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 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 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 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 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 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 varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS caucásico, I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY CUC I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY compatible. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY mesalazina I-PAST_MEDICAL_HISTORY 1.000 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY c/8 I-PAST_MEDICAL_HISTORY h I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY prednisona I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY decrecientes I-PAST_MEDICAL_HISTORY (5 I-PAST_MEDICAL_HISTORY mg/día), I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY actividad I-PAST_MEDICAL_HISTORY inflamatoria I-PAST_MEDICAL_HISTORY actual. I-PAST_MEDICAL_HISTORY Tres B-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS intensa I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS agregándose I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS trastorno I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lenguaje. I-PRESENT_ILLNESS Sin I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS fotofobia I-PRESENT_ILLNESS o I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS visuales. I-PRESENT_ILLNESS No B-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION signología I-EXPLORATION focal I-EXPLORATION ni I-EXPLORATION movimientos I-EXPLORATION anormales. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION examen, I-EXPLORATION afebril, I-EXPLORATION normotenso, I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION 98% I-EXPLORATION ambiental, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION perfusión. I-EXPLORATION Ritmo I-EXPLORATION cardiaco I-EXPLORATION regular I-EXPLORATION de I-EXPLORATION 88 I-EXPLORATION lpm. I-EXPLORATION Sin I-EXPLORATION alteraciones I-EXPLORATION pleuropulmonares. I-EXPLORATION Abdomen I-EXPLORATION indoloro. I-EXPLORATION Neurológicamente I-EXPLORATION estaba I-EXPLORATION vigil I-EXPLORATION pero I-EXPLORATION confuso, I-EXPLORATION con I-EXPLORATION afasia I-EXPLORATION fluente I-EXPLORATION y I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION comprensión. I-EXPLORATION Sin I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION oculomotricidad. I-EXPLORATION Sector I-EXPLORATION espinal I-EXPLORATION y I-EXPLORATION meníngeo I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Valoración I-EXPLORATION general I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION sin I-EXPLORATION elementos I-EXPLORATION a I-EXPLORATION destacar. I-EXPLORATION I-EXPLORATION Tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION encéfalo I-EXPLORATION mostró I-EXPLORATION imagen I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION cortical I-EXPLORATION con I-EXPLORATION infarto I-EXPLORATION parenquimatoso I-EXPLORATION temporo-basal I-EXPLORATION izquierdo. I-EXPLORATION Resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION con I-EXPLORATION angiorresonancia I-EXPLORATION en I-EXPLORATION tiempo I-EXPLORATION venoso I-EXPLORATION informó I-EXPLORATION infarto I-EXPLORATION hemorrágico I-EXPLORATION temporal I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION seno I-EXPLORATION venoso I-EXPLORATION sigmoideo I-EXPLORATION homolateral.. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION búsqueda I-EXPLORATION de I-EXPLORATION trombofilias I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (proteínas I-EXPLORATION C, I-EXPLORATION S, I-EXPLORATION antitrombina I-EXPLORATION III, I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION activada, I-EXPLORATION homocisteinemia, I-EXPLORATION factor I-EXPLORATION 20210A, I-EXPLORATION FV I-EXPLORATION Leiden, I-EXPLORATION metil I-EXPLORATION tetra I-EXPLORATION hidro I-EXPLORATION folato I-EXPLORATION reductasa, I-EXPLORATION lipoproteína I-EXPLORATION (a), I-EXPLORATION factor I-EXPLORATION VIII, I-EXPLORATION anticuerpos I-EXPLORATION anticardiolipinas, I-EXPLORATION anti I-EXPLORATION beta2 I-EXPLORATION glicoproteína, I-EXPLORATION inhibidor I-EXPLORATION lúpico, I-EXPLORATION inhibidor I-EXPLORATION del I-EXPLORATION activador I-EXPLORATION tisular I-EXPLORATION del I-EXPLORATION plasminógeno). I-EXPLORATION Todos I-EXPLORATION fueron I-EXPLORATION solicitados I-EXPLORATION posteriormente I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION del I-EXPLORATION tratamiento I-EXPLORATION anticoagulante. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT anticoagulación I-TREATMENT con I-TREATMENT enoxaparina I-TREATMENT (1 I-TREATMENT mg/Kg I-TREATMENT subcutánea I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h) I-TREATMENT con I-TREATMENT buena I-TREATMENT evolución. I-TREATMENT Se I-TREATMENT mantuvo I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT CUC I-TREATMENT con I-TREATMENT mesalazina I-TREATMENT y I-TREATMENT prednisona. I-TREATMENT Se B-EVOLUTION otorgó I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION 10º I-EVOLUTION día, I-EVOLUTION asintomático, I-EVOLUTION continuando B-TREATMENT anticoagulación I-TREATMENT con I-TREATMENT enoxaparina I-TREATMENT subcutánea I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT con I-TREATMENT dicumarínicos I-TREATMENT por I-TREATMENT vía I-TREATMENT oral. I-TREATMENT I-TREATMENT 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 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 Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS había I-PRESENT_ILLNESS consultado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 38º I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nauseas, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS kilogramos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY exfumador, I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatopatía I-PAST_MEDICAL_HISTORY criptogenética, I-PAST_MEDICAL_HISTORY taquicardia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY aberrante I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY ablación I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY angor I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY coronariografía I-PAST_MEDICAL_HISTORY normal, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY ansioso-depresivo I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ulcus I-PAST_MEDICAL_HISTORY duodenal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY apendicitis. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY viajes I-PAST_MEDICAL_HISTORY recientemente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY prácticas I-PAST_MEDICAL_HISTORY sexuales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION clínico I-EXPLORATION se I-EXPLORATION objetivaba I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 39, I-EXPLORATION 7 I-EXPLORATION ºC, I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION hepatomegalia I-EXPLORATION a I-EXPLORATION unos I-EXPLORATION 3-4 I-EXPLORATION centímetros I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION costal, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION cuanto I-EXPLORATION a I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION destacaban I-EXPLORATION 15.900/mm3 I-EXPLORATION leucocitos I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION izquierda, I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 10.5 I-EXPLORATION g/dl I-EXPLORATION y I-EXPLORATION una I-EXPLORATION VSG I-EXPLORATION de I-EXPLORATION 101 I-EXPLORATION mm. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION hepáticos: I-EXPLORATION GOT I-EXPLORATION 101 I-EXPLORATION U/l, I-EXPLORATION GPT I-EXPLORATION 128 I-EXPLORATION U/l, I-EXPLORATION FA I-EXPLORATION 208 I-EXPLORATION U/l, I-EXPLORATION GGT I-EXPLORATION 172 I-EXPLORATION U/l, I-EXPLORATION LDH I-EXPLORATION 1366 I-EXPLORATION UI/l. I-EXPLORATION La I-EXPLORATION PCR I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION asimismo I-EXPLORATION elevada. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION sistemático I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION Mantoux I-EXPLORATION negativo. I-EXPLORATION Serologías I-EXPLORATION de I-EXPLORATION Brucella, I-EXPLORATION Leishmania, I-EXPLORATION C. I-EXPLORATION Burnetti, I-EXPLORATION lúes, I-EXPLORATION Salmonella, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hepatitis I-EXPLORATION A, I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION y I-EXPLORATION VIH I-EXPLORATION negativos. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION serologías I-EXPLORATION de I-EXPLORATION citomegalovirus, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein-Barr I-EXPLORATION y I-EXPLORATION toxoplasma I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION IgG I-EXPLORATION + I-EXPLORATION y I-EXPLORATION IgM I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Hemocultivos I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION ambulatorio I-EXPLORATION y I-EXPLORATION hospitalizado I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION hígado, I-EXPLORATION vía I-EXPLORATION biliar, I-EXPLORATION vesícula, I-EXPLORATION porción I-EXPLORATION visible I-EXPLORATION de I-EXPLORATION retroperitoneo I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION porta I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION ecográficos I-EXPLORATION significativos. I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION efectúo I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION un I-EXPLORATION extenso I-EXPLORATION engrosamiento I-EXPLORATION mamelonado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION y I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 12 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud, I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION de I-EXPLORATION colon; I-EXPLORATION gran I-EXPLORATION lesión I-EXPLORATION sólida I-EXPLORATION con I-EXPLORATION captación I-EXPLORATION heterogénea I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo I-EXPLORATION segmento I-EXPLORATION IV, I-EXPLORATION sugestiva I-EXPLORATION de I-EXPLORATION metástasis. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION en I-EXPLORATION "corazón I-EXPLORATION de I-EXPLORATION manzana" I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION con I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION en I-EXPLORATION un I-EXPLORATION tramo I-EXPLORATION aproximadamente I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION centímetros. I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION circunferencial I-EXPLORATION a I-EXPLORATION 110 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION ano I-EXPLORATION que I-EXPLORATION impedía I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio, I-EXPLORATION tomándose I-EXPLORATION biopsias. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION granulación I-EXPLORATION y I-EXPLORATION tejido I-EXPLORATION conectivo I-EXPLORATION en I-EXPLORATION los I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION densos I-EXPLORATION infiltrados I-EXPLORATION linfocitarios I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION CD20+ I-EXPLORATION que I-EXPLORATION con I-EXPLORATION frecuencia I-EXPLORATION expresaban I-EXPLORATION tinción I-EXPLORATION nuclear I-EXPLORATION bcl-6. I-EXPLORATION Los I-EXPLORATION cambios I-EXPLORATION morfológicos I-EXPLORATION sugerían I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION tipo I-EXPLORATION B I-EXPLORATION aunque I-EXPLORATION no I-EXPLORATION era I-EXPLORATION concluyente I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION PAAF I-EXPLORATION hepática I-EXPLORATION confirmando I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION linfoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes I-EXPLORATION difuso I-EXPLORATION tipo I-EXPLORATION B. I-EXPLORATION I-EXPLORATION Posteriormente B-DERIVED_FROM/TO se I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO hematología, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO inició I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO de I-DERIVED_FROM/TO quimioterapia I-DERIVED_FROM/TO siguiendo I-DERIVED_FROM/TO el I-DERIVED_FROM/TO esquema I-DERIVED_FROM/TO CHOP I-DERIVED_FROM/TO (ciclofosfamida, I-DERIVED_FROM/TO doxorrubicina, I-DERIVED_FROM/TO vincristina I-DERIVED_FROM/TO y I-DERIVED_FROM/TO prednisona) I-DERIVED_FROM/TO y I-DERIVED_FROM/TO de I-DERIVED_FROM/TO momento I-DERIVED_FROM/TO no I-DERIVED_FROM/TO tenemos I-DERIVED_FROM/TO datos I-DERIVED_FROM/TO sobre I-DERIVED_FROM/TO la I-DERIVED_FROM/TO eventual I-DERIVED_FROM/TO respuesta I-DERIVED_FROM/TO tumoral. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY residencia I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY IX I-PAST_MEDICAL_HISTORY región. