREATMENT +21/06/10 I-TREATMENT +por I-TREATMENT +trombosis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +yugular I-TREATMENT +izquierda. I-TREATMENT + I-TREATMENT +• I-TREATMENT +Catéter I-TREATMENT +permanente I-TREATMENT +femoral I-TREATMENT +derecho I-TREATMENT +colocado I-TREATMENT +el I-TREATMENT +21/06/10 I-TREATMENT +y I-TREATMENT +retirado I-TREATMENT +4 I-TREATMENT +días I-TREATMENT +después I-TREATMENT +por I-TREATMENT +disfunción I-TREATMENT +persistente. I-TREATMENT + I-TREATMENT +• B-EXPLORATION +Tras I-EXPLORATION +ello I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +endovascular I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +oclusión I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +iliaca I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +cava I-EXPLORATION +inferior, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +inhabilitaba I-EXPLORATION +los I-EXPLORATION +accesos I-EXPLORATION +femorales. I-EXPLORATION +En I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +respecta I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +troncos I-EXPLORATION +superiores I-EXPLORATION +la I-EXPLORATION +situación I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +mejor I-EXPLORATION +pues I-EXPLORATION +existe I-EXPLORATION +oclusión I-EXPLORATION +de I-EXPLORATION +venas I-EXPLORATION +subclavias, I-EXPLORATION +yugular I-EXPLORATION +derecha, I-EXPLORATION +tronco I-EXPLORATION +braquio-cefálico I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +cava I-EXPLORATION +superior. I-EXPLORATION +Ante B-TREATMENT +esta I-TREATMENT +situación I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +catéter I-TREATMENT +permanente I-TREATMENT +por I-TREATMENT +abordaje I-TREATMENT +transhepático I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +suprahepática I-TREATMENT +derecha, I-TREATMENT +con I-TREATMENT +extremo I-TREATMENT +en I-TREATMENT +aurícula I-TREATMENT +derecha9. I-TREATMENT +Se I-TREATMENT +recambió I-TREATMENT +el I-TREATMENT +03/07/2012 I-TREATMENT +por I-TREATMENT +disfunción. I-TREATMENT +Desde B-EVOLUTION +entonces I-EVOLUTION +ha I-EVOLUTION +sufrido I-EVOLUTION +continuas I-EVOLUTION +infecciones I-EVOLUTION +que I-EVOLUTION +han I-EVOLUTION +obligado I-EVOLUTION +a I-EVOLUTION +instaurar I-EVOLUTION +tratamiento I-EVOLUTION +antibiótico I-EVOLUTION +casi I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +continua. I-EVOLUTION + I-EVOLUTION +• I-EVOLUTION +En I-EVOLUTION +12/2012 I-EVOLUTION +sufre I-EVOLUTION +extrusión I-EVOLUTION +espontánea I-EVOLUTION +colocándose B-TREATMENT +catéter I-TREATMENT +femoral I-TREATMENT +provisional I-TREATMENT +izquierdo. I-TREATMENT + I-TREATMENT +• B-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +nuevo I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +troncos I-EXPLORATION +venosos I-EXPLORATION +encontrando I-EXPLORATION +oclusión I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +iliaca I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +del I-EXPLORATION +flujo I-EXPLORATION +por I-EXPLORATION +rama I-EXPLORATION +hipogástrica I-EXPLORATION +hasta I-EXPLORATION +iliaca I-EXPLORATION +común, I-EXPLORATION +de I-EXPLORATION +modo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +subsidiaria I-EXPLORATION +de I-EXPLORATION +catéter I-EXPLORATION +de I-EXPLORATION +diálisis I-EXPLORATION +permanente I-EXPLORATION +por I-EXPLORATION +este I-EXPLORATION +acceso. I-EXPLORATION +La I-EXPLORATION +vena I-EXPLORATION +femoral I-EXPLORATION +común I-EXPLORATION +derecha I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +permeable I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +flujo I-EXPLORATION +doppler I-EXPLORATION +en I-EXPLORATION +vena I-EXPLORATION +iliaca, I-EXPLORATION +probablemente I-EXPLORATION +por I-EXPLORATION +trombosis. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +flebografías I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +brazos I-EXPLORATION +encontrando I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +flujo I-EXPLORATION +va I-EXPLORATION +por I-EXPLORATION +colaterales I-EXPLORATION +a I-EXPLORATION +intercostales I-EXPLORATION +hasta I-EXPLORATION +acigos-hemiacigos I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +bilateral I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +oclusión I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +venas I-EXPLORATION +subclavias. I-EXPLORATION +Se I-EXPLORATION +descartó I-EXPLORATION +colocar I-EXPLORATION +un I-EXPLORATION +catéter I-EXPLORATION +por I-EXPLORATION +subclavia. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +doppler I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +yugulares I-EXPLORATION +visualizando I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +yugular I-EXPLORATION +izquierda I-EXPLORATION +permeable I-EXPLORATION +aunque I-EXPLORATION +es I-EXPLORATION +muy I-EXPLORATION +probable I-EXPLORATION +estenosis I-EXPLORATION +central I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +braquiocefálico I-EXPLORATION +venoso I-EXPLORATION +izquierdo I-EXPLORATION +dada I-EXPLORATION +la I-EXPLORATION +flebografía I-EXPLORATION +de I-EXPLORATION +ese I-EXPLORATION +miembro I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +yugular I-EXPLORATION +derecha I-EXPLORATION +ocluida I-EXPLORATION +crónica I-EXPLORATION +(no I-EXPLORATION +visible I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía). I-EXPLORATION + I-EXPLORATION +• B-TREATMENT +El I-TREATMENT +17/01/2013 I-TREATMENT +se I-TREATMENT +le I-TREATMENT +implantó I-TREATMENT +nuevo I-TREATMENT +catéter I-TREATMENT +transhepático I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +recambiado I-TREATMENT +el I-TREATMENT +20/03/2013 I-TREATMENT +por I-TREATMENT +disfunción. I-TREATMENT +Este B-EVOLUTION +es I-EVOLUTION +su I-EVOLUTION +acceso I-EVOLUTION +actual I-EVOLUTION +y I-EVOLUTION +probablemente I-EVOLUTION +el I-EVOLUTION +único I-EVOLUTION +posible. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +todos I-EVOLUTION +estos I-EVOLUTION +problemas I-EVOLUTION +vasculares I-EVOLUTION +que I-EVOLUTION +ponen I-EVOLUTION +en I-EVOLUTION +riesgo I-EVOLUTION +su I-EVOLUTION +supervivencia I-EVOLUTION +se I-EVOLUTION +suma I-EVOLUTION +la I-EVOLUTION +situación I-EVOLUTION +social I-EVOLUTION +complicadísima I-EVOLUTION +que I-EVOLUTION +vive I-EVOLUTION +la I-EVOLUTION +paciente, I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +recibe I-EVOLUTION +ningún I-EVOLUTION +apoyo I-EVOLUTION +familiar I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +totalmente I-EVOLUTION +desmotivada I-EVOLUTION +presentando I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +mayoría I-EVOLUTION +de I-EVOLUTION +ocasiones I-EVOLUTION +un I-EVOLUTION +comportamiento I-EVOLUTION +rebelde I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +rechazo I-EVOLUTION +a I-EVOLUTION +cualquier I-EVOLUTION +cambio I-EVOLUTION +en I-EVOLUTION +sus I-EVOLUTION +opciones I-EVOLUTION +de I-EVOLUTION +tratamiento, I-EVOLUTION +hecho I-EVOLUTION +que I-EVOLUTION +dificulta I-EVOLUTION +enormemente I-EVOLUTION +la I-EVOLUTION +labor I-EVOLUTION +de I-EVOLUTION +enfermería I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +ámbito I-EVOLUTION +de I-EVOLUTION +educación I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +salud. I-EVOLUTION + I-EVOLUTION +Cabe B-TREATMENT +reseñar I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +rechaza I-TREATMENT +iniciar I-TREATMENT +cualquier I-TREATMENT +tipo I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +anticoagulante I-TREATMENT +(se I-TREATMENT +le I-TREATMENT +ha I-TREATMENT +propuesto I-TREATMENT +tomar I-TREATMENT +sintrom® I-TREATMENT +en I-TREATMENT +muchas I-TREATMENT +ocasiones). I-TREATMENT + I-TREATMENT +Por I-TREATMENT +otra I-TREATMENT +parte I-TREATMENT +se I-TREATMENT +descartó I-TREATMENT +su I-TREATMENT +inclusión I-TREATMENT +en I-TREATMENT +la I-TREATMENT +lista