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS manifestaciones I-PRESENT_ILLNESS clínicas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS hipertensión I-PRESENT_ILLNESS intracraneana I-PRESENT_ILLNESS (cefalea I-PRESENT_ILLNESS holocránea I-PRESENT_ILLNESS recurrente I-PRESENT_ILLNESS [2-3 I-PRESENT_ILLNESS veces I-PRESENT_ILLNESS por I-PRESENT_ILLNESS semana], I-PRESENT_ILLNESS mareos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS ocasionales) I-PRESENT_ILLNESS e I-PRESENT_ILLNESS irritativa I-PRESENT_ILLNESS (dos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS convulsivas I-PRESENT_ILLNESS tónico-clónicas I-PRESENT_ILLNESS generalizadas). I-PRESENT_ILLNESS El B-EXPLORATION electroencefalograma I-EXPLORATION (EEG) I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION cerebral I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION quiste I-EXPLORATION intraxial I-EXPLORATION temporal I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION bien I-EXPLORATION delimitado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION severo I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa, I-EXPLORATION desviación I-EXPLORATION de I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION mm, I-EXPLORATION herniación I-EXPLORATION uncal I-EXPLORATION e I-EXPLORATION hidrocefalia. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION mostró I-EXPLORATION además I-EXPLORATION un I-EXPLORATION doble I-EXPLORATION contorno I-EXPLORATION en I-EXPLORATION la I-EXPLORATION periferia, I-EXPLORATION por I-EXPLORATION desprendimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION germinal, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION ligera I-EXPLORATION impregnación I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION gadolinio. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION demostró I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION papila I-EXPLORATION bilateral, I-EXPLORATION sin I-EXPLORATION evidenciarse I-EXPLORATION déficit I-EXPLORATION motor I-EXPLORATION ni I-EXPLORATION sensitivo I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico. I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION resultaron I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION demostrarse I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION quísticas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION (Rx) I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecotomografía I-EXPLORATION abdominal. I-EXPLORATION Se B-TREATMENT planteó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT hidatidosis I-TREATMENT cerebral I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT exéresis I-TREATMENT completa I-TREATMENT e I-TREATMENT intacta I-TREATMENT del I-TREATMENT quiste, I-TREATMENT confirmando I-TREATMENT el I-TREATMENT estudio I-TREATMENT histopatológico I-TREATMENT la I-TREATMENT etiología I-TREATMENT hidatídica I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION asintomático, I-EVOLUTION sin I-EVOLUTION déficit I-EVOLUTION neurológico I-EVOLUTION ni I-EVOLUTION complicaciones I-EVOLUTION post I-EVOLUTION operatorias. I-EVOLUTION I-EVOLUTION 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 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 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 Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipo I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS dispepsia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS plenitud I-PRESENT_ILLNESS postprandrial. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY laparotomía I-PAST_MEDICAL_HISTORY exploradora I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 14 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY abdominal, I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY desconocemos I-PAST_MEDICAL_HISTORY datos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY haberse I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY centro. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION ocupación I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION hemiabdomen I-EXPLORATION derecho I-EXPLORATION por I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica, I-EXPLORATION a I-EXPLORATION tensión, I-EXPLORATION indolora I-EXPLORATION y I-EXPLORATION mate I-EXPLORATION a I-EXPLORATION la I-EXPLORATION percusión I-EXPLORATION que I-EXPLORATION sobrepasaba I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION de I-EXPLORATION rutina I-EXPLORATION que I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION un I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 13 I-EXPLORATION x I-EXPLORATION 106 I-EXPLORATION hematíes, I-EXPLORATION 20.5 I-EXPLORATION g/dl I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION y I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 65.9%, I-EXPLORATION con I-EXPLORATION cifras I-EXPLORATION similares I-EXPLORATION en I-EXPLORATION el I-EXPLORATION preoperatorio I-EXPLORATION inmediato. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION hidronefrosis I-EXPLORATION masiva I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION ectasia I-EXPLORATION pielocalicial I-EXPLORATION masiva I-EXPLORATION con I-EXPLORATION prácticamente I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION cortical, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION hemiabdomen I-EXPLORATION derecho, I-EXPLORATION sobrepasando I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION hasta I-EXPLORATION contactar I-EXPLORATION con I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION en I-EXPLORATION herradura I-EXPLORATION I-EXPLORATION Se B-TREATMENT practicó, I-TREATMENT por I-TREATMENT lumbotomía, I-TREATMENT nefrectomía I-TREATMENT derecha I-TREATMENT de I-TREATMENT un I-TREATMENT gran I-TREATMENT riñón I-TREATMENT hidronefrótico I-TREATMENT secundario I-TREATMENT a I-TREATMENT estenosis I-TREATMENT de I-TREATMENT la I-TREATMENT unión I-TREATMENT pieloureteral, I-TREATMENT cursando I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION hidronefrótico I-EXPLORATION con I-EXPLORATION atrofia I-EXPLORATION cortical I-EXPLORATION marcada. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION al I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION Hemoglobina I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION g/dl, I-EXPLORATION 4, I-EXPLORATION 6 I-EXPLORATION millones I-EXPLORATION de I-EXPLORATION eritrocitos I-EXPLORATION y I-EXPLORATION 43, I-EXPLORATION 7% I-EXPLORATION de I-EXPLORATION hematocrito. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION otro I-EXPLORATION hemograma I-EXPLORATION 10 I-EXPLORATION meses I-EXPLORATION después I-EXPLORATION evidenciándose I-EXPLORATION una I-EXPLORATION normalización I-EXPLORATION del I-EXPLORATION recuento I-EXPLORATION eritrocitario. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumadora B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY cigarrillos/día, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY poliquistosis I-PAST_MEDICAL_HISTORY hepatorrenal I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY (con I-PAST_MEDICAL_HISTORY aclaramiento I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY ml/min I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY proteinuria). I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY patológico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS que I-PRESENT_ILLNESS requiere I-PRESENT_ILLNESS ingreso. I-PRESENT_ILLNESS Inicialmente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS orienta I-PRESENT_ILLNESS como I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS quística. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION ecografía I-EXPLORATION reno-vesical I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION poliquistosis I-EXPLORATION hepatorrenal, I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION desestructuración I-EXPLORATION parenquimatosa I-EXPLORATION renal I-EXPLORATION por I-EXPLORATION quistes, I-EXPLORATION preferentemente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION contralateral, I-EXPLORATION Existe I-EXPLORATION una I-EXPLORATION ecogenicidad I-EXPLORATION heterogénea I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION preservado I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION turgencia I-EXPLORATION parenquimatosa I-EXPLORATION y I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION desdibujamiento I-EXPLORATION sinusal I-EXPLORATION izquierdo I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION ecogénico I-EXPLORATION que I-EXPLORATION ejerce I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION y I-EXPLORATION se I-EXPLORATION proyecta I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION pelvis I-EXPLORATION renal. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION poca I-EXPLORATION especificidad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION ecográficos I-EXPLORATION se I-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION mediante I-EXPLORATION TC I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION nuevamente I-EXPLORATION desestructuración I-EXPLORATION renal I-EXPLORATION bilateral I-EXPLORATION por I-EXPLORATION poliquistosis, I-EXPLORATION con I-EXPLORATION algunos I-EXPLORATION quistes I-EXPLORATION hiperdensos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION basal I-EXPLORATION realizado I-EXPLORATION sin I-EXPLORATION contraste I-EXPLORATION endovenoso. I-EXPLORATION La I-EXPLORATION afectación I-EXPLORATION es I-EXPLORATION asimétrica, I-EXPLORATION más I-EXPLORATION intensa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo, I-EXPLORATION siendo I-EXPLORATION dicho I-EXPLORATION riñón I-EXPLORATION de I-EXPLORATION mayor I-EXPLORATION tamaño. I-EXPLORATION La I-EXPLORATION región I-EXPLORATION piélica I-EXPLORATION izquierda I-EXPLORATION está I-EXPLORATION ocupada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION realce I-EXPLORATION moderado I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION endovenosa I-EXPLORATION de I-EXPLORATION contraste, I-EXPLORATION sin I-EXPLORATION definición I-EXPLORATION clara I-EXPLORATION de I-EXPLORATION sus I-EXPLORATION límites. I-EXPLORATION Funcionalmente I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION evidente I-EXPLORATION retraso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION eliminación I-EXPLORATION del I-EXPLORATION contraste I-EXPLORATION endovenoso I-EXPLORATION en I-EXPLORATION las I-EXPLORATION secciones I-EXPLORATION realizadas I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION retardada. I-EXPLORATION El I-EXPLORATION conjunto I-EXPLORATION de I-EXPLORATION hallazgos I-EXPLORATION sugiere I-EXPLORATION ocupación I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pelvis I-EXPLORATION renal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION poliquistosis I-EXPLORATION con I-EXPLORATION alteración I-EXPLORATION funcional I-EXPLORATION secundaria. I-EXPLORATION Se I-EXPLORATION observan I-EXPLORATION ganglios I-EXPLORATION retroperitoneales I-EXPLORATION no I-EXPLORATION aumentados I-EXPLORATION significativamente I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION situación I-EXPLORATION interaortocava I-EXPLORATION y I-EXPLORATION retroaórtica. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT clínico I-TREATMENT de I-TREATMENT masa I-TREATMENT renal I-TREATMENT compatible I-TREATMENT con I-TREATMENT proceso I-TREATMENT neoformativo, I-TREATMENT se I-TREATMENT realiza I-TREATMENT nefrectomía I-TREATMENT radical I-TREATMENT izquierda, I-TREATMENT con I-TREATMENT suprarrenalectomía I-TREATMENT izquierda I-TREATMENT más I-TREATMENT linfadenectomía I-TREATMENT aortocava, I-TREATMENT sin I-TREATMENT incidencias I-TREATMENT ni I-TREATMENT complicaciones I-TREATMENT inmediatas. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION no I-EVOLUTION surgen I-EVOLUTION complicaciones, I-EVOLUTION con I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION estable. I-EVOLUTION Un I-EVOLUTION mes I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION nefrectomía, I-EVOLUTION el I-EVOLUTION aclaramiento I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 52 I-EVOLUTION ml/min I-EVOLUTION y I-EVOLUTION aparece I-EVOLUTION proteinuria I-EVOLUTION de I-EVOLUTION 0, I-EVOLUTION 16 I-EVOLUTION g/24 I-EVOLUTION h. I-EVOLUTION I-EVOLUTION En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION anátomo-patológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza, I-EXPLORATION macroscópicamente I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION renal I-EXPLORATION blanquecina, I-EXPLORATION firme, I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 8, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION cm., I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION mal I-EXPLORATION definidos, I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION área I-EXPLORATION central I-EXPLORATION de I-EXPLORATION necrosis. I-EXPLORATION Está I-EXPLORATION situada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION central I-EXPLORATION renal, I-EXPLORATION afectando I-EXPLORATION la I-EXPLORATION práctica I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION parénquima, I-EXPLORATION alcanzando I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION perirrenal I-EXPLORATION y I-EXPLORATION rodeando I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION suprarrenal. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hilio I-EXPLORATION renal I-EXPLORATION se I-EXPLORATION identifican I-EXPLORATION cuatro I-EXPLORATION ganglios I-EXPLORATION linfáticos. I-EXPLORATION El I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION no I-EXPLORATION tumoral I-EXPLORATION está I-EXPLORATION totalmente I-EXPLORATION desestructurado I-EXPLORATION y I-EXPLORATION sustituido I-EXPLORATION por I-EXPLORATION múltiples I-EXPLORATION quistes I-EXPLORATION de I-EXPLORATION hasta I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION y I-EXPLORATION que I-EXPLORATION afectan I-EXPLORATION tanto I-EXPLORATION corteza I-EXPLORATION como I-EXPLORATION médula I-EXPLORATION renal. I-EXPLORATION Histológicamente, I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION está I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION células I-EXPLORATION de I-EXPLORATION citoplasma I-EXPLORATION amplio I-EXPLORATION y I-EXPLORATION eosinófilo, I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION redondeados I-EXPLORATION con I-EXPLORATION marcada I-EXPLORATION atipia, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION organizan I-EXPLORATION en I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION sólido I-EXPLORATION cohesivo, I-EXPLORATION característico I-EXPLORATION de I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION escamoso I-EXPLORATION pobremente I-EXPLORATION diferenciado. I-EXPLORATION Son I-EXPLORATION extensas I-EXPLORATION las I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION tumoral. I-EXPLORATION El I-EXPLORATION tumor I-EXPLORATION afecta I-EXPLORATION uréter I-EXPLORATION proximal, I-EXPLORATION pelvis I-EXPLORATION renal, I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION tanto I-EXPLORATION perirrenal I-EXPLORATION como I-EXPLORATION perihiliar. I-EXPLORATION Se I-EXPLORATION objetiva I-EXPLORATION infiltración I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION extensa I-EXPLORATION infiltración I-EXPLORATION tumoral I-EXPLORATION perineural I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION ganglios I-EXPLORATION simpáticos I-EXPLORATION del I-EXPLORATION hilio I-EXPLORATION renal. I-EXPLORATION La I-EXPLORATION masa I-EXPLORATION tumoral I-EXPLORATION está I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION carcinoma I-EXPLORATION escamoso, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cual, I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION área I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION urotelial I-EXPLORATION papilar I-EXPLORATION intraureteral. I-EXPLORATION Se I-EXPLORATION identifica I-EXPLORATION metástasis I-EXPLORATION del I-EXPLORATION carcinoma I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuatro I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION hiliares I-EXPLORATION identificados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pieza. I-EXPLORATION Los I-EXPLORATION márgenes I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION quirúrgica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza, I-EXPLORATION son I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION linfadenectomía I-EXPLORATION paraórtica I-EXPLORATION se I-EXPLORATION identifican I-EXPLORATION 6 I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION neoplásica. I-EXPLORATION En I-EXPLORATION resumen, I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION anátomo-patológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION es I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION escamoso I-EXPLORATION pobremente I-EXPLORATION diferenciado I-EXPLORATION originado I-EXPLORATION en I-EXPLORATION pelvis I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION uréter, I-EXPLORATION categoría I-EXPLORATION pT4pN2, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION renal I-EXPLORATION poliquística I-EXPLORATION autosómico-dominante I-EXPLORATION (riñón I-EXPLORATION poliquístico I-EXPLORATION del I-EXPLORATION adulto). I-EXPLORATION B-TREATMENT En I-TREATMENT la I-TREATMENT actualidad, I-TREATMENT la I-TREATMENT paciente I-TREATMENT sigue I-TREATMENT tratamiento I-TREATMENT oncológico. I-TREATMENT I-TREATMENT 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 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 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 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 La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS índice I-PRESENT_ILLNESS (PAF19) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS (2004) I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS anémico. I-PRESENT_ILLNESS Como B-EXPLORATION parte I-EXPLORATION de I-EXPLORATION su I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION y I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION completa I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION pólipos I-EXPLORATION sésiles I-EXPLORATION (más I-EXPLORATION de I-EXPLORATION 100) I-EXPLORATION y I-EXPLORATION pediculados I-EXPLORATION (más I-EXPLORATION de I-EXPLORATION 15), I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION margen I-EXPLORATION anal I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION ciego. I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION cecal I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION proliferativa I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION cuya I-EXPLORATION biopsia I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION tubular I-EXPLORATION moderadamente I-EXPLORATION diferenciado. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION preliminar I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION una I-EXPLORATION PAF I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION cecal. I-EXPLORATION El B-TREATMENT estudio I-TREATMENT de I-TREATMENT etapificación I-TREATMENT con I-TREATMENT TAC I-TREATMENT (tomografía I-TREATMENT abdominal I-TREATMENT computarizada) I-TREATMENT de I-TREATMENT abdomen I-TREATMENT y I-TREATMENT pelvis I-TREATMENT no I-TREATMENT mostró I-TREATMENT signos I-TREATMENT de I-TREATMENT diseminación I-TREATMENT tumoral, I-TREATMENT realizándose I-TREATMENT una I-TREATMENT colectomía I-TREATMENT total I-TREATMENT con I-TREATMENT íleorrectoanastomosis. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION con I-EXPLORATION invasión I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION subserosa I-EXPLORATION y I-EXPLORATION compromiso I-EXPLORATION linfonodal. I-EXPLORATION La I-EXPLORATION mucosa I-EXPLORATION del I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION resecada I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION centenar I-EXPLORATION de I-EXPLORATION pólipos I-EXPLORATION sésiles I-EXPLORATION y I-EXPLORATION pediculados, I-EXPLORATION abollonados I-EXPLORATION y I-EXPLORATION lisos I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 2 I-EXPLORATION a I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor. I-EXPLORATION Por B-TREATMENT tratarse I-TREATMENT de I-TREATMENT una I-TREATMENT paciente I-TREATMENT en I-TREATMENT etapa I-TREATMENT III I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT adyuvante I-TREATMENT en I-TREATMENT base I-TREATMENT a I-TREATMENT 5-fluorouracilo I-TREATMENT y I-TREATMENT leucovorina. I-TREATMENT Hasta B-EVOLUTION la I-EVOLUTION fecha I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION completado I-EVOLUTION 70 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Debido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO historia I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO (poliposis I-DERIVED_FROM/TO colónica I-DERIVED_FROM/TO y I-DERIVED_FROM/TO CCR I-DERIVED_FROM/TO a I-DERIVED_FROM/TO edad I-DERIVED_FROM/TO temprana), I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO al I-DERIVED_FROM/TO registro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tumores I-DERIVED_FROM/TO hereditarios I-DERIVED_FROM/TO para I-DERIVED_FROM/TO definir I-DERIVED_FROM/TO el I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO genético I-DERIVED_FROM/TO apropiado. I-DERIVED_FROM/TO Este I-DERIVED_FROM/TO registro I-DERIVED_FROM/TO incorpora I-DERIVED_FROM/TO a I-DERIVED_FROM/TO pacientes I-DERIVED_FROM/TO con I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO de I-DERIVED_FROM/TO enfermedades I-DERIVED_FROM/TO hereditarias I-DERIVED_FROM/TO (poliposis I-DERIVED_FROM/TO adenomatosa I-DERIVED_FROM/TO familiar, I-DERIVED_FROM/TO síndrome I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Lynch, I-DERIVED_FROM/TO síndrome I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Peutz-Jeghers, I-DERIVED_FROM/TO entre I-DERIVED_FROM/TO otros) I-DERIVED_FROM/TO con I-DERIVED_FROM/TO la I-DERIVED_FROM/TO finalidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO educar I-DERIVED_FROM/TO a I-DERIVED_FROM/TO los I-DERIVED_FROM/TO pacientes I-DERIVED_FROM/TO y I-DERIVED_FROM/TO familiares I-DERIVED_FROM/TO respecto I-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO enfermedad, I-DERIVED_FROM/TO predisposición I-DERIVED_FROM/TO de I-DERIVED_FROM/TO desarrollarla I-DERIVED_FROM/TO y I-DERIVED_FROM/TO transmitirla I-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO descendencia, I-DERIVED_FROM/TO y I-DERIVED_FROM/TO de I-DERIVED_FROM/TO este I-DERIVED_FROM/TO modo I-DERIVED_FROM/TO prevenir I-DERIVED_FROM/TO el I-DERIVED_FROM/TO desarrollo I-DERIVED_FROM/TO del I-DERIVED_FROM/TO CCR I-DERIVED_FROM/TO en I-DERIVED_FROM/TO aquellos I-DERIVED_FROM/TO familiares I-DERIVED_FROM/TO asintomáticos. I-DERIVED_FROM/TO I-DERIVED_FROM/TO El B-FAMILY_HISTORY análisis I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY genealogía I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY paciente I-FAMILY_HISTORY índice I-FAMILY_HISTORY demostró I-FAMILY_HISTORY consanguinidad I-FAMILY_HISTORY de I-FAMILY_HISTORY los I-FAMILY_HISTORY padres, I-FAMILY_HISTORY sin I-FAMILY_HISTORY historia I-FAMILY_HISTORY de I-FAMILY_HISTORY poliposis I-FAMILY_HISTORY o I-FAMILY_HISTORY CCR I-FAMILY_HISTORY en I-FAMILY_HISTORY ellos. I-FAMILY_HISTORY Además I-FAMILY_HISTORY permitió I-FAMILY_HISTORY identificar I-FAMILY_HISTORY a I-FAMILY_HISTORY una I-FAMILY_HISTORY hermana I-FAMILY_HISTORY (de I-FAMILY_HISTORY un I-FAMILY_HISTORY total I-FAMILY_HISTORY de I-FAMILY_HISTORY 12 I-FAMILY_HISTORY hermanos) I-FAMILY_HISTORY que I-FAMILY_HISTORY presentó I-FAMILY_HISTORY CCR, I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY que I-FAMILY_HISTORY identificamos I-FAMILY_HISTORY como I-FAMILY_HISTORY PAF585. I-FAMILY_HISTORY Ella I-FAMILY_HISTORY presentó I-FAMILY_HISTORY un I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY de I-FAMILY_HISTORY colon I-FAMILY_HISTORY derecho I-FAMILY_HISTORY con I-FAMILY_HISTORY invasión I-FAMILY_HISTORY hasta I-FAMILY_HISTORY la I-FAMILY_HISTORY subserosa I-FAMILY_HISTORY y I-FAMILY_HISTORY compromiso I-FAMILY_HISTORY linfonodal I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 53 I-FAMILY_HISTORY años I-FAMILY_HISTORY que I-FAMILY_HISTORY fue I-FAMILY_HISTORY tratado I-FAMILY_HISTORY con I-FAMILY_HISTORY cirugía I-FAMILY_HISTORY y I-FAMILY_HISTORY quimioterapia I-FAMILY_HISTORY adyuvante. I-FAMILY_HISTORY Un I-FAMILY_HISTORY año I-FAMILY_HISTORY después, I-FAMILY_HISTORY la I-FAMILY_HISTORY colonoscopia I-FAMILY_HISTORY de I-FAMILY_HISTORY control I-FAMILY_HISTORY mostró I-FAMILY_HISTORY dos I-FAMILY_HISTORY nuevos I-FAMILY_HISTORY tumores I-FAMILY_HISTORY sincrónicos, I-FAMILY_HISTORY uno I-FAMILY_HISTORY en I-FAMILY_HISTORY colon I-FAMILY_HISTORY sigmoides I-FAMILY_HISTORY a I-FAMILY_HISTORY 35 I-FAMILY_HISTORY cm I-FAMILY_HISTORY del I-FAMILY_HISTORY margen I-FAMILY_HISTORY anal I-FAMILY_HISTORY y I-FAMILY_HISTORY otro I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY en I-FAMILY_HISTORY recto I-FAMILY_HISTORY inferior I-FAMILY_HISTORY (adenocarcinoma I-FAMILY_HISTORY tubular I-FAMILY_HISTORY invasor). I-FAMILY_HISTORY Cabe I-FAMILY_HISTORY destacar I-FAMILY_HISTORY que I-FAMILY_HISTORY el I-FAMILY_HISTORY informe I-FAMILY_HISTORY médico I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY paciente I-FAMILY_HISTORY no I-FAMILY_HISTORY registra I-FAMILY_HISTORY la I-FAMILY_HISTORY presencia I-FAMILY_HISTORY de I-FAMILY_HISTORY poliposis I-FAMILY_HISTORY adenomatosa I-FAMILY_HISTORY colónica. I-FAMILY_HISTORY La I-FAMILY_HISTORY paciente I-FAMILY_HISTORY evolucionó I-FAMILY_HISTORY tórpidamente I-FAMILY_HISTORY falleciendo I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 4 I-FAMILY_HISTORY meses I-FAMILY_HISTORY posterior I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY cirugía I-FAMILY_HISTORY debido I-FAMILY_HISTORY a I-FAMILY_HISTORY un I-FAMILY_HISTORY cuadro I-FAMILY_HISTORY séptico