I-TREATMENT +de I-TREATMENT +trasplante I-TREATMENT +al I-TREATMENT +no I-TREATMENT +acudir I-TREATMENT +a I-TREATMENT +las I-TREATMENT +reiteradas I-TREATMENT +citas, I-TREATMENT +autoexcluyéndose I-TREATMENT +además I-TREATMENT +como I-TREATMENT +candidata I-TREATMENT +a I-TREATMENT +diálisis I-TREATMENT +peritoneal I-TREATMENT +dada I-TREATMENT +su I-TREATMENT +negativa I-TREATMENT +a I-TREATMENT +cumplir I-TREATMENT +con I-TREATMENT +las I-TREATMENT +pautas I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +propuestas I-TREATMENT +por I-TREATMENT +el I-TREATMENT +personal I-TREATMENT +médico I-TREATMENT +y I-TREATMENT +de I-TREATMENT +enfermería. I-TREATMENT + I-TREATMENT +En I-TREATMENT +las I-TREATMENT +figuras I-TREATMENT +1 I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +se I-TREATMENT +muestra I-TREATMENT +el I-TREATMENT +acceso I-TREATMENT +actual I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente: I-TREATMENT +el I-TREATMENT +catéter I-TREATMENT +transhepático. I-TREATMENT + I-TREATMENT +Cuidados I-TREATMENT +de I-TREATMENT +enfermería I-TREATMENT + I-TREATMENT +En B-EVOLUTION +cada I-EVOLUTION +sesión I-EVOLUTION +se I-EVOLUTION +informa I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +cuidados I-EVOLUTION +que I-EVOLUTION +debe I-EVOLUTION +tener I-EVOLUTION +para I-EVOLUTION +cuidar I-EVOLUTION +al I-EVOLUTION +máximo I-EVOLUTION +su I-EVOLUTION +AV I-EVOLUTION +haciendo I-EVOLUTION +especial I-EVOLUTION +hincapié I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +importancia I-EVOLUTION +de I-EVOLUTION +mantener I-EVOLUTION +el I-EVOLUTION +apósito I-EVOLUTION +seco I-EVOLUTION +y I-EVOLUTION +limpio I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +informar I-EVOLUTION +al I-EVOLUTION +personal I-EVOLUTION +de I-EVOLUTION +enfermería I-EVOLUTION +acerca I-EVOLUTION +de I-EVOLUTION +cualquier I-EVOLUTION +incidencia I-EVOLUTION +que I-EVOLUTION +note, I-EVOLUTION +especialmente I-EVOLUTION +si I-EVOLUTION +aparece I-EVOLUTION +dolor I-EVOLUTION +o I-EVOLUTION +calor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +de I-EVOLUTION +inserción I-EVOLUTION +y I-EVOLUTION +fiebre. I-EVOLUTION + I-EVOLUTION +Todo I-EVOLUTION +el I-EVOLUTION +equipo I-EVOLUTION +de I-EVOLUTION +enfermería I-EVOLUTION +cumple I-EVOLUTION +con I-EVOLUTION +los I-EVOLUTION +protocolos I-EVOLUTION +de I-EVOLUTION +cura I-EVOLUTION +del I-EVOLUTION +orificio I-EVOLUTION +de I-EVOLUTION +salida I-EVOLUTION +del I-EVOLUTION +catéter, I-EVOLUTION +conexión I-EVOLUTION +y I-EVOLUTION +desconexión I-EVOLUTION +según I-EVOLUTION +los I-EVOLUTION +criterios I-EVOLUTION +aceptados I-EVOLUTION +en I-EVOLUTION +nuestra I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +diálisis: I-EVOLUTION + I-EVOLUTION +• B-TREATMENT +La I-TREATMENT +cura I-TREATMENT +del I-TREATMENT +orificio I-TREATMENT +de I-TREATMENT +salida I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +(OSC) I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +aséptica I-TREATMENT +con I-TREATMENT +cloruro I-TREATMENT +sódico I-TREATMENT +al I-TREATMENT +20%, I-TREATMENT +clorhexidina I-TREATMENT +alcohólica I-TREATMENT +al I-TREATMENT +2% I-TREATMENT +y I-TREATMENT +gasas I-TREATMENT +estériles, I-TREATMENT +observando I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +exhaustiva I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +para I-TREATMENT +detectar I-TREATMENT +precozmente I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +eritema, I-TREATMENT +secreción, I-TREATMENT +etc. I-TREATMENT +Después I-TREATMENT +se I-TREATMENT +cubre I-TREATMENT +el I-TREATMENT +orificio I-TREATMENT +con I-TREATMENT +un I-TREATMENT +apósito I-TREATMENT +estéril. I-TREATMENT + I-TREATMENT +• I-TREATMENT +El I-TREATMENT +sellado I-TREATMENT +de I-TREATMENT +las I-TREATMENT +ramas I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +con I-TREATMENT +Taurolock® I-TREATMENT +y I-TREATMENT +tapones I-TREATMENT +tipo I-TREATMENT +luer-lock. I-TREATMENT +Desde I-TREATMENT +el I-TREATMENT +último I-TREATMENT +recambio I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +transhepático I-TREATMENT +en I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +sesión I-TREATMENT +de I-TREATMENT +diálisis I-TREATMENT +semanal I-TREATMENT +se I-TREATMENT +sella I-TREATMENT +con I-TREATMENT +Urokinasa I-TREATMENT +50.000 I-TREATMENT +UI/rama I-TREATMENT +como I-TREATMENT +terapia I-TREATMENT +fibrinolítica I-TREATMENT +intraluminal I-TREATMENT +según I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +nuestra I-TREATMENT +unidad. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +valora I-EXPLORATION +el I-EXPLORATION +funcionamiento I-EXPLORATION +adecuado I-EXPLORATION +del I-EXPLORATION +catéter I-EXPLORATION +en I-EXPLORATION +cada I-EXPLORATION +sesión I-EXPLORATION +de I-EXPLORATION +hemodiálisis I-EXPLORATION +alcanzando I-EXPLORATION +flujos I-EXPLORATION +sanguíneos I-EXPLORATION +adecuados I-EXPLORATION +superiores I-EXPLORATION +a I-EXPLORATION +300 I-EXPLORATION +ml/min I-EXPLORATION +y I-EXPLORATION +Kt I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +L. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +figura I-EXPLORATION +3 I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +obtenidos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +sesiones I-EXPLORATION +de I-EXPLORATION +diálisis I-EXPLORATION +desde I-EXPLORATION +enero I-EXPLORATION +de I-EXPLORATION +2013. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ERC I-PRESENT_ILLNESS +estadio I-PRESENT_ILLNESS +V I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +perfil I-PRESENT_ILLNESS +intersticial I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +recibir I-PRESENT_ILLNESS +educación I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +opciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +elige I-PRESENT_ILLNESS +DPCA. I-PRESENT_ILLNESS +En B-TREATMENT +septiembre I-TREATMENT +de I-TREATMENT +2014 I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +implantación I-TREATMENT +de I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +silicona I-TREATMENT +Swan-neck I-TREATMENT +con I-TREATMENT +doble I-TREATMENT +cuff I-TREATMENT +y I-TREATMENT +reparación I-TREATMENT +de I-TREATMENT +dos I-TREATMENT +hernias, I-TREATMENT +inguinal I-TREATMENT +y I-TREATMENT +umbilical. I-TREATMENT +Su B-EXPLORATION +superficie I-EXPLORATION +corporal I-EXPLORATION +era I-EXPLORATION +2.06 I-EXPLORATION +m2 I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +Indice I-EXPLORATION +de I-EXPLORATION +Masa I-EXPLORATION +Corporal I-EXPLORATION +26.1. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +educación I-TREATMENT +para I-TREATMENT +el I-TREATMENT +aprendizaje I-TREATMENT +de I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +y I-TREATMENT +en I-TREATMENT +Noviembre I-TREATMENT +de I-TREATMENT +2014 I-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +en I-TREATMENT +domicilio I-TREATMENT +con I-TREATMENT +4 I-TREATMENT +intercambios I-TREATMENT +de I-TREATMENT +Bicavera I-TREATMENT +al I-TREATMENT +1, I-TREATMENT +5% I-TREATMENT +de I-TREATMENT +glucosa I-TREATMENT +y I-TREATMENT +2000 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +volumen, I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT +Los B-EXPLORATION +volúmenes I-EXPLORATION +de I-EXPLORATION +UF I-EXPLORATION +eran I-EXPLORATION +de I-EXPLORATION +500-700 I-EXPLORATION +ml/ I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +diuresis I-EXPLORATION +residual I-EXPLORATION +de I-EXPLORATION +1700 I-EXPLORATION +ml. I-EXPLORATION +En B-EVOLUTION +diciembre I-EVOLUTION +de I-EVOLUTION +2014 I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +Prueba I-EVOLUTION +de I-EVOLUTION +función I-EVOLUTION +peritoneal I-EVOLUTION +catalogándose I-EVOLUTION +como I-EVOLUTION +alto I-EVOLUTION +transportador I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +volumen I-EVOLUTION +residual I-EVOLUTION +de I-EVOLUTION +411, I-EVOLUTION +39 I-EVOLUTION +ml I-EVOLUTION +y I-EVOLUTION +Presión I-EVOLUTION +Intraperitoneal I-EVOLUTION +(PIP) I-EVOLUTION +de I-EVOLUTION +16, I-EVOLUTION +05 I-EVOLUTION +cm I-EVOLUTION +H2O. I-EVOLUTION +El I-EVOLUTION +2 I-EVOLUTION +de I-EVOLUTION +febrero I-EVOLUTION +de I-EVOLUTION +2015 I-EVOLUTION +acudió I-EVOLUTION +a I-EVOLUTION +urgencias I-EVOLUTION +por I-EVOLUTION +dificultad I-EVOLUTION +para I-EVOLUTION +el I-EVOLUTION +drenaje, I-EVOLUTION +su I-EVOLUTION +patrón I-EVOLUTION +intestinal I-EVOLUTION +era I-EVOLUTION +normal I-EVOLUTION +sin I-EVOLUTION +estreñimiento I-EVOLUTION +ni I-EVOLUTION +diarrea I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +radiografía I-EVOLUTION +de I-EVOLUTION +abdomen I-EVOLUTION +mostró I-EVOLUTION +migración I-EVOLUTION +del I-EVOLUTION +catéter, I-EVOLUTION +tratado I-EVOLUTION +con I-EVOLUTION +laxantes I-EVOLUTION +mejoraron I-EVOLUTION +los I-EVOLUTION +drenajes I-EVOLUTION +pero I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +ganancia I-EVOLUTION +de I-EVOLUTION +4 I-EVOLUTION +kg I-EVOLUTION +de I-EVOLUTION +peso. I-EVOLUTION +Se B-TREATMENT +cambió I-TREATMENT +pauta I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +2 I-TREATMENT +intercambios I-TREATMENT +de I-TREATMENT +2, I-TREATMENT +3 I-TREATMENT +% I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +5% I-TREATMENT +de I-TREATMENT +glucosa I-TREATMENT +bajando I-TREATMENT +800 I-TREATMENT +gr I-TREATMENT +de I-TREATMENT +peso. I-TREATMENT +Al B-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +telefónica I-EVOLUTION +se I-EVOLUTION +percibió I-EVOLUTION +disnea I-EVOLUTION +al I-EVOLUTION +hablar I-EVOLUTION +y I-EVOLUTION +tos, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +indicó I-EVOLUTION +acudir I-EVOLUTION +urgentemente I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +consulta I-EVOLUTION +del I-EVOLUTION +hospital. I-EVOLUTION +La B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +mostró I-EXPLORATION +gran I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +existía I-EXPLORATION +en I-EXPLORATION +radiografías I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +posteriores I-EXPLORATION +al I-EXPLORATION +comienzo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +DP. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +toracentesis, I-TREATMENT +mostrando I-TREATMENT +la I-TREATMENT +bioquímica I-TREATMENT +del I-TREATMENT +líquido I-TREATMENT +una I-TREATMENT +concentración I-TREATMENT +de I-TREATMENT +glucosa I-TREATMENT +en I-TREATMENT +líquido I-TREATMENT +pleural I-TREATMENT +mayor I-TREATMENT +de I-TREATMENT +la I-TREATMENT +presentada I-TREATMENT +en I-TREATMENT +plasma I-TREATMENT +y I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +líquido I-TREATMENT +de I-TREATMENT +diálisis. I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +fuga I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +hacia I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +pleural, I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +diálisis I-TREATMENT +peritoneal. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +gammagrafía I-EXPLORATION +administrando I-EXPLORATION +117 I-EXPLORATION +MBq I-EXPLORATION +de I-EXPLORATION +Nanocoloide I-EXPLORATION +de I-EXPLORATION +albumina I-EXPLORATION +TC I-EXPLORATION +99 I-EXPLORATION +m. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +administración I-EXPLORATION +del I-EXPLORATION +radio I-EXPLORATION +fármaco I-EXPLORATION +requirió I-EXPLORATION +la I-EXPLORATION +colaboración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermería I-EXPLORATION +de I-EXPLORATION +DP I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +Nuclear I-EXPLORATION +(MN). I-EXPLORATION +La I-EXPLORATION +enfermera I-EXPLORATION +de I-EXPLORATION +DP I-EXPLORATION +realizó I-EXPLORATION +el I-EXPLORATION +intercambio I-EXPLORATION +manual I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +MN I-EXPLORATION +dosificó I-EXPLORATION +e I-EXPLORATION +inyectó I-EXPLORATION +el I-EXPLORATION +radiofármaco I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +solución I-EXPLORATION +de I-EXPLORATION +diálisis, I-EXPLORATION +según I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +medicación I-EXPLORATION +en I-EXPLORATION +líquido I-EXPLORATION +de I-EXPLORATION +diálisis, I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +infundirlo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +peritoneal. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +10-15 I-EXPLORATION +minutos I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +lectura I-EXPLORATION +y I-EXPLORATION +tras I-EXPLORATION +3-4 I-EXPLORATION +horas I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +tardías. I-EXPLORATION +Al B-TREATMENT +finalizar, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +intercambio I-TREATMENT +manual I-TREATMENT +para I-TREATMENT +drenar I-TREATMENT +completamente I-TREATMENT +el I-TREATMENT +abdomen, I-TREATMENT +desechando I-TREATMENT +el I-TREATMENT +líquido I-TREATMENT +drenado I-TREATMENT +en I-TREATMENT +el I-TREATMENT +contenedor I-TREATMENT +específico I-TREATMENT +según I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +MN. I-TREATMENT +El I-TREATMENT +estudio I-TREATMENT +fue I-TREATMENT +indicativo I-TREATMENT +de I-TREATMENT +comunicación I-TREATMENT +peritoneopleural, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +definitivamente I-TREATMENT +la I-TREATMENT +DP. I-TREATMENT +Se I-TREATMENT +transfirió I-TREATMENT +a I-TREATMENT +hemodialisis I-TREATMENT +(HD), I-TREATMENT +resolviendose I-TREATMENT +el I-TREATMENT +hidrotórax. I-TREATMENT +Actualmente B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +esta I-EVOLUTION +trasplantado. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +83 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +terminal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +etiología I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +filiada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +centro I-PAST_MEDICAL_HISTORY +periférico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diálisis I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +Octubre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2004. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Antecedentes I-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +dislipemia, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus, I-PAST_MEDICAL_HISTORY +artritis I-PAST_MEDICAL_HISTORY +reumatoide I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +actual, I-PAST_MEDICAL_HISTORY +osteoporosis I-PAST_MEDICAL_HISTORY +severa I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +vertebral, I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardíaca I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +disfunción I-PAST_MEDICAL_HISTORY +diastólica I-PAST_MEDICAL_HISTORY +moderada/leve. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +han I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +fístulas I-PAST_MEDICAL_HISTORY +arteriovenosas I-PAST_MEDICAL_HISTORY +internas I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +función I-PAST_MEDICAL_HISTORY +posterior, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +actualmente I-PAST_MEDICAL_HISTORY +porta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +catéter I-PAST_MEDICAL_HISTORY +venoso I-PAST_MEDICAL_HISTORY +central I-PAST_MEDICAL_HISTORY +tunelizado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +yugular I-PAST_MEDICAL_HISTORY +interna I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +acceso I-PAST_MEDICAL_HISTORY +vascular. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +hospitalarios. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +tiempo I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +modificado I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +pauta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diálisis, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sesiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +240 I-PAST_MEDICAL_HISTORY +minutos I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +días/semana, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dializador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +permeabilidad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +2m2 I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +superficie, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Qb I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +350 I-PAST_MEDICAL_HISTORY +ml/min, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +conseguido I-PAST_MEDICAL_HISTORY +mantener I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +estable I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sesiones I-PAST_MEDICAL_HISTORY +confortables I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +asintomáticas, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cifras I-PAST_MEDICAL_HISTORY +adecuadas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +seco I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +42-43 I-PAST_MEDICAL_HISTORY +Kg, I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +índice I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diálisis I-PAST_MEDICAL_HISTORY +adecuada I-PAST_MEDICAL_HISTORY +Kt/v I-PAST_MEDICAL_HISTORY +>1.8. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Situación B-PRESENT_ILLNESS +actual: I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Aproximadamente I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +verano, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +mala I-PRESENT_ILLNESS +tolerancia I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ultrafiltración I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +severos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipotensión I-PRESENT_ILLNESS +arterial I-PRESENT_ILLNESS +prácticamente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +todas I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +sesiones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diálisis, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +requirieron I-PRESENT_ILLNESS +infusión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fluidos I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +estabilización, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +reprogramación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +sesiones I-PRESENT_ILLNESS +renunciando I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +lograr I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +seco I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +final I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +sesiones. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Por B-DERIVED_FROM/TO +ello I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +día I-DERIVED_FROM/TO +8/08/16, I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +trasladada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +hospitalaria I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +diálisis I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +mejor I-DERIVED_FROM/TO +control I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +hemodiálisis. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-EXPLORATION +su I-EXPLORATION +llegada I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +unidad, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +signos I-EXPLORATION +evidentes I-EXPLORATION +de I-EXPLORATION +sobrecarga I-EXPLORATION +hídrica, I-EXPLORATION +con I-EXPLORATION +hipertensión I-EXPLORATION +arterial I-EXPLORATION +pre I-EXPLORATION +hemodiálisis, I-EXPLORATION +peso I-EXPLORATION +prediálisis I-EXPLORATION +de I-EXPLORATION +47.5 I-EXPLORATION +Kg I-EXPLORATION +que I-EXPLORATION +indica I-EXPLORATION +un I-EXPLORATION +sobrepeso I-EXPLORATION +de I-EXPLORATION +4.2 I-EXPLORATION +Kg I-EXPLORATION +sobre I-EXPLORATION +su I-EXPLORATION +peso I-EXPLORATION +seco I-EXPLORATION +anterior, I-EXPLORATION +ortopnea, I-EXPLORATION +y I-EXPLORATION +edemas I-EXPLORATION +muy I-EXPLORATION +intensos I-EXPLORATION +en I-EXPLORATION +MMII. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +anamnesis I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +refiere I-EXPLORATION +que I-EXPLORATION +desde I-EXPLORATION +que I-EXPLORATION +empezó I-EXPLORATION +el I-EXPLORATION +calor I-EXPLORATION +del I-EXPLORATION +verano, I-EXPLORATION +prácticamente I-EXPLORATION +no I-EXPLORATION +comía I-EXPLORATION +nada, I-EXPLORATION +y I-EXPLORATION +destaca I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +albuminemia I-EXPLORATION +2.6 I-EXPLORATION +g/dl I-EXPLORATION +y I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +en I-EXPLORATION +suero I-EXPLORATION +5.5 I-EXPLORATION +g/dl, I-EXPLORATION +motivo B-TREATMENT +por I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +le I-TREATMENT +prescribió I-TREATMENT +hace I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +suplementación I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +Renilón7.5©, I-TREATMENT +1 I-TREATMENT +frasco I-TREATMENT +al I-TREATMENT +día. I-TREATMENT + I-TREATMENT +Durante I-TREATMENT +las I-TREATMENT +dos I-TREATMENT +primeras I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +su I-TREATMENT +estancia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +hospitalaria, I-TREATMENT +se I-TREATMENT +intenta I-TREATMENT +sin I-TREATMENT +éxito I-TREATMENT +conseguir I-TREATMENT +el I-TREATMENT +peso I-TREATMENT +seco I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +al I-TREATMENT +persistir I-TREATMENT +los I-TREATMENT +episodios I-TREATMENT +de I-TREATMENT +hipotensión I-TREATMENT +intradiálisis. I-TREATMENT +Incluso I-TREATMENT +ganó I-TREATMENT +1 I-TREATMENT +Kg I-TREATMENT +en I-TREATMENT +este I-TREATMENT +periodo, I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +poner I-TREATMENT +en I-TREATMENT +práctica I-TREATMENT +diferentes I-TREATMENT +estrategias I-TREATMENT +como I-TREATMENT +limitar I-TREATMENT +la I-TREATMENT +ultrafiltración I-TREATMENT +horaria I-TREATMENT +a I-TREATMENT +300- I-TREATMENT +400 I-TREATMENT +ml/h, I-TREATMENT +haciendo I-TREATMENT +diálisis I-TREATMENT +secuencial I-TREATMENT +prolongando I-TREATMENT +las I-TREATMENT +sesiones I-TREATMENT +con I-TREATMENT +tiempos I-TREATMENT +de I-TREATMENT +ultrafiltración I-TREATMENT +aislada I-TREATMENT +pre I-TREATMENT +o I-TREATMENT +post I-TREATMENT +hemodiálisis, I-TREATMENT +bajando I-TREATMENT +la I-TREATMENT +temperatura I-TREATMENT +del I-TREATMENT +baño I-TREATMENT +a I-TREATMENT +35oC, I-TREATMENT +y I-TREATMENT +fijando I-TREATMENT +la I-TREATMENT +concentración I-TREATMENT +de I-TREATMENT +Na I-TREATMENT +en I-TREATMENT +el I-TREATMENT +baño I-TREATMENT +en I-TREATMENT +140 I-TREATMENT +meq/l. I-TREATMENT + I-TREATMENT +Durante I-TREATMENT +este I-TREATMENT +tiempo, I-TREATMENT +se I-TREATMENT +revisa I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +retirándole I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +medicación I-TREATMENT +hipotensora, I-TREATMENT +se B-EXPLORATION +realiza I-EXPLORATION +ecocardiograma I-EXPLORATION +descartando I-EXPLORATION +agravamiento I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +insuficiencia I-EXPLORATION +cardíaca, I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +persistir I-EXPLORATION +los I-EXPLORATION +intensos I-EXPLORATION +edemas I-EXPLORATION +en I-EXPLORATION +MMII, I-EXPLORATION +aparecen I-EXPLORATION +heridas I-EXPLORATION +ulcerosas I-EXPLORATION +que B-TREATMENT +requieren I-TREATMENT +curas I-TREATMENT +diarias I-TREATMENT +según I-TREATMENT +pauta I-TREATMENT +descrita I-TREATMENT +por I-TREATMENT +cirugía I-TREATMENT +plástica, I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +IV I-TREATMENT +(Vancomicina) I-TREATMENT +por I-TREATMENT +cultivo I-TREATMENT ++ I-TREATMENT +a I-TREATMENT +staphylococo I-TREATMENT +epidermidis. I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +cuarta I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +en I-TREATMENT +la I-TREATMENT +unidad, I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +intolerancia I-TREATMENT +a I-TREATMENT +la I-TREATMENT +ultrafiltración, I-TREATMENT +y I-TREATMENT +para I-TREATMENT +limitar I-TREATMENT +en I-TREATMENT +lo I-TREATMENT +posible I-TREATMENT +un I-TREATMENT +sobrepeso I-TREATMENT +excesivo I-TREATMENT +entre I-TREATMENT +sesiones, I-TREATMENT +se I-TREATMENT +pasa I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +a I-TREATMENT +hemodiálisis I-TREATMENT +diaria, I-TREATMENT +prescribiéndose I-TREATMENT +6 I-TREATMENT +sesiones I-TREATMENT +semanales I-TREATMENT +de I-TREATMENT +2.5 I-TREATMENT +h, I-TREATMENT +haciendo I-TREATMENT +ultrafiltración I-TREATMENT +aislada I-TREATMENT +pre I-TREATMENT +diálisis, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cursa I-TREATMENT +interconsulta I-TREATMENT +a I-TREATMENT +Endocrinología- I-TREATMENT +Nutrición, I-TREATMENT +para I-TREATMENT +valorar I-TREATMENT +la I-TREATMENT +indicación I-TREATMENT +de I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +intradiálisis I-TREATMENT +(NPID), I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +con I-TREATMENT +los I-TREATMENT +suplementos I-TREATMENT +orales I-TREATMENT +las I-TREATMENT +cifras I-TREATMENT +de I-TREATMENT +albuminemia I-TREATMENT +y I-TREATMENT +proteínas I-TREATMENT +totales I-TREATMENT +en I-TREATMENT +suero I-TREATMENT +han I-TREATMENT +bajado I-TREATMENT +situándose I-TREATMENT +en I-TREATMENT +2.4 I-TREATMENT +g/dl I-TREATMENT +y I-TREATMENT +5.3 I-TREATMENT +g/dl I-TREATMENT +respectivamente. I-TREATMENT + I-TREATMENT +Aunque I-TREATMENT +en I-TREATMENT +principio I-TREATMENT +Endocrinología I-TREATMENT +descartó I-TREATMENT +la I-TREATMENT +prescripción I-TREATMENT +de I-TREATMENT +nutrición I-TREATMENT +parenteral, I-TREATMENT +al I-TREATMENT +considerar I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +tenía I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +alimentación I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +y I-TREATMENT +propuso I-TREATMENT +su I-TREATMENT +seguimiento I-TREATMENT +en I-TREATMENT +consulta I-TREATMENT +de I-TREATMENT +dietética I-TREATMENT +manteniendo I-TREATMENT +los I-TREATMENT +suplementos I-TREATMENT +que I-TREATMENT +tenía I-TREATMENT +prescritos, I-TREATMENT +en I-TREATMENT +la I-TREATMENT +sexta I-TREATMENT +semana I-TREATMENT +tras I-TREATMENT +valorar I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +prescribieron I-TREATMENT +NPID I-TREATMENT +con I-TREATMENT +bajo I-TREATMENT +volumen I-TREATMENT +(900 I-TREATMENT +ml/sesión), I-TREATMENT +al I-TREATMENT +considerar I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +estaba I-TREATMENT +en I-TREATMENT +riesgo I-TREATMENT +nutricional I-TREATMENT +alto/intermedio, I-TREATMENT +con I-TREATMENT +mala I-TREATMENT +respuesta I-TREATMENT +al I-TREATMENT +suplemento I-TREATMENT +oral. I-TREATMENT + I-TREATMENT +A I-TREATMENT +partir I-TREATMENT +del I-TREATMENT +inicio I-TREATMENT +de I-TREATMENT +la I-TREATMENT +NPID, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +es I-TREATMENT +bien I-TREATMENT +tolerada I-TREATMENT +por I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +sin I-TREATMENT +requerimientos I-TREATMENT +de I-TREATMENT +insulina I-TREATMENT +adicionales I-TREATMENT +por I-TREATMENT +hiperglucemias, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +presenta I-TREATMENT +buena I-TREATMENT +tolerancia I-TREATMENT +a I-TREATMENT +la I-TREATMENT +ultrafiltración I-TREATMENT +que I-TREATMENT +nos I-TREATMENT +permite I-TREATMENT +aumentar I-TREATMENT +el I-TREATMENT +tiempo I-TREATMENT +de I-TREATMENT +las I-TREATMENT +sesiones I-TREATMENT +a I-TREATMENT +3 I-TREATMENT +horas I-TREATMENT +manteniendo I-TREATMENT +las I-TREATMENT +seis I-TREATMENT +semanales, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +consigue I-TREATMENT +bajar I-TREATMENT +el I-TREATMENT +peso I-TREATMENT +seco I-TREATMENT +(44.5 I-TREATMENT +Kg), I-TREATMENT +hasta I-TREATMENT +niveles I-TREATMENT +próximos I-TREATMENT +al I-TREATMENT +peso I-TREATMENT +seco I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +tenía I-TREATMENT +antes I-TREATMENT +del I-TREATMENT +traslado I-TREATMENT +a I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +hospitalaria I-TREATMENT +(43.3 I-TREATMENT +Kg). I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +octava I-TREATMENT +semana I-TREATMENT +se I-TREATMENT +revisa I-TREATMENT +la I-TREATMENT +prescripción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +NPID, I-TREATMENT +bajando I-TREATMENT +el I-TREATMENT +volumen I-TREATMENT +a I-TREATMENT +infundir I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +sesión I-TREATMENT +a I-TREATMENT +700 I-TREATMENT +ml, I-TREATMENT +los B-EVOLUTION +edemas I-EVOLUTION +en I-EVOLUTION +MMII I-EVOLUTION +persisten I-EVOLUTION +aunque I-EVOLUTION +son I-EVOLUTION +casi I-EVOLUTION +inapreciables I-EVOLUTION +post I-EVOLUTION +diálisis, I-EVOLUTION +las I-EVOLUTION +heridas I-EVOLUTION +ulcerosas I-EVOLUTION +están I-EVOLUTION +prácticamente I-EVOLUTION +cicatrizadas, I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +sesiones I-EVOLUTION +transcurren I-EVOLUTION +sin I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +hipotensión. I-EVOLUTION +Por B-TREATMENT +tanto I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +reducir I-TREATMENT +el I-TREATMENT +número I-TREATMENT +de I-TREATMENT +sesiones I-TREATMENT +semanales I-TREATMENT +a I-TREATMENT +cinco, I-TREATMENT +y I-TREATMENT +seguir I-TREATMENT +bajando I-TREATMENT +el I-TREATMENT +peso I-TREATMENT +seco I-TREATMENT +paulatinamente I-TREATMENT +hasta I-TREATMENT +alcanzar I-TREATMENT +los I-TREATMENT +42 I-TREATMENT +Kg, I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +consigue I-TREATMENT +en I-TREATMENT +la I-TREATMENT +semana I-TREATMENT +décima. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +partir I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +semana, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +permanecido I-EVOLUTION +estable I-EVOLUTION +hemodinámicamente I-EVOLUTION +durante I-EVOLUTION +las I-EVOLUTION +sesiones I-EVOLUTION +de I-EVOLUTION +hemodiálisis, I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +dificultades I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +ultrafiltración I-EVOLUTION +ni I-EVOLUTION +para I-EVOLUTION +alcanzar I-EVOLUTION +el I-EVOLUTION +peso I-EVOLUTION +seco I-EVOLUTION +al I-EVOLUTION +final I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +sesiones, I-EVOLUTION +y B-TREATMENT +se I-TREATMENT +decide I-TREATMENT +mantener I-TREATMENT +la I-TREATMENT +NPID I-TREATMENT +hasta I-TREATMENT +recuperación I-TREATMENT +total I-TREATMENT +de I-TREATMENT +las I-TREATMENT +cifras I-TREATMENT +analíticas I-TREATMENT +y I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +cicatrización I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +las I-TREATMENT +úlceras I-TREATMENT +en I-TREATMENT +MMII, I-TREATMENT +y I-TREATMENT +cuando I-TREATMENT +la I-TREATMENT +dieta I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +corrija I-TREATMENT +para I-TREATMENT +que I-TREATMENT +tenga I-TREATMENT +todos I-TREATMENT +los I-TREATMENT +aportes I-TREATMENT +necesarios I-TREATMENT +asegurados, I-TREATMENT +e I-TREATMENT +ir I-TREATMENT +reduciendo I-TREATMENT +paulatinamente I-TREATMENT +los I-TREATMENT +días I-TREATMENT +de I-TREATMENT +diálisis I-TREATMENT +prescritos I-TREATMENT +hasta I-TREATMENT +llegar I-TREATMENT +a I-TREATMENT +su I-TREATMENT +esquema I-TREATMENT +original I-TREATMENT +de I-TREATMENT +tres I-TREATMENT +días I-TREATMENT +en I-TREATMENT +semana. I-TREATMENT + I-TREATMENT + +Presentamos B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Von I-PAST_MEDICAL_HISTORY +Willebrand I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +hemorragia I-PAST_MEDICAL_HISTORY +digestiva I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +glomerulonefritis, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +DP I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2011. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tuvo I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +peritonitis, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +diciembre I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +2015 I-PAST_MEDICAL_HISTORY +recibiendo I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +vancomicina I-PAST_MEDICAL_HISTORY +intraperitoneal, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +peritonitis. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +elevación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +transaminasas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +bilirrubina. I-PRESENT_ILLNESS +Tras B-TREATMENT +la I-TREATMENT +suspensión I-TREATMENT +del I-TREATMENT +fármaco I-TREATMENT +hubo I-TREATMENT +mejoría I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +analítica. I-TREATMENT + I-TREATMENT +En I-TREATMENT +marzo I-TREATMENT +del I-TREATMENT +2016, I-TREATMENT +tuvo I-TREATMENT +nuevo I-TREATMENT +episodio I-TREATMENT +de I-TREATMENT +peritonitis, I-TREATMENT +decidiéndose I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +teicoplanina I-TREATMENT +y I-TREATMENT +tobramicina. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +estar I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +consulta I-EVOLUTION +por I-EVOLUTION +malestar I-EVOLUTION +generalizado, I-EVOLUTION +vómitos, I-EVOLUTION +diarrea, I-EVOLUTION +fiebre I-EVOLUTION +e I-EVOLUTION +ictericia. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +(ERC) I-PRESENT_ILLNESS +estadio I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +atribuida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nefroangioes-clerosis, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +hiperparatiroidismo I-PAST_MEDICAL_HISTORY +secundario, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +anémico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +leucemia I-PAST_MEDICAL_HISTORY +linfática I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +B, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +eligió I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +sustitutiva I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +DP I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +proceso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +toma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +decisión. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tiene I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +hijos I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +vive I-PAST_MEDICAL_HISTORY +acompañada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dos, I-PAST_MEDICAL_HISTORY +cuida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +nietos, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +sabe I-PAST_MEDICAL_HISTORY +leer I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +escribir, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +independiente I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +actividades I-PAST_MEDICAL_HISTORY +diarias I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +instrumentales: I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +(Enero I-PAST_MEDICAL_HISTORY +2014) I-PAST_MEDICAL_HISTORY += I-PAST_MEDICAL_HISTORY +Barthel I-PAST_MEDICAL_HISTORY +100%, I-PAST_MEDICAL_HISTORY +Lawton-Brody I-PAST_MEDICAL_HISTORY +8/8, I-PAST_MEDICAL_HISTORY +Calidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +(sf-12): I-PAST_MEDICAL_HISTORY +PCS I-PAST_MEDICAL_HISTORY +50.6, I-PAST_MEDICAL_HISTORY +MCS I-PAST_MEDICAL_HISTORY +59, I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +10/04/2013 B-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +catéter I-TREATMENT +peritoneal I-TREATMENT +e I-TREATMENT +inició I-TREATMENT +DPCA I-TREATMENT +en I-TREATMENT +domicilio I-TREATMENT +el I-TREATMENT +22/5/2013, I-TREATMENT +siendo I-TREATMENT +la I-TREATMENT +propia I-TREATMENT +paciente I-TREATMENT +la I-TREATMENT +cuidadora I-TREATMENT +principal. I-TREATMENT + I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +DPCA I-TREATMENT +inicial I-TREATMENT +fue I-TREATMENT +de: I-TREATMENT +3 I-TREATMENT +intercambios/ I-TREATMENT +día I-TREATMENT +(2 I-TREATMENT +con I-TREATMENT +Phisioneal I-TREATMENT +35 I-TREATMENT +1, I-TREATMENT +36% I-TREATMENT +de I-TREATMENT +glucosa I-TREATMENT +y I-TREATMENT +1 I-TREATMENT +con I-TREATMENT +Extraneal, I-TREATMENT +con I-TREATMENT +volúmenes I-TREATMENT +de I-TREATMENT +2000 I-TREATMENT +ml). I-TREATMENT +Diariamente I-TREATMENT +ultrafiltraba I-TREATMENT +500 I-TREATMENT +ml I-TREATMENT +con I-TREATMENT +los I-TREATMENT +intercambios I-TREATMENT +y I-TREATMENT +mantenía I-TREATMENT +un I-TREATMENT +volumen I-TREATMENT +de I-TREATMENT +diuresis I-TREATMENT +de I-TREATMENT +1500 I-TREATMENT +ml. I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +peritoneal I-EXPLORATION +antes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ultima I-EXPLORATION +peritonitis I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +membrana I-EXPLORATION +peritoneal I-EXPLORATION +HA I-EXPLORATION +(transportador I-EXPLORATION +medio I-EXPLORATION +alto). I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +presentó I-EVOLUTION +4 I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +peritonitis, I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +cuales I-EVOLUTION +3 I-EVOLUTION +fueron I-EVOLUTION +recidivante, I-EVOLUTION +con I-EVOLUTION +cultivo I-EVOLUTION +positivo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +bacteria I-EVOLUTION +(Staphylococcus I-EVOLUTION +epidermidis). I-EVOLUTION + I-EVOLUTION +Se B-TREATMENT +administró I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +protocolizado: I-TREATMENT +Vancomicina I-TREATMENT +1gr/72h I-TREATMENT +intraperitoneal I-TREATMENT +(IP) I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +Fluconazol I-TREATMENT +via I-TREATMENT +oral I-TREATMENT +(vo) I-TREATMENT +durante I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +resolución I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ultima I-TREATMENT +infección I-TREATMENT +peritoneal I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar, I-TREATMENT +además, I-TREATMENT +sellados I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +con I-TREATMENT +Daptomicina I-TREATMENT +(35 I-TREATMENT +mg I-TREATMENT +en I-TREATMENT +7, I-TREATMENT +2 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +ringer/24h I-TREATMENT +después I-TREATMENT +del I-TREATMENT +último I-TREATMENT +intercambio I-TREATMENT +del I-TREATMENT +día) I-TREATMENT +medicación I-TREATMENT +que I-TREATMENT +se I-TREATMENT +preparaba I-TREATMENT +en I-TREATMENT +el I-TREATMENT +hospital, I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +recogía I-TREATMENT +semanalmente I-TREATMENT +y I-TREATMENT +se I-TREATMENT +auto I-TREATMENT +administraba I-TREATMENT +después I-TREATMENT +del I-TREATMENT +último I-TREATMENT +intercambio I-TREATMENT +del I-TREATMENT +día I-TREATMENT +en I-TREATMENT +el I-TREATMENT +domicilio. I-TREATMENT + I-TREATMENT +Episodio B-EVOLUTION +de I-EVOLUTION +peritonitis I-EVOLUTION +fúngica: I-EVOLUTION + I-EVOLUTION +Durante I-EVOLUTION +el I-EVOLUTION +periodo I-EVOLUTION +de I-EVOLUTION +sellado I-EVOLUTION +(14/8/2014) I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +avisa I-EVOLUTION +al I-EVOLUTION +teléfono I-EVOLUTION +de I-EVOLUTION +urgencias, I-EVOLUTION +por I-EVOLUTION +líquido I-EVOLUTION +turbio, I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +malestar I-EVOLUTION +general. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +protocolizado I-EXPLORATION +y I-EXPLORATION +quedó I-EXPLORATION +ingresada I-EXPLORATION +en I-EXPLORATION +espera I-EXPLORATION +de I-EXPLORATION +resultados. I-EXPLORATION +Tras B-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +del I-TREATMENT +recuento I-TREATMENT +celular, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +Vancomicina I-TREATMENT +1gr/72h I-TREATMENT +y I-TREATMENT +Ceftazidima I-TREATMENT +1gr/24h I-TREATMENT +IP. I-TREATMENT +El B-EXPLORATION +cultivo I-EXPLORATION +mostró I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +BGN I-EXPLORATION +(Klebsiella I-EXPLORATION +oxytoca I-EXPLORATION +y I-EXPLORATION +Acinetobacter I-EXPLORATION +sp I-EXPLORATION +multisensible), I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Ceftazidima I-TREATMENT +1gr/24h/IP, I-TREATMENT +añadiéndose I-TREATMENT +Gentamicina I-TREATMENT +40mgr/24h/IP I-TREATMENT +y I-TREATMENT +Ciprofloxacino I-TREATMENT +500 I-TREATMENT +mg/12h I-TREATMENT +vo. I-TREATMENT + I-TREATMENT +Ante B-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +(efluente I-EVOLUTION +claro I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +problemas I-EVOLUTION +de I-EVOLUTION +drenaje) I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +domicilio. I-EVOLUTION +Se B-TREATMENT +realizó I-TREATMENT +reentrenamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +y I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +medicación I-TREATMENT +antibiótica I-TREATMENT +domiciliaria I-TREATMENT +(tratamiento I-TREATMENT +IP I-TREATMENT +durante I-TREATMENT +21 I-TREATMENT +días). I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +ocho I-EVOLUTION +días, I-EVOLUTION +acude I-EVOLUTION +nuevamente I-EVOLUTION +a I-EVOLUTION +urgencias I-EVOLUTION +por I-EVOLUTION +líquido I-EVOLUTION +turbio, I-EVOLUTION +apareciendo B-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +patógeno I-EXPLORATION +(Cándida I-EXPLORATION +parapsilosis) I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +añadió I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +Fluconazol I-TREATMENT +200 I-TREATMENT +mg I-TREATMENT +vo/24h, I-TREATMENT +y I-TREATMENT +quedó I-TREATMENT +nuevamente I-TREATMENT +ingresada. I-TREATMENT + I-TREATMENT +Debido B-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +mala I-EVOLUTION +respuesta I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +se B-TREATMENT +decidió I-TREATMENT +retirar I-TREATMENT +el I-TREATMENT +catéter I-TREATMENT +Tenckoff, I-TREATMENT +como I-TREATMENT +recomienda I-TREATMENT +el I-TREATMENT +protocolo, I-TREATMENT +y I-TREATMENT +transferirla I-TREATMENT +a I-TREATMENT +Hemodiálisis I-TREATMENT +definitivamente. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +coloco I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +venoso I-TREATMENT +bilumen I-TREATMENT +(yugular I-TREATMENT +derecho) I-TREATMENT +provisional, I-TREATMENT +en I-TREATMENT +espera I-TREATMENT +de I-TREATMENT +programar I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +de I-TREATMENT +fístula I-TREATMENT +arterio-venosa I-TREATMENT +interna I-TREATMENT +en I-TREATMENT +codo I-TREATMENT +derecho I-TREATMENT +(5/09/2014). I-TREATMENT + I-TREATMENT +Cinco B-EVOLUTION +días I-EVOLUTION +después, I-EVOLUTION +se I-EVOLUTION +recambió I-EVOLUTION +el I-EVOLUTION +catéter I-EVOLUTION +venoso I-EVOLUTION +por I-EVOLUTION +disfunción I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +visualizó I-EVOLUTION +mediante I-EVOLUTION +angio I-EVOLUTION +TAC, I-EVOLUTION +importante I-EVOLUTION +trombo I-EVOLUTION +en I-EVOLUTION +vena I-EVOLUTION +yugular I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +cirugía, I-TREATMENT +ingreso I-TREATMENT +en I-TREATMENT +cuidados I-TREATMENT +intensivos I-TREATMENT +y I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +catéter I-TREATMENT +(ubicación I-TREATMENT +femoral). I-TREATMENT +Este B-EVOLUTION +nuevo I-EVOLUTION +catéter, I-EVOLUTION +también, I-EVOLUTION +presentó I-EVOLUTION +trombosis I-EVOLUTION +venosa I-EVOLUTION +no I-EVOLUTION +oclusiva, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +anticoagulación I-TREATMENT +y I-TREATMENT +retirada I-TREATMENT +en I-TREATMENT +2-3 I-TREATMENT +semanas. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +utilización I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fistula I-EVOLUTION +arterio-venosa I-EVOLUTION +interna I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +intervención, I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +mala I-EVOLUTION +adaptación I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +de I-EVOLUTION +HD I-EVOLUTION +por I-EVOLUTION +continuas I-EVOLUTION +hipotensiones, I-EVOLUTION +dificultad I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +canalización I-EVOLUTION +venosa I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +por I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +"robo". I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +calidad I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +había I-EVOLUTION +empeorado I-EVOLUTION +notablemente, I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +ingreso I-EVOLUTION +de I-EVOLUTION +74 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +traspaso I-EVOLUTION +a I-EVOLUTION +hemodiálisis: I-EVOLUTION + I-EVOLUTION +(Octubre I-EVOLUTION +2014) I-EVOLUTION += I-EVOLUTION +Barthel I-EVOLUTION +95%, I-EVOLUTION +Lawton-Brody I-EVOLUTION +6/8, I-EVOLUTION +Calidad I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +(sf-12): I-EVOLUTION +PCS I-EVOLUTION +20, I-EVOLUTION +1, I-EVOLUTION +MCS I-EVOLUTION +40, I-EVOLUTION +3 I-EVOLUTION + I-EVOLUTION +Debido I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +complicaciones, I-EVOLUTION +la I-EVOLUTION +mala I-EVOLUTION +adaptación I-EVOLUTION +a I-EVOLUTION +HD I-EVOLUTION +y B-TREATMENT +por I-TREATMENT +petición I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +se I-TREATMENT +replanteó I-TREATMENT +volver I-TREATMENT +a I-TREATMENT +DP I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +cicladora I-TREATMENT +nocturna. I-TREATMENT + I-TREATMENT +Regreso I-TREATMENT +a I-TREATMENT +Dialisis I-TREATMENT +Peritoneal: I-TREATMENT + I-TREATMENT +Así I-TREATMENT +pues, I-TREATMENT +el I-TREATMENT +19/12/14 I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +catéter I-TREATMENT +Tenckoff I-TREATMENT +(vía I-TREATMENT +laparoscopia I-TREATMENT +para I-TREATMENT +poder I-TREATMENT +valorar I-TREATMENT +las I-TREATMENT +posibles I-TREATMENT +adherencias, I-TREATMENT +que I-TREATMENT +pueden I-TREATMENT +aparecer I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +peritonitis I-TREATMENT +fúngicas) I-TREATMENT +y I-TREATMENT +como I-TREATMENT +no I-TREATMENT +hubieron I-TREATMENT +problemas, I-TREATMENT +en I-TREATMENT +1 I-TREATMENT +mes I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +reinició I-TREATMENT +terapia I-TREATMENT +domiciliaria I-TREATMENT +de I-TREATMENT +diálisis I-TREATMENT +peritoneal I-TREATMENT +automática I-TREATMENT +(DPA). I-TREATMENT +Como I-TREATMENT +cuidador I-TREATMENT +principal I-TREATMENT +quedó I-TREATMENT +la I-TREATMENT +hija I-TREATMENT +menor I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +que I-TREATMENT +aunque I-TREATMENT +no I-TREATMENT +vive I-TREATMENT +con I-TREATMENT +ella I-TREATMENT +realizaba I-TREATMENT +el I-TREATMENT +montaje I-TREATMENT +y I-TREATMENT +conexión I-TREATMENT +desplazándose I-TREATMENT +al I-TREATMENT +domicilio I-TREATMENT +diariamente. I-TREATMENT +La I-TREATMENT +desconexión, I-TREATMENT +solución I-TREATMENT +de I-TREATMENT +alarmas I-TREATMENT +nocturnas I-TREATMENT +y I-TREATMENT +desmontaje I-TREATMENT +de I-TREATMENT +la I-TREATMENT +maquina, I-TREATMENT +lo I-TREATMENT +realiza I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +sin I-TREATMENT +supervisión. I-TREATMENT + I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +pautado I-TREATMENT +con I-TREATMENT +cicladora I-TREATMENT +fue I-TREATMENT +de: I-TREATMENT +8 I-TREATMENT +horas, I-TREATMENT +4 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +2000 I-TREATMENT +ml I-TREATMENT +(Phisioneal I-TREATMENT +35 I-TREATMENT +1, I-TREATMENT +36%), I-TREATMENT +80 I-TREATMENT +minutos I-TREATMENT +de I-TREATMENT +permanencia I-TREATMENT +y I-TREATMENT +día I-TREATMENT +seco. I-TREATMENT + I-TREATMENT +Diariamente B-EVOLUTION +tiene I-EVOLUTION +una I-EVOLUTION +ultrafiltrafiltración I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +de I-EVOLUTION +400-500 I-EVOLUTION +ml I-EVOLUTION +y I-EVOLUTION +mantiene I-EVOLUTION +un I-EVOLUTION +volumen I-EVOLUTION +de I-EVOLUTION +diuresis I-EVOLUTION +de I-EVOLUTION +1500 I-EVOLUTION +ml. I-EVOLUTION +El I-EVOLUTION +test I-EVOLUTION +de I-EVOLUTION +equilibrio I-EVOLUTION +peritoneal I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +igual I-EVOLUTION +que I-EVOLUTION +al I-EVOLUTION +inicio. I-EVOLUTION + I-EVOLUTION +Actualmente I-EVOLUTION +lleva I-EVOLUTION +> I-EVOLUTION +de I-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +sin I-EVOLUTION +ningún I-EVOLUTION +tipo I-EVOLUTION +de I-EVOLUTION +problema, I-EVOLUTION +recuperando I-EVOLUTION +prácticamente I-EVOLUTION +la I-EVOLUTION +autonomía I-EVOLUTION +y I-EVOLUTION +calidad I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +del I-EVOLUTION +inicio: I-EVOLUTION + I-EVOLUTION +(Septiembre I-EVOLUTION +2015) I-EVOLUTION += I-EVOLUTION +Barthel I-EVOLUTION +100%, I-EVOLUTION +Lawton-Brody I-EVOLUTION +8/8, I-EVOLUTION +Calidad I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +(sf-12): I-EVOLUTION +PCS I-EVOLUTION +43, I-EVOLUTION +6, I-EVOLUTION +MCS I-EVOLUTION +51, I-EVOLUTION +5 I-EVOLUTION + I-EVOLUTION +Las B-TREATMENT +guías I-TREATMENT +SEN I-TREATMENT +recomiendan I-TREATMENT +realizar I-TREATMENT +reentrenamiento I-TREATMENT +después I-TREATMENT +de I-TREATMENT +cada I-TREATMENT +episodio I-TREATMENT +de I-TREATMENT +peritonitis. I-TREATMENT +El I-TREATMENT +objetivo I-TREATMENT +es I-TREATMENT +buscar I-TREATMENT +causas I-TREATMENT +posibles, I-TREATMENT +evaluar I-TREATMENT +la I-TREATMENT +capacitación I-TREATMENT +del I-TREATMENT +responsable I-TREATMENT +y I-TREATMENT +rectificar I-TREATMENT +aquellos I-TREATMENT +procedimientos I-TREATMENT +erróneos. I-TREATMENT +Esta I-TREATMENT +metodología I-TREATMENT +nos I-TREATMENT +ayuda I-TREATMENT +a I-TREATMENT +revelar I-TREATMENT +la I-TREATMENT +posible I-TREATMENT +causa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +infección. I-TREATMENT +En I-TREATMENT +nuestro I-TREATMENT +caso, I-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +indicó I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +había I-TREATMENT +seguido I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +de I-TREATMENT +asepsia I-TREATMENT +recomendadas I-TREATMENT +en I-TREATMENT +la I-TREATMENT +manipulación I-TREATMENT +del I-TREATMENT +antibiótico I-TREATMENT +para I-TREATMENT +el I-TREATMENT +sellado. I-TREATMENT + I-TREATMENT +Con I-TREATMENT +el I-TREATMENT +primer I-TREATMENT +resultado I-TREATMENT +del I-TREATMENT +cultivo I-TREATMENT +del I-TREATMENT +líquido I-TREATMENT +peritoneal I-TREATMENT +se I-TREATMENT +diagnosticó I-TREATMENT +la I-TREATMENT +peritonitis I-TREATMENT +bacteriana, I-TREATMENT +pero I-TREATMENT +acabo I-TREATMENT +añadiendose, I-TREATMENT +también, I-TREATMENT +una I-TREATMENT +peritonitis I-TREATMENT +fúngica. I-TREATMENT +Así I-TREATMENT +pues, I-TREATMENT +la I-TREATMENT +infección I-TREATMENT +fúngica I-TREATMENT +condicionó I-TREATMENT +la I-TREATMENT +retirada I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +peritoneal I-TREATMENT +y I-TREATMENT +el I-TREATMENT +abandono I-TREATMENT +del I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +diálisis I-TREATMENT +peritoneal. I-TREATMENT +El I-TREATMENT +equipo I-TREATMENT +multidisciplinar I-TREATMENT +tomó I-TREATMENT +la I-TREATMENT +decisión I-TREATMENT +de I-TREATMENT +transferirla I-TREATMENT +a I-TREATMENT +HD I-TREATMENT +definitivamente I-TREATMENT +tras I-TREATMENT +el I-TREATMENT +diagnostico I-TREATMENT +de I-TREATMENT +peritonitis I-TREATMENT +fúngica. I-TREATMENT + I-TREATMENT +Muchos I-TREATMENT +autores I-TREATMENT +describen I-TREATMENT +que I-TREATMENT +la I-TREATMENT +supervivencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +tras I-TREATMENT +una I-TREATMENT +peritonitis I-TREATMENT +fúngica I-TREATMENT +por I-TREATMENT +Candidas I-TREATMENT +no I-TREATMENT +Albicans I-TREATMENT +es I-TREATMENT +muy I-TREATMENT +baja, I-TREATMENT +y I-TREATMENT +además I-TREATMENT +existen I-TREATMENT +pocos I-TREATMENT +pacientes I-TREATMENT +que I-TREATMENT +pueden I-TREATMENT +retornar I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +DP I-TREATMENT +tras I-TREATMENT +el I-TREATMENT +suceso, I-TREATMENT +así I-TREATMENT +lo I-TREATMENT +describen I-TREATMENT +García-Martos1, I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +Molina3 I-TREATMENT +en I-TREATMENT +sus I-TREATMENT +estudios. I-TREATMENT + I-TREATMENT +Las I-TREATMENT +causas I-TREATMENT +de I-TREATMENT +que I-TREATMENT +nos I-TREATMENT +planteáramos I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +volviera I-TREATMENT +a I-TREATMENT +DP, I-TREATMENT +fueron: I-TREATMENT +la I-TREATMENT +mala I-TREATMENT +adaptación I-TREATMENT +a I-TREATMENT +la I-TREATMENT +HD, I-TREATMENT +las I-TREATMENT +complicaciones I-TREATMENT +surgidas I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +traspaso I-TREATMENT +a I-TREATMENT +hemodiálisis I-TREATMENT +y I-TREATMENT +la I-TREATMENT +petición I-TREATMENT +de I-TREATMENT +la I-TREATMENT +propia I-TREATMENT +paciente. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +tuvo I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +la I-TREATMENT +recomendación I-TREATMENT +de I-TREATMENT +las I-TREATMENT +guías I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +reinserción I-TREATMENT +de I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +catéter I-TREATMENT +peritoneal I-TREATMENT +a I-TREATMENT +las I-TREATMENT +4-6 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +resolución I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +clínico. I-TREATMENT + I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +tomada I-TREATMENT +la I-TREATMENT +decisión I-TREATMENT +de I-TREATMENT +regresar I-TREATMENT +al I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +DP, I-TREATMENT +estaba I-TREATMENT +claro I-TREATMENT +que I-TREATMENT +era I-TREATMENT +necesario I-TREATMENT +un I-TREATMENT +cambio I-TREATMENT +de I-TREATMENT +estrategia, I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +que I-TREATMENT +se I-TREATMENT +propuso I-TREATMENT +iniciar I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +de I-TREATMENT +cicladora I-TREATMENT +automática, I-TREATMENT +con I-TREATMENT +la I-TREATMENT +finalidad I-TREATMENT +de I-TREATMENT +disminuir I-TREATMENT +el I-TREATMENT +número I-TREATMENT +de I-TREATMENT +manipulaciones I-TREATMENT +del I-TREATMENT +paciente/familia I-TREATMENT +con I-TREATMENT +el I-TREATMENT +catéter. I-TREATMENT +Pero I-TREATMENT +también, I-TREATMENT +era I-TREATMENT +imprescindible I-TREATMENT +evitar I-TREATMENT +nuevos I-TREATMENT +episodios I-TREATMENT +de I-TREATMENT +infección, I-TREATMENT +por I-TREATMENT +eso, I-TREATMENT +se I-TREATMENT +pensó I-TREATMENT +en I-TREATMENT +buscar I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +responsable I-TREATMENT +para I-TREATMENT +realizar I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +y I-TREATMENT +todo I-TREATMENT +ello I-TREATMENT +nos I-TREATMENT +condujo I-TREATMENT +a I-TREATMENT +reiniciar I-TREATMENT +el I-TREATMENT +proceso I-TREATMENT +de I-TREATMENT +entrenamiento I-TREATMENT +con I-TREATMENT +la I-TREATMENT +hija I-TREATMENT +y I-TREATMENT +puesta I-TREATMENT +en I-TREATMENT +marcha I-TREATMENT +de I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +en I-TREATMENT +casa. I-TREATMENT + I-TREATMENT +