I-FAMILY_HISTORY secundario. I-FAMILY_HISTORY I-FAMILY_HISTORY Con I-FAMILY_HISTORY respecto I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY demás I-FAMILY_HISTORY hermanos, I-FAMILY_HISTORY cinco I-FAMILY_HISTORY de I-FAMILY_HISTORY ellos I-FAMILY_HISTORY fallecieron I-FAMILY_HISTORY en I-FAMILY_HISTORY la I-FAMILY_HISTORY infancia I-FAMILY_HISTORY por I-FAMILY_HISTORY accidentes I-FAMILY_HISTORY y I-FAMILY_HISTORY enfermedades I-FAMILY_HISTORY no I-FAMILY_HISTORY relacionadas I-FAMILY_HISTORY al I-FAMILY_HISTORY cáncer. I-FAMILY_HISTORY En I-FAMILY_HISTORY los I-FAMILY_HISTORY cinco I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY vivos, I-FAMILY_HISTORY la I-FAMILY_HISTORY paciente I-FAMILY_HISTORY índice I-FAMILY_HISTORY no I-FAMILY_HISTORY declara I-FAMILY_HISTORY más I-FAMILY_HISTORY casos I-FAMILY_HISTORY afectados I-FAMILY_HISTORY de I-FAMILY_HISTORY poliposis I-FAMILY_HISTORY o I-FAMILY_HISTORY CCR, I-FAMILY_HISTORY sin I-FAMILY_HISTORY embargo, I-FAMILY_HISTORY desconocemos I-FAMILY_HISTORY si I-FAMILY_HISTORY ellos I-FAMILY_HISTORY se I-FAMILY_HISTORY han I-FAMILY_HISTORY realizado I-FAMILY_HISTORY estudios I-FAMILY_HISTORY colonoscópicos. I-FAMILY_HISTORY I-FAMILY_HISTORY Estudio B-EXPLORATION genético I-EXPLORATION I-EXPLORATION Obtención I-EXPLORATION del I-EXPLORATION ADN I-EXPLORATION genómico I-EXPLORATION desde I-EXPLORATION sangre I-EXPLORATION periférica: I-EXPLORATION el I-EXPLORATION ADN I-EXPLORATION genómico I-EXPLORATION fue I-EXPLORATION aislado I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION venosa I-EXPLORATION periférica, I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION protocolo I-EXPLORATION descrito I-EXPLORATION por I-EXPLORATION Lahiri I-EXPLORATION y I-EXPLORATION Nurnberger I-EXPLORATION (1991 I-EXPLORATION ) I-EXPLORATION 9. I-EXPLORATION I-EXPLORATION Este I-EXPLORATION ADN I-EXPLORATION fue I-EXPLORATION previamente I-EXPLORATION estudiado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION molecular I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION APC, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION resultó I-EXPLORATION negativo8. I-EXPLORATION I-EXPLORATION Análisis I-EXPLORATION mutacional I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION MUTYH: I-EXPLORATION Los I-EXPLORATION 16 I-EXPLORATION exones I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION MUTYH I-EXPLORATION fueron I-EXPLORATION amplificados I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION (reacción I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION la I-EXPLORATION polimerasa) I-EXPLORATION usando I-EXPLORATION los I-EXPLORATION partidores I-EXPLORATION descritos I-EXPLORATION por I-EXPLORATION Kim I-EXPLORATION y I-EXPLORATION colaboradores, I-EXPLORATION en I-EXPLORATION 200610. I-EXPLORATION Reacciones I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION realizadas I-EXPLORATION en I-EXPLORATION un I-EXPLORATION volumen I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION Ql I-EXPLORATION que I-EXPLORATION contiene I-EXPLORATION 100 I-EXPLORATION ng I-EXPLORATION de I-EXPLORATION ADN I-EXPLORATION genómico, I-EXPLORATION 25 I-EXPLORATION pmoles I-EXPLORATION de I-EXPLORATION cada I-EXPLORATION partidor, I-EXPLORATION 0, I-EXPLORATION 2 I-EXPLORATION mM I-EXPLORATION de I-EXPLORATION cada I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dNTPs, I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION mM I-EXPLORATION MgCl2 I-EXPLORATION 1X I-EXPLORATION del I-EXPLORATION amortiguador I-EXPLORATION suministrado I-EXPLORATION por I-EXPLORATION la I-EXPLORATION enzima I-EXPLORATION y I-EXPLORATION 1U I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enzima I-EXPLORATION Platinum I-EXPLORATION Taq I-EXPLORATION ADN I-EXPLORATION polimerasa I-EXPLORATION (Invitrogen, I-EXPLORATION Sao I-EXPLORATION Paulo, I-EXPLORATION Brasil). I-EXPLORATION La I-EXPLORATION amplificación I-EXPLORATION fue I-EXPLORATION realizada I-EXPLORATION con I-EXPLORATION el I-EXPLORATION siguiente I-EXPLORATION protocolo: I-EXPLORATION una I-EXPLORATION desnaturación I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION min I-EXPLORATION a I-EXPLORATION 95°C, I-EXPLORATION seguido I-EXPLORATION por I-EXPLORATION 30 I-EXPLORATION ciclos I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION seg I-EXPLORATION a I-EXPLORATION 95°C, I-EXPLORATION 30 I-EXPLORATION seg I-EXPLORATION a I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION apareamiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION partidores I-EXPLORATION (rango I-EXPLORATION 50-58°C), I-EXPLORATION 30 I-EXPLORATION seg I-EXPLORATION a I-EXPLORATION 72°C, I-EXPLORATION y I-EXPLORATION un I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION final I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION min I-EXPLORATION a I-EXPLORATION 72°C. I-EXPLORATION Los I-EXPLORATION productos I-EXPLORATION amplificados I-EXPLORATION fueron I-EXPLORATION posteriormente I-EXPLORATION analizados I-EXPLORATION mediante I-EXPLORATION dos I-EXPLORATION técnicas I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION sensibilidad I-EXPLORATION para I-EXPLORATION la I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION del I-EXPLORATION ADN, I-EXPLORATION que I-EXPLORATION incluye I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION SSCP I-EXPLORATION (single I-EXPLORATION strand I-EXPLORATION conformation I-EXPLORATION polymorphism) I-EXPLORATION y I-EXPLORATION secuenciación I-EXPLORATION de I-EXPLORATION ADN. I-EXPLORATION Brevemente, I-EXPLORATION los I-EXPLORATION productos I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION desnaturados I-EXPLORATION a I-EXPLORATION 95°C I-EXPLORATION por I-EXPLORATION 5 I-EXPLORATION min, I-EXPLORATION enfriados I-EXPLORATION en I-EXPLORATION hielo I-EXPLORATION por I-EXPLORATION 5 I-EXPLORATION min, I-EXPLORATION y I-EXPLORATION resueltos I-EXPLORATION por I-EXPLORATION electroforesis I-EXPLORATION en I-EXPLORATION geles I-EXPLORATION de I-EXPLORATION poliacrilamida I-EXPLORATION MDE I-EXPLORATION 0, I-EXPLORATION 5X I-EXPLORATION I-EXPLORATION (FMC I-EXPLORATION Bioproducts), I-EXPLORATION aplicando I-EXPLORATION una I-EXPLORATION corriente I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION W I-EXPLORATION a I-EXPLORATION 18°C I-EXPLORATION por I-EXPLORATION 12 I-EXPLORATION h. I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION la I-EXPLORATION electroforesis, I-EXPLORATION los I-EXPLORATION geles I-EXPLORATION fueron I-EXPLORATION teñidos I-EXPLORATION con I-EXPLORATION nitrato I-EXPLORATION de I-EXPLORATION plata I-EXPLORATION con I-EXPLORATION el I-EXPLORATION fin I-EXPLORATION de I-EXPLORATION visualizar I-EXPLORATION las I-EXPLORATION bandas I-EXPLORATION de I-EXPLORATION ADN. I-EXPLORATION Los I-EXPLORATION productos I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION que I-EXPLORATION presentaron I-EXPLORATION una I-EXPLORATION migración I-EXPLORATION anormal I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION al I-EXPLORATION control, I-EXPLORATION fueron I-EXPLORATION secuenciados. I-EXPLORATION Las I-EXPLORATION mutaciones I-EXPLORATION fueron I-EXPLORATION analizadas I-EXPLORATION y I-EXPLORATION confirmadas I-EXPLORATION por I-EXPLORATION dos I-EXPLORATION reacciones I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION independientes I-EXPLORATION y I-EXPLORATION por I-EXPLORATION secuenciación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION dos I-EXPLORATION hebras I-EXPLORATION de I-EXPLORATION ADN. I-EXPLORATION La I-EXPLORATION mutación I-EXPLORATION se I-EXPLORATION nombró I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION la I-EXPLORATION nomenclatura I-EXPLORATION propuesta I-EXPLORATION por I-EXPLORATION la I-EXPLORATION Human I-EXPLORATION Genome I-EXPLORATION Variation I-EXPLORATION Society I-EXPLORATION (www. I-EXPLORATION hgvs.org/mutnomen/). I-EXPLORATION I-EXPLORATION 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 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 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 Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que B-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY bronquial I-PAST_MEDICAL_HISTORY extrínseco I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY eco-transtorácico I-PAST_MEDICAL_HISTORY (ETT) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY hipertrófica I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY obstructiva, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY mitral I-PAST_MEDICAL_HISTORY leve-moderada. I-PAST_MEDICAL_HISTORY Realizaba I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY activa I-PAST_MEDICAL_HISTORY encontrándose I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY I. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS precordial I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS esfuerzo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS de I-PRESENT_ILLNESS palpitaciones. I-PRESENT_ILLNESS En B-EXPLORATION un I-EXPLORATION primer I-EXPLORATION electrocardiograma I-EXPLORATION (ECG) I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION taquicardia I-EXPLORATION regular I-EXPLORATION con I-EXPLORATION QRS I-EXPLORATION ancho I-EXPLORATION a I-EXPLORATION 210 I-EXPLORATION lpm, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION respondió I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION adenosina I-EXPLORATION ni I-EXPLORATION a I-EXPLORATION maniobras I-EXPLORATION vagales. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT realizar I-TREATMENT una I-TREATMENT cardioversión I-TREATMENT eléctrica I-TREATMENT con I-TREATMENT 100 I-TREATMENT J I-TREATMENT que I-TREATMENT derivó I-TREATMENT en I-TREATMENT fibrilación I-TREATMENT ventricular I-TREATMENT (FV) I-TREATMENT revertida I-TREATMENT con I-TREATMENT dos I-TREATMENT choques I-TREATMENT de I-TREATMENT 360 I-TREATMENT J. I-TREATMENT Se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amiodarona I-TREATMENT intravenosa, I-TREATMENT pero I-TREATMENT fue I-TREATMENT preciso I-TREATMENT suspenderla I-TREATMENT poco I-TREATMENT después I-TREATMENT por I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT disfunción I-TREATMENT sinusal, I-TREATMENT con I-TREATMENT ritmo I-TREATMENT de I-TREATMENT la I-TREATMENT unión I-TREATMENT a I-TREATMENT 40 I-TREATMENT latidos/ I-TREATMENT minuto. I-TREATMENT Se I-TREATMENT le I-TREATMENT administró I-TREATMENT de I-TREATMENT forma I-TREATMENT empírica I-TREATMENT sulfato I-TREATMENT de I-TREATMENT magnesio I-TREATMENT y I-TREATMENT el I-TREATMENT paciente I-TREATMENT ingresó I-TREATMENT en I-TREATMENT la I-TREATMENT Unidad I-TREATMENT Coronaria. I-TREATMENT I-TREATMENT En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION sistémica I-EXPLORATION de I-EXPLORATION 130/70 I-EXPLORATION mmHg. I-EXPLORATION Se I-EXPLORATION auscultaba I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION sistólico, I-EXPLORATION en I-EXPLORATION ápex I-EXPLORATION y I-EXPLORATION borde I-EXPLORATION esternal I-EXPLORATION izquierdo, I-EXPLORATION y I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION congestión I-EXPLORATION pulmonar. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION ECG I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION disfunción I-EXPLORATION sinusal, I-EXPLORATION QRS I-EXPLORATION ancho I-EXPLORATION con I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION bloqueo I-EXPLORATION completo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION izquierda I-EXPLORATION e I-EXPLORATION intervalo I-EXPLORATION QT I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 30 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION de I-EXPLORATION los I-EXPLORATION síntomas I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION CPK I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 2.657 I-EXPLORATION U/l I-EXPLORATION y I-EXPLORATION una I-EXPLORATION troponina I-EXPLORATION I I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 21 I-EXPLORATION ng/ml. I-EXPLORATION Los I-EXPLORATION iones I-EXPLORATION séricos I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION ecocardiograma I-EXPLORATION realizado I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION con I-EXPLORATION un I-EXPLORATION equipo I-EXPLORATION portátil I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION un I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION (VI) I-EXPLORATION muy I-EXPLORATION dilatado I-EXPLORATION y I-EXPLORATION globalmente I-EXPLORATION hipoquinético, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION miocardio I-EXPLORATION muy I-EXPLORATION hipertrófico, I-EXPLORATION con I-EXPLORATION trabeculaciones. I-EXPLORATION I-EXPLORATION Como I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION taquicardias I-EXPLORATION ventriculares I-EXPLORATION (TV), I-EXPLORATION con I-EXPLORATION sospecha I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION miocardiopatía I-EXPLORATION dilatada, I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION hemodinámico. I-EXPLORATION La I-EXPLORATION ventriculografía I-EXPLORATION izquierda I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION ventrículo I-EXPLORATION con I-EXPLORATION fracción I-EXPLORATION de I-EXPLORATION eyección I-EXPLORATION (FE) I-EXPLORATION del I-EXPLORATION 20%, I-EXPLORATION con I-EXPLORATION defectos I-EXPLORATION generalizados I-EXPLORATION de I-EXPLORATION la I-EXPLORATION contractilidad I-EXPLORATION y I-EXPLORATION con I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION importante I-EXPLORATION trabeculación I-EXPLORATION que I-EXPLORATION sugirió I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION miocardiopatía I-EXPLORATION no I-EXPLORATION compactada I-EXPLORATION (MNC) I-EXPLORATION o I-EXPLORATION miocardiopatía I-EXPLORATION espongiforme I-EXPLORATION (ME). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION angiográficamente I-EXPLORATION significativa. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION cateterismo I-EXPLORATION derecho I-EXPLORATION las I-EXPLORATION presiones I-EXPLORATION fueron: I-EXPLORATION aurícula I-EXPLORATION derecha I-EXPLORATION (AD) I-EXPLORATION 10 I-EXPLORATION mmHg, I-EXPLORATION ventrículo I-EXPLORATION derecho I-EXPLORATION (VD) I-EXPLORATION 70/4 I-EXPLORATION mmHg, I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION (AP) I-EXPLORATION 70/15 I-EXPLORATION mmHg, I-EXPLORATION enclavamiento I-EXPLORATION capilar I-EXPLORATION pulmonar I-EXPLORATION (PECP) I-EXPLORATION 15 I-EXPLORATION mmHg. I-EXPLORATION Índice I-EXPLORATION cardíaco I-EXPLORATION 2 I-EXPLORATION litros/minuto/m2; I-EXPLORATION presión I-EXPLORATION telediastólica I-EXPLORATION VI I-EXPLORATION (PTDVI) I-EXPLORATION 30 I-EXPLORATION mmHg; I-EXPLORATION gradiente I-EXPLORATION mitral I-EXPLORATION invertido I-EXPLORATION (PTDVI I-EXPLORATION > I-EXPLORATION PECP). I-EXPLORATION La I-EXPLORATION coronariografía I-EXPLORATION mostró I-EXPLORATION unas I-EXPLORATION arterias I-EXPLORATION epicárdicas I-EXPLORATION angiográficamente I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION MNC I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION ecocardiografía I-EXPLORATION por I-EXPLORATION personal I-EXPLORATION especializado. I-EXPLORATION La I-EXPLORATION ecocardiografía-2D I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION marcada I-EXPLORATION trabeculación I-EXPLORATION del I-EXPLORATION VI, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION ápex I-EXPLORATION y I-EXPLORATION segmentos I-EXPLORATION medios I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION e I-EXPLORATION inferior, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION relación I-EXPLORATION telesistólica I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION gruesa I-EXPLORATION capa I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION miocardio I-EXPLORATION no I-EXPLORATION compactado I-EXPLORATION (NC) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION fina I-EXPLORATION capa I-EXPLORATION externa I-EXPLORATION de I-EXPLORATION miocardio I-EXPLORATION compactado I-EXPLORATION (NC/C I-EXPLORATION > I-EXPLORATION 2). I-EXPLORATION Con I-EXPLORATION doppler I-EXPLORATION color I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION el I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION en I-EXPLORATION comunicación I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION profundos I-EXPLORATION recesos I-EXPLORATION intertrabeculares I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION ventricular. I-EXPLORATION El I-EXPLORATION flujo I-EXPLORATION diastólico I-EXPLORATION mitral I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION restrictivo. I-EXPLORATION El I-EXPLORATION VI I-EXPLORATION tenía I-EXPLORATION morfología I-EXPLORATION esferoidal I-EXPLORATION y I-EXPLORATION medía I-EXPLORATION en I-EXPLORATION telediástole I-EXPLORATION 70 I-EXPLORATION mm, I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION izquierda I-EXPLORATION 47 I-EXPLORATION mm I-EXPLORATION y I-EXPLORATION el I-EXPLORATION VD I-EXPLORATION 30 I-EXPLORATION mm. I-EXPLORATION Un I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION regurgitación I-EXPLORATION mitral I-EXPLORATION fue I-EXPLORATION valorado I-EXPLORATION como I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION moderada, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION insuficiencia I-EXPLORATION tricuspídea I-EXPLORATION permitió I-EXPLORATION calcular I-EXPLORATION un I-EXPLORATION gradiente I-EXPLORATION AD-VD I-EXPLORATION de I-EXPLORATION 55 I-EXPLORATION mmHg, I-EXPLORATION estimándose I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION AP I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION mmHg. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectaron I-EXPLORATION anomalías I-EXPLORATION valvulares I-EXPLORATION estructurales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION consideró I-EXPLORATION necesario I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION ecocardiografía I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION dada I-EXPLORATION la I-EXPLORATION buena I-EXPLORATION calidad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bidimensional1. I-EXPLORATION I-EXPLORATION Con B-EVOLUTION estos I-EVOLUTION hallazgos I-EVOLUTION ecocardiográficos I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION MNC I-EVOLUTION según I-EVOLUTION los I-EVOLUTION criterios I-EVOLUTION de I-EVOLUTION Jenni, I-EVOLUTION por I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION compactación I-EVOLUTION del I-EVOLUTION miocardio I-EVOLUTION ventricular I-EVOLUTION izquierdo I-EVOLUTION sin I-EVOLUTION otras I-EVOLUTION anomalías I-EVOLUTION cardíacas I-EVOLUTION asociadas2, I-EVOLUTION 3. I-EVOLUTION Aunque I-EVOLUTION hubiera I-EVOLUTION sido I-EVOLUTION interesante I-EVOLUTION una I-EVOLUTION cardiorresonancia, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION realizar I-EVOLUTION por I-EVOLUTION no I-EVOLUTION disponer I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION técnica I-EVOLUTION en I-EVOLUTION nuestro I-EVOLUTION hospital4, I-EVOLUTION 5. I-EVOLUTION I-EVOLUTION 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 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 Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY controlado. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY patológico I-PAST_MEDICAL_HISTORY relevante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY habia I-PAST_MEDICAL_HISTORY advertido I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY masa I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY palpable I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pulsátil I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY mes. I-PAST_MEDICAL_HISTORY Diez B-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS intenso. I-PRESENT_ILLNESS La B-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION abdominal I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION aneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION infrarrenal, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION que I-EXPLORATION involucra I-EXPLORATION y I-EXPLORATION lo I-EXPLORATION adhiere I-EXPLORATION a I-EXPLORATION la I-EXPLORATION tercera I-EXPLORATION porción I-EXPLORATION del I-EXPLORATION duodeno. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT solicitó I-TREATMENT el I-TREATMENT alta I-TREATMENT voluntaria I-TREATMENT ante I-TREATMENT la I-TREATMENT propuesta I-TREATMENT quirúrgica. I-TREATMENT Cinco B-EVOLUTION días I-EVOLUTION después I-EVOLUTION reingresó I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Terapia I-EVOLUTION Intensiva I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION alta I-EVOLUTION manifestada I-EVOLUTION por I-EVOLUTION hematemesis I-EVOLUTION y I-EVOLUTION melena I-EVOLUTION de I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION shock I-EVOLUTION hipovolémico, I-EVOLUTION tensión I-EVOLUTION arterial I-EVOLUTION media I-EVOLUTION (TAM) I-EVOLUTION 30 I-EVOLUTION mmHg, I-EVOLUTION frecuencia I-EVOLUTION cardíaca I-EVOLUTION (FC): I-EVOLUTION 140 I-EVOLUTION lpm I-EVOLUTION y I-EVOLUTION hematocrito I-EVOLUTION del I-EVOLUTION 18%. I-EVOLUTION Una B-EXPLORATION vez I-EXPLORATION compensado I-EXPLORATION el I-EXPLORATION trastorno I-EXPLORATION hemodinámico, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION fibroendoscopia I-EXPLORATION digestiva I-EXPLORATION alta, I-EXPLORATION constatándose I-EXPLORATION sangrado I-EXPLORATION activo I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tercera I-EXPLORATION porción I-EXPLORATION duodenal. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT entonces I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT por I-TREATMENT resangrado I-TREATMENT masivo, I-TREATMENT con I-TREATMENT el I-TREATMENT hallazgo I-TREATMENT intraoperatorio I-TREATMENT de I-TREATMENT aneurisma I-TREATMENT de I-TREATMENT aorta I-TREATMENT abdominal I-TREATMENT infrarrenal I-TREATMENT sacular I-TREATMENT adherido I-TREATMENT a I-TREATMENT la I-TREATMENT cara I-TREATMENT posterior I-TREATMENT de I-TREATMENT la I-TREATMENT tercera I-TREATMENT porción I-TREATMENT duodenal I-TREATMENT con I-TREATMENT comunicación I-TREATMENT a I-TREATMENT la I-TREATMENT luz I-TREATMENT de I-TREATMENT dicho I-TREATMENT órgano I-TREATMENT por I-TREATMENT un I-TREATMENT orificio I-TREATMENT de I-TREATMENT unos I-TREATMENT 4 I-TREATMENT cm I-TREATMENT de I-TREATMENT diámetro. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT un I-TREATMENT by-pass I-TREATMENT aorto-bifemoral. I-TREATMENT Debido B-EVOLUTION al I-EVOLUTION grave I-EVOLUTION compromiso I-EVOLUTION hemodinámico I-EVOLUTION presentó I-EVOLUTION paro I-EVOLUTION cardiorrespiratorio I-EVOLUTION en I-EVOLUTION quirófano, I-EVOLUTION falleciendo I-EVOLUTION pocas I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Terapia I-EVOLUTION Intensiva. I-EVOLUTION I-EVOLUTION 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 Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Neurolues, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY secuelas I-PAST_MEDICAL_HISTORY establecidas I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY trastornos I-PAST_MEDICAL_HISTORY mnésicos I-PAST_MEDICAL_HISTORY visuales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY verbales, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY radiculoneuropatía I-PAST_MEDICAL_HISTORY múltiple. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION radiología I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION presentaba I-EXPLORATION elongación I-EXPLORATION aórtica I-EXPLORATION sin I-EXPLORATION repercusión I-EXPLORATION clínica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION electroencefalograma I-EXPLORATION con I-EXPLORATION trazado I-EXPLORATION normal, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION TC I-EXPLORATION craneal I-EXPLORATION con I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION contraste I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION morfología I-EXPLORATION cerebral I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION Lues I-EXPLORATION en I-EXPLORATION los I-EXPLORATION test I-EXPLORATION RPR I-EXPLORATION y I-EXPLORATION TPHA I-EXPLORATION fueron I-EXPLORATION positivos. I-EXPLORATION El I-EXPLORATION ácido I-EXPLORATION fólico I-EXPLORATION y I-EXPLORATION la I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION rango I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestras I-DERIVED_FROM/TO consultas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Urodinámica I-DERIVED_FROM/TO por I-DERIVED_FROM/TO trastornos I-DERIVED_FROM/TO miccionales I-DERIVED_FROM/TO refiriendo I-DERIVED_FROM/TO incontinencia I-DERIVED_FROM/TO por I-DERIVED_FROM/TO urgencia, I-DERIVED_FROM/TO no I-DERIVED_FROM/TO precisando I-DERIVED_FROM/TO de I-DERIVED_FROM/TO prensa I-DERIVED_FROM/TO abdominal I-DERIVED_FROM/TO para I-DERIVED_FROM/TO el I-DERIVED_FROM/TO vaciado I-DERIVED_FROM/TO vesical. I-DERIVED_FROM/TO Se B-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION urodinámico I-EXPLORATION objetivándose I-EXPLORATION un I-EXPLORATION detrusor I-EXPLORATION hiperrefléxico I-EXPLORATION con I-EXPLORATION presiones I-EXPLORATION altas I-EXPLORATION y I-EXPLORATION contracciones I-EXPLORATION involuntarias I-EXPLORATION no I-EXPLORATION inhibidas I-EXPLORATION que I-EXPLORATION ocasionaban I-EXPLORATION escapes; I-EXPLORATION la I-EXPLORATION curva I-EXPLORATION de I-EXPLORATION Presión/ I-EXPLORATION Flujo I-EXPLORATION no I-EXPLORATION mostraba I-EXPLORATION alteraciones. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT detrusor I-TREATMENT hiperactivo I-TREATMENT de I-TREATMENT causa I-TREATMENT neurogénica I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anticolinérgicos, I-TREATMENT estando B-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION estable I-EVOLUTION clínicamente I-EVOLUTION con I-EVOLUTION urgencia I-EVOLUTION ocasional I-EVOLUTION sin I-EVOLUTION incontinencia. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 60 I-PAST_MEDICAL_HISTORY cigarrillos/día I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY adolescencia, I-PAST_MEDICAL_HISTORY hospitalizado B-PRESENT_ILLNESS por I-PRESENT_ILLNESS síncope I-PRESENT_ILLNESS recurrente. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso, I-EXPLORATION se I-EXPLORATION registró I-EXPLORATION TV I-EXPLORATION monoforma I-EXPLORATION con I-EXPLORATION frecuencia I-EXPLORATION de I-EXPLORATION 233 I-EXPLORATION lpm I-EXPLORATION en I-EXPLORATION trazado I-EXPLORATION de I-EXPLORATION monitor, I-EXPLORATION que I-EXPLORATION convirtió I-EXPLORATION espontáneamente I-EXPLORATION a I-EXPLORATION ritmo I-EXPLORATION sinusal. I-EXPLORATION El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY consumidor I-PAST_MEDICAL_HISTORY ocasional I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cocaína I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso. I-PAST_MEDICAL_HISTORY Negó B-PRESENT_ILLNESS tener I-PRESENT_ILLNESS angina I-PRESENT_ILLNESS o I-PRESENT_ILLNESS disnea. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION ECG I-EXPLORATION post-conversión I-EXPLORATION a I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION (-) I-EXPLORATION en I-EXPLORATION las I-EXPLORATION derivaciones I-EXPLORATION precordiales I-EXPLORATION y I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION inferior. I-EXPLORATION La I-EXPLORATION troponina I-EXPLORATION I I-EXPLORATION alcanzó I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION máximo I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION ng/ml I-EXPLORATION [VN I-EXPLORATION < I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION ng/ml]. I-EXPLORATION Un I-EXPLORATION ecocardiograma I-EXPLORATION reveló I-EXPLORATION leve I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION diámetros I-EXPLORATION internos I-EXPLORATION del I-EXPLORATION VI, I-EXPLORATION disquinesia I-EXPLORATION apical I-EXPLORATION y I-EXPLORATION lateroapical I-EXPLORATION con I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION global I-EXPLORATION levemente I-EXPLORATION disminuida I-EXPLORATION [FE I-EXPLORATION 45%, I-EXPLORATION Simpson]. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION anormalidades. I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION presuntivo I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION coronaria, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION angiográfico I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION arterias I-EXPLORATION coronarias I-EXPLORATION normales. I-EXPLORATION Para I-EXPLORATION avanzar I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION diagnóstico, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION RC. I-EXPLORATION Las I-EXPLORATION imágenes I-EXPLORATION con I-EXPLORATION secuencias I-EXPLORATION de I-EXPLORATION eco-gradiente I-EXPLORATION en I-EXPLORATION 4-cavidades I-EXPLORATION y I-EXPLORATION eje I-EXPLORATION corto, I-EXPLORATION mostraron I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION [VDVD/ASC I-EXPLORATION 122/m2] I-EXPLORATION con I-EXPLORATION acentuada I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION espesor I-EXPLORATION parietal I-EXPLORATION especialmente I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION lateral, I-EXPLORATION microaneurismas I-EXPLORATION (flechas I-EXPLORATION amarillas), I-EXPLORATION disquinesia I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION basal I-EXPLORATION e I-EXPLORATION inferior I-EXPLORATION (flechas I-EXPLORATION azules) I-EXPLORATION y I-EXPLORATION función I-EXPLORATION global I-EXPLORATION severamente I-EXPLORATION disminuida I-EXPLORATION (FE I-EXPLORATION 19%). I-EXPLORATION Al I-EXPLORATION mismo I-EXPLORATION tiempo, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION leve I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION diámetros I-EXPLORATION internos I-EXPLORATION del I-EXPLORATION VI I-EXPLORATION con I-EXPLORATION moderada I-EXPLORATION diminución I-EXPLORATION de I-EXPLORATION su I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION global I-EXPLORATION (FE I-EXPLORATION 38%), I-EXPLORATION dos I-EXPLORATION zonas I-EXPLORATION con I-EXPLORATION disquinesia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION apical I-EXPLORATION con I-EXPLORATION adelgazamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION miocárdica I-EXPLORATION (flechas I-EXPLORATION azules) I-EXPLORATION y I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION aquinesia I-EXPLORATION con I-EXPLORATION miocardio I-EXPLORATION adelgazado I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION (flecha I-EXPLORATION roja) I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION grasa I-EXPLORATION adyacente I-EXPLORATION (flecha I-EXPLORATION verde). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION axial I-EXPLORATION potenciada I-EXPLORATION en I-EXPLORATION T1, I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION infiltración I-EXPLORATION grasa I-EXPLORATION subepicárdica I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION del I-EXPLORATION VD, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION y I-EXPLORATION ápex I-EXPLORATION del I-EXPLORATION VI I-EXPLORATION (flechas I-EXPLORATION verdes). I-EXPLORATION A I-EXPLORATION su I-EXPLORATION vez, I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION 4-cavidades I-EXPLORATION con I-EXPLORATION secuencias I-EXPLORATION de I-EXPLORATION inversión-recuperación I-EXPLORATION para I-EXPLORATION evaluar I-EXPLORATION viabilidad, I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION gadolinio I-EXPLORATION endovenoso, I-EXPLORATION mostró I-EXPLORATION extensa I-EXPLORATION área I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION (realce I-EXPLORATION tardío) I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION y I-EXPLORATION región I-EXPLORATION subtricuspídea I-EXPLORATION (flechas I-EXPLORATION naranjas). I-EXPLORATION I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION descritos I-EXPLORATION son I-EXPLORATION diagnósticos I-EXPLORATION para I-EXPLORATION DAVD I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION VI, I-EXPLORATION en I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tres I-EXPLORATION criterios I-EXPLORATION diagnósticos I-EXPLORATION mayores: I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION invertidas I-EXPLORATION en I-EXPLORATION derivaciones I-EXPLORATION precordiales I-EXPLORATION derechas I-EXPLORATION (V1 I-EXPLORATION a I-EXPLORATION V6) I-EXPLORATION en I-EXPLORATION individuo I-EXPLORATION > I-EXPLORATION 14 I-EXPLORATION años I-EXPLORATION sin I-EXPLORATION bloqueo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION derecho, I-EXPLORATION disquinesia I-EXPLORATION regionales I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION más I-EXPLORATION cociente I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION telediastólico I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION > I-EXPLORATION 110 I-EXPLORATION ml/m2 I-EXPLORATION (varones); I-EXPLORATION TV I-EXPLORATION documentada. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT incluyó I-TREATMENT la I-TREATMENT implantación I-TREATMENT de I-TREATMENT un I-TREATMENT CDI. I-TREATMENT I-TREATMENT 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 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 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 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 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 Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY relevancia, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS en I-PRESENT_ILLNESS junio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2005, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS epigástrico, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carácter I-PRESENT_ILLNESS sordo, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS moderada I-PRESENT_ILLNESS intensidad, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedió I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antiespasmó-dicos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS bloqueadores I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS bomba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS protones, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS dada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS reconsultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día I-PRESENT_ILLNESS siguiente I-PRESENT_ILLNESS por I-PRESENT_ILLNESS persistencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS epigastralgia, I-PRESENT_ILLNESS realizándose B-EXPLORATION una I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION retroperitoneal. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC), I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION quística I-EXPLORATION multitabicada I-EXPLORATION de I-EXPLORATION 44 I-EXPLORATION x I-EXPLORATION 26 I-EXPLORATION mm, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION que I-EXPLORATION contactaba I-EXPLORATION caudalmente I-EXPLORATION con I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION del I-EXPLORATION páncreas. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometida I-TREATMENT a I-TREATMENT una I-TREATMENT laparotomía I-TREATMENT exploradora I-TREATMENT subcostal I-TREATMENT bilateral, I-TREATMENT encontrándose I-TREATMENT la I-TREATMENT lesión, I-TREATMENT descrita I-TREATMENT en I-TREATMENT la I-TREATMENT TAC, I-TREATMENT íntimamente I-TREATMENT adherida I-TREATMENT al I-TREATMENT páncreas, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT debió I-TREATMENT realizar I-TREATMENT una I-TREATMENT pancreatectomía I-TREATMENT distal I-TREATMENT junto I-TREATMENT a I-TREATMENT la I-TREATMENT resección I-TREATMENT del I-TREATMENT quiste, I-TREATMENT enviándose I-TREATMENT la I-TREATMENT pieza I-TREATMENT a I-TREATMENT anatomía I-TREATMENT patológica. I-TREATMENT I-TREATMENT Hallazgos I-TREATMENT patológicos I-TREATMENT I-TREATMENT El I-TREATMENT páncreas I-TREATMENT mostraba I-TREATMENT acinos I-TREATMENT e I-TREATMENT islotes I-TREATMENT pancreáticos I-TREATMENT de I-TREATMENT arquitectura I-TREATMENT normal. I-TREATMENT Se I-TREATMENT identificaban I-TREATMENT además I-TREATMENT dos I-TREATMENT ganglios I-TREATMENT linfáticos I-TREATMENT peripancreáticos I-TREATMENT sin I-TREATMENT alteraciones. I-TREATMENT I-TREATMENT El I-TREATMENT diagnóstico I-TREATMENT histológico I-TREATMENT fue I-TREATMENT compatible I-TREATMENT con I-TREATMENT un I-TREATMENT quiste I-TREATMENT broncogénico I-TREATMENT retroperitoneal. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION en I-EVOLUTION el I-EVOLUTION posopera-torio, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION décimo I-EVOLUTION día I-EVOLUTION posoperatorio. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS Colombiana B-PAST_MEDICAL_HISTORY de B-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS año I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS episódico I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS punzada I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hematuria, I-PRESENT_ILLNESS nauseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS Con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY patológico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY obstructiva I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY quirúrgico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY histerectomía. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION sus I-EXPLORATION signos I-EXPLORATION vitales, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 20kg/Mts2, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION único I-EXPLORATION signo I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION era I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION flanco I-EXPLORATION izquierdo. I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT manejo I-TREATMENT médico I-TREATMENT considerando I-TREATMENT pielonefritis, I-TREATMENT sin B-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología, I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION toma I-EXPLORATION Tomografía I-EXPLORATION Axial I-EXPLORATION Computarizada, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION informa I-EXPLORATION masa I-EXPLORATION dependiente I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 10 I-EXPLORATION cms, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION nefrectomía. I-EXPLORATION I-EXPLORATION La I-EXPLORATION muestra I-EXPLORATION quirúrgica I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION renal I-EXPLORATION fue I-EXPLORATION fijada I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION extraerse I-EXPLORATION con I-EXPLORATION formaldehído I-EXPLORATION al I-EXPLORATION 10% I-EXPLORATION y I-EXPLORATION embebido I-EXPLORATION en I-EXPLORATION parafina I-EXPLORATION para I-EXPLORATION su I-EXPLORATION preparación I-EXPLORATION y I-EXPLORATION análisis I-EXPLORATION microscópico, I-EXPLORATION la I-EXPLORATION coloración I-EXPLORATION empleada I-EXPLORATION fue I-EXPLORATION Hematoxilina I-EXPLORATION y I-EXPLORATION Eosina. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY manejo I-PAST_MEDICAL_HISTORY farmacológico, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alcoholismo, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY clínico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY súbito I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sensación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mareo; I-PAST_MEDICAL_HISTORY cuatro B-PRESENT_ILLNESS horas I-PRESENT_ILLNESS después I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS disartria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hemiparesia I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consultó B-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION urgencias I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION le I-EXPLORATION encontró I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 120/70 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION y I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 100 I-EXPLORATION por I-EXPLORATION minuto; I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION general I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Estaba I-EXPLORATION alerta, I-EXPLORATION orientado I-EXPLORATION en I-EXPLORATION persona, I-EXPLORATION tiempo I-EXPLORATION y I-EXPLORATION espacio, I-EXPLORATION con I-EXPLORATION disartria, I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION esfera I-EXPLORATION mental, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION meníngeos; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cráneo I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION la I-EXPLORATION columna I-EXPLORATION vertebral; I-EXPLORATION había I-EXPLORATION isocoria I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION pupila I-EXPLORATION de I-EXPLORATION Argyll I-EXPLORATION Robertson, I-EXPLORATION parálisis I-EXPLORATION facial I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION escasa I-EXPLORATION elevación I-EXPLORATION del I-EXPLORATION velo I-EXPLORATION del I-EXPLORATION paladar I-EXPLORATION y I-EXPLORATION trastornos I-EXPLORATION dinámicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION deglución, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION los I-EXPLORATION nervios I-EXPLORATION craneales. I-EXPLORATION I-EXPLORATION Presentaba I-EXPLORATION hemiparesia I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fuerza I-EXPLORATION en I-EXPLORATION el I-EXPLORATION miembro I-EXPLORATION superior I-EXPLORATION (3/5) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION inferior I-EXPLORATION (4/5), I-EXPLORATION con I-EXPLORATION hiperreflexia I-EXPLORATION generalizada I-EXPLORATION simétrica, I-EXPLORATION con I-EXPLORATION respuesta I-EXPLORATION plantar I-EXPLORATION izquierda I-EXPLORATION neutra I-EXPLORATION y I-EXPLORATION de I-EXPLORATION flexión I-EXPLORATION contralateral; I-EXPLORATION además, I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION temblor I-EXPLORATION de I-EXPLORATION acción I-EXPLORATION y I-EXPLORATION postural I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computadorizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hipodensa, I-EXPLORATION lacunar, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION interna. I-EXPLORATION Ese I-EXPLORATION mismo I-EXPLORATION día I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION póntico I-EXPLORATION extenso, I-EXPLORATION con I-EXPLORATION estenosis I-EXPLORATION crítica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION basilar I-EXPLORATION y I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION vertebral I-EXPLORATION izquierda, I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION circulación I-EXPLORATION anterior. I-EXPLORATION I-EXPLORATION Se B-TREATMENT sometió I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT endovascular I-TREATMENT en I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT encontró I-TREATMENT estenosis I-TREATMENT completa I-TREATMENT del I-TREATMENT tercio I-TREATMENT inferior I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT basilar, I-TREATMENT sin I-TREATMENT flujo I-TREATMENT distal, I-TREATMENT y I-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT stent I-TREATMENT sin I-TREATMENT complicaciones, I-TREATMENT quedando I-TREATMENT con I-TREATMENT una I-TREATMENT estenosis I-TREATMENT residual I-TREATMENT de I-TREATMENT 24 I-TREATMENT %. I-TREATMENT I-TREATMENT Durante B-EXPLORATION la I-EXPLORATION hospitalización I-EXPLORATION se I-EXPLORATION hicieron I-EXPLORATION estudios I-EXPLORATION para I-EXPLORATION accidente I-EXPLORATION cerebrovascular I-EXPLORATION y I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION era I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION VIH, I-EXPLORATION el I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION suero I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION (1:256) I-EXPLORATION con I-EXPLORATION FTA-ABS, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION compromiso I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION nervioso I-EXPLORATION central. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION pleocitosis I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION leucocitos I-EXPLORATION por I-EXPLORATION mm3 I-EXPLORATION con I-EXPLORATION 10 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION polimorfonucleares I-EXPLORATION y I-EXPLORATION 90 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION mononucleares, I-EXPLORATION glucosa I-EXPLORATION de I-EXPLORATION 71 I-EXPLORATION mg/dl, I-EXPLORATION proteínas I-EXPLORATION de I-EXPLORATION 33 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION un I-EXPLORATION VDRL I-EXPLORATION reactivo I-EXPLORATION (1:2). I-EXPLORATION I-EXPLORATION Con B-TREATMENT estos I-TREATMENT hallazgos I-TREATMENT se I-TREATMENT confirmó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT neurosífilis I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT 24 I-TREATMENT millones I-TREATMENT de I-TREATMENT unidades I-TREATMENT de I-TREATMENT penicilina I-TREATMENT cristalina I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT 21 I-TREATMENT días. I-TREATMENT Durante I-TREATMENT su I-TREATMENT estadía I-TREATMENT en I-TREATMENT la I-TREATMENT unidad I-TREATMENT de I-TREATMENT cuidados I-TREATMENT intensivos, I-TREATMENT el I-TREATMENT paciente I-TREATMENT requirió I-TREATMENT intubación I-TREATMENT orotraqueal I-TREATMENT por I-TREATMENT riesgo I-TREATMENT de I-TREATMENT compromiso I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea I-TREATMENT debido I-TREATMENT a I-TREATMENT su I-TREATMENT infarto I-TREATMENT en I-TREATMENT el I-TREATMENT tallo I-TREATMENT cerebral. I-TREATMENT Presentó B-EVOLUTION una I-EVOLUTION neumonía I-EVOLUTION tardía I-EVOLUTION asociada I-EVOLUTION al I-EVOLUTION respirador I-EVOLUTION por I-EVOLUTION Serratia I-EVOLUTION marcescens, I-EVOLUTION para B-TREATMENT la I-TREATMENT cual I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT antibiótico, I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT I-TREATMENT Durante B-EVOLUTION su I-EVOLUTION hospitalización, I-EVOLUTION no I-EVOLUTION recuperó I-EVOLUTION la I-EVOLUTION funcionalidad I-EVOLUTION de I-EVOLUTION los I-EVOLUTION nervios I-EVOLUTION craneales I-EVOLUTION bulbares, I-EVOLUTION por B-TREATMENT lo I-TREATMENT cual I-TREATMENT fue I-TREATMENT necesario I-TREATMENT practicar I-TREATMENT traqueostomía I-TREATMENT y I-TREATMENT gastrostomía. I-TREATMENT Antes B-EXPLORATION de I-EXPLORATION dar I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION al I-EXPLORATION paciente, I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION importante I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pleocitosis I-EXPLORATION y I-EXPLORATION proteinorraquia; I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION el I-EXPLORATION VDRL I-EXPLORATION fue I-EXPLORATION reactivo I-EXPLORATION (1:8), I-EXPLORATION probablemente I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION inflamatoria I-EXPLORATION posterior I-EXPLORATION al I-EXPLORATION tratamiento. I-EXPLORATION I-EXPLORATION Fue B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION disartria, I-EVOLUTION parálisis I-EVOLUTION supranuclear I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mirada, I-EVOLUTION hemiparesia I-EVOLUTION izquierda, I-EVOLUTION traqueostomía, I-EVOLUTION gastrostomía I-EVOLUTION percutánea I-EVOLUTION y B-TREATMENT manejo I-TREATMENT ambulatorio I-TREATMENT dual I-TREATMENT con I-TREATMENT antiagregación I-TREATMENT plaquetaria. I-TREATMENT I-TREATMENT 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 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 de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY H.T.A. I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS hematuria I-PRESENT_ILLNESS con I-PRESENT_ILLNESS coágulos I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS urológicos I-PRESENT_ILLNESS destacables I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION no I-EXPLORATION detecta I-EXPLORATION anomalías I-EXPLORATION de I-EXPLORATION interés, I-EXPLORATION con I-EXPLORATION riñones I-EXPLORATION y I-EXPLORATION vías I-EXPLORATION excretoras I-EXPLORATION normales, I-EXPLORATION próstata I-EXPLORATION discretamente I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION vejiga I-EXPLORATION sin I-EXPLORATION hallazgos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cistoscopia I-EXPLORATION practicada I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION papilar I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION izquierda I-EXPLORATION retromeatal I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION hasta I-EXPLORATION vertiente I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION vesical. I-EXPLORATION Se B-TREATMENT practica I-TREATMENT resección I-TREATMENT transuretral. I-TREATMENT I-TREATMENT El B-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION de I-EXPLORATION Brunner I-EXPLORATION (papiloma I-EXPLORATION invertido) I-EXPLORATION sobre I-EXPLORATION varios I-EXPLORATION fragmentos I-EXPLORATION resecados I-EXPLORATION que I-EXPLORATION en I-EXPLORATION conjunto I-EXPLORATION miden I-EXPLORATION 10x15x5 I-EXPLORATION mm.. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomático I-EVOLUTION tras I-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 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 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 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 masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS originario B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Tamaulipas, I-PAST_MEDICAL_HISTORY México, I-PAST_MEDICAL_HISTORY evaluado B-PRESENT_ILLNESS por I-PRESENT_ILLNESS xerosis I-PRESENT_ILLNESS generalizada, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS incierto. I-PRESENT_ILLNESS Producto B-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY segundo I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY pareja I-PAST_MEDICAL_HISTORY sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY aparentes I-FAMILY_HISTORY de I-FAMILY_HISTORY consanguineidad, I-FAMILY_HISTORY se B-PAST_MEDICAL_HISTORY caracteriza I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY intolerancia I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY calor I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ausencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY sudoración I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY nacimiento. I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY refierían I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY heredofamiliares I-FAMILY_HISTORY de I-FAMILY_HISTORY importancia. I-FAMILY_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION frenteprominente, I-EXPLORATION hipoplasia I-EXPLORATION del I-EXPLORATION puente I-EXPLORATION nasal, I-EXPLORATION dos I-EXPLORATION incisivos I-EXPLORATION únicos I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION cono, I-EXPLORATION pigmentación I-EXPLORATION periorbitaria, I-EXPLORATION pelo I-EXPLORATION escaso, I-EXPLORATION fino, I-EXPLORATION disperso I-EXPLORATION y I-EXPLORATION frágil I-EXPLORATION así I-EXPLORATION como I-EXPLORATION cejas I-EXPLORATION y I-EXPLORATION pestañas. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION dermatosis I-EXPLORATION diseminada I-EXPLORATION a I-EXPLORATION cabeza, I-EXPLORATION tronco I-EXPLORATION y I-EXPLORATION principalmente I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores, I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION pápulas I-EXPLORATION puntiformes I-EXPLORATION eritematosas, I-EXPLORATION con I-EXPLORATION eritema I-EXPLORATION difuso I-EXPLORATION en I-EXPLORATION una I-EXPLORATION piel I-EXPLORATION xerótica. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION palma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION izquierda I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION las I-EXPLORATION glándulas I-EXPLORATION sudoríparas I-EXPLORATION y I-EXPLORATION sebáceas. I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION obtener I-EXPLORATION el I-EXPLORATION consentimiento I-EXPLORATION informado, I-EXPLORATION obtuvimos I-EXPLORATION sangre I-EXPLORATION periférica I-EXPLORATION para I-EXPLORATION realizar I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION cariotipo I-EXPLORATION reportándose I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION vez, I-EXPLORATION obtuvimos I-EXPLORATION sangre I-EXPLORATION no I-EXPLORATION coagulada I-EXPLORATION en I-EXPLORATION tubos I-EXPLORATION de I-EXPLORATION EDTA I-EXPLORATION (ácido I-EXPLORATION etilendiaminotetraacético) I-EXPLORATION de I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION miembros I-EXPLORATION de I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION siguiendo I-EXPLORATION los I-EXPLORATION Principios I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Declaración I-EXPLORATION de I-EXPLORATION Helsinki. I-EXPLORATION Se I-EXPLORATION extrajo I-EXPLORATION ADN I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION sanguíneas I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION PUREGENER I-EXPLORATION (Systema I-EXPLORATION Gentra). I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mutaciones I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION exones I-EXPLORATION así I-EXPLORATION como I-EXPLORATION las I-EXPLORATION secuencias I-EXPLORATION de I-EXPLORATION los I-EXPLORATION uniones I-EXPLORATION de I-EXPLORATION los I-EXPLORATION intrones-exones I-EXPLORATION fueron I-EXPLORATION amplificados I-EXPLORATION por I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION (reacción I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION la I-EXPLORATION polimerasa) I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION EDA-A1 I-EXPLORATION en I-EXPLORATION condiciones I-EXPLORATION reportadas I-EXPLORATION previamente. I-EXPLORATION Las I-EXPLORATION condiciones I-EXPLORATION para I-EXPLORATION la I-EXPLORATION amplificación I-EXPLORATION de I-EXPLORATION cada I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 94 I-EXPLORATION °C I-EXPLORATION por I-EXPLORATION 2 I-EXPLORATION minutos, I-EXPLORATION seguido I-EXPLORATION por I-EXPLORATION 35 I-EXPLORATION ciclos I-EXPLORATION de I-EXPLORATION 94°C I-EXPLORATION durante I-EXPLORATION 30 I-EXPLORATION segundos, I-EXPLORATION 55°C I-EXPLORATION por I-EXPLORATION 30 I-EXPLORATION segundos I-EXPLORATION y I-EXPLORATION 72°C I-EXPLORATION por I-EXPLORATION 30 I-EXPLORATION segundos I-EXPLORATION con I-EXPLORATION una I-EXPLORATION extensión I-EXPLORATION final I-EXPLORATION a I-EXPLORATION 72°C I-EXPLORATION durante I-EXPLORATION 7 I-EXPLORATION minutos. I-EXPLORATION Los I-EXPLORATION productos I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION colocados I-EXPLORATION en I-EXPLORATION un I-EXPLORATION gel I-EXPLORATION de I-EXPLORATION agarosa I-EXPLORATION al I-EXPLORATION 1% I-EXPLORATION y I-EXPLORATION posteriormente I-EXPLORATION fueron I-EXPLORATION analizados I-EXPLORATION por I-EXPLORATION la I-EXPLORATION Secuenciadora I-EXPLORATION Automática I-EXPLORATION Directa I-EXPLORATION ABI I-EXPLORATION Prism I-EXPLORATION 310, I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION Reacción I-EXPLORATION "ABI I-EXPLORATION PRISM® I-EXPLORATION BigDye™ I-EXPLORATION Terminator I-EXPLORATION Cycle I-EXPLORATION Sequencing' I-EXPLORATION (PE I-EXPLORATION Biosystem) I-EXPLORATION 8. I-EXPLORATION I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION que I-EXPLORATION comúnmente I-EXPLORATION la I-EXPLORATION displasia I-EXPLORATION ectodérmica I-EXPLORATION hipohidrótica I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION ligada I-EXPLORATION a I-EXPLORATION X, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION obtener I-EXPLORATION ADN I-EXPLORATION genómico, I-EXPLORATION logrando I-EXPLORATION identificar I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION sinsentido I-EXPLORATION Ala349Thr I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION EDA, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION la I-EXPLORATION correlación I-EXPLORATION clínico-patológica, I-EXPLORATION concluyendo I-EXPLORATION así I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION displasia I-EXPLORATION ectodérmica I-EXPLORATION hipohidrótica.. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS indio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 44 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipertenso B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY ocasional, I-PAST_MEDICAL_HISTORY quien B-PRESENT_ILLNESS se I-PRESENT_ILLNESS levantó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mañana I-PRESENT_ILLNESS previa I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS con I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hemicuerpo I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sensibilidad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hemicara I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS que I-PRESENT_ILLNESS progresó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS siguientes I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS imposibilidad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS hubo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ingresar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS vez I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS llevado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS departamento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS emergencias, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS constató I-PRESENT_ILLNESS una I-PRESENT_ILLNESS presión I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 165/105 I-PRESENT_ILLNESS mmHg, I-PRESENT_ILLNESS pulso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 92 I-PRESENT_ILLNESS latidos I-PRESENT_ILLNESS x' I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS frecuencia I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS x'. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION hipoestesia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION rama I-EXPLORATION maxilar I-EXPLORATION del I-EXPLORATION trigémino I-EXPLORATION derecho I-EXPLORATION como I-EXPLORATION único I-EXPLORATION trastorno I-EXPLORATION objetivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad. I-EXPLORATION La I-EXPLORATION fuerza I-EXPLORATION muscular I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tono I-EXPLORATION estaba I-EXPLORATION conservados I-EXPLORATION a I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION niveles, I-EXPLORATION pero I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION hiperreflexia I-EXPLORATION osteotendinosa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemicuerpo I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION Babinski I-EXPLORATION ipsilateral. I-EXPLORATION Elementos I-EXPLORATION de I-EXPLORATION disfunción I-EXPLORATION cerebelosa I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION al I-EXPLORATION existir I-EXPLORATION disdiadococinesia, I-EXPLORATION dismetría I-EXPLORATION y I-EXPLORATION discronometría I-EXPLORATION al I-EXPLORATION movilizar I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION derechas. I-EXPLORATION La I-EXPLORATION marcha I-EXPLORATION era I-EXPLORATION imposible I-EXPLORATION por I-EXPLORATION la I-EXPLORATION tendencia I-EXPLORATION a I-EXPLORATION caer I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION derecha I-EXPLORATION al I-EXPLORATION tratar I-EXPLORATION de I-EXPLORATION hacerla I-EXPLORATION sin I-EXPLORATION apoyo. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION mostró I-EXPLORATION hemoglobina, I-EXPLORATION conteo I-EXPLORATION diferencial I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION y I-EXPLORATION electrolitos I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION una I-EXPLORATION hiperlipidemia I-EXPLORATION dada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION incremento I-EXPLORATION del I-EXPLORATION colesterol I-EXPLORATION total I-EXPLORATION (7, I-EXPLORATION 42 I-EXPLORATION mm/1). I-EXPLORATION El I-EXPLORATION electrocardiograma I-EXPLORATION y I-EXPLORATION el I-EXPLORATION ecocardiograma I-EXPLORATION transtorácico I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RMN) I-EXPLORATION identificó I-EXPLORATION un I-EXPLORATION área I-EXPLORATION de I-EXPLORATION infarto I-EXPLORATION isquémico I-EXPLORATION subagudo I-EXPLORATION que I-EXPLORATION comprendía I-EXPLORATION el I-EXPLORATION núcleo I-EXPLORATION lenticular I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION interna I-EXPLORATION izquierdos. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT consistió I-TREATMENT en I-TREATMENT anti-agregantes I-TREATMENT plaquetarios, I-TREATMENT estatinas I-TREATMENT y I-TREATMENT fisioterapia. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION egresado I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION después I-EVOLUTION con I-EVOLUTION evidente I-EVOLUTION mejoría. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad, I-PAST_MEDICAL_HISTORY brucelosis, I-PAST_MEDICAL_HISTORY lumboartrosis, I-PAST_MEDICAL_HISTORY litiasis I-PAST_MEDICAL_HISTORY biliar, I-PAST_MEDICAL_HISTORY apendicectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cesárea. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar, I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION casual, I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm. I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION confirma I-EXPLORATION este I-EXPLORATION hallazgo I-EXPLORATION evidenciándose I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho; I-EXPLORATION comprobándose I-EXPLORATION realce I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION infusión I-EXPLORATION de I-EXPLORATION contraste, I-EXPLORATION no I-EXPLORATION objetivándose I-EXPLORATION adenopatías I-EXPLORATION hiliares, I-EXPLORATION ni I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION de I-EXPLORATION vecindad. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT masa I-TREATMENT sólida I-TREATMENT compatible I-TREATMENT con I-TREATMENT adenocarcinoma I-TREATMENT renal I-TREATMENT es I-TREATMENT intervenida, I-TREATMENT realizándose I-TREATMENT por I-TREATMENT vía I-TREATMENT lumbar I-TREATMENT oblícua I-TREATMENT nefrectomía I-TREATMENT radical, I-TREATMENT siendo I-TREATMENT el I-TREATMENT curso I-TREATMENT postoperatorio I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT I-TREATMENT En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION tumoración I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION que I-EXPLORATION no I-EXPLORATION invade I-EXPLORATION cápsula, I-EXPLORATION su I-EXPLORATION aspecto I-EXPLORATION al I-EXPLORATION corte I-EXPLORATION es I-EXPLORATION homogéneo, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blancogrisaceo. I-EXPLORATION La I-EXPLORATION pelvis I-EXPLORATION y I-EXPLORATION cálices I-EXPLORATION no I-EXPLORATION están I-EXPLORATION afectados I-EXPLORATION por I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION y I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION renal I-EXPLORATION esta I-EXPLORATION libre. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION tumoración I-EXPLORATION redondeada I-EXPLORATION de I-EXPLORATION márgenes I-EXPLORATION bien I-EXPLORATION definidos, I-EXPLORATION que I-EXPLORATION crece I-EXPLORATION por I-EXPLORATION expansión I-EXPLORATION sin I-EXPLORATION invadir, I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION mesenquimal, I-EXPLORATION compuesta I-EXPLORATION por I-EXPLORATION células I-EXPLORATION dispuestas I-EXPLORATION en I-EXPLORATION fascículos I-EXPLORATION entrelazados, I-EXPLORATION los I-EXPLORATION núcleos I-EXPLORATION presentan I-EXPLORATION ligera I-EXPLORATION variación I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION forma, I-EXPLORATION la I-EXPLORATION actividad I-EXPLORATION mitótica I-EXPLORATION es I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION mitosis I-EXPLORATION por I-EXPLORATION 50 I-EXPLORATION CGA, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION hemorragias I-EXPLORATION ni I-EXPLORATION necrosis. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION negatividad I-EXPLORATION para I-EXPLORATION queratinas I-EXPLORATION (AE-1,AE-3), I-EXPLORATION EMA I-EXPLORATION (anfígeno I-EXPLORATION epitelial I-EXPLORATION de I-EXPLORATION membrana) I-EXPLORATION con I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION excluye I-EXPLORATION la I-EXPLORATION naturaleza I-EXPLORATION epitelial I-EXPLORATION del I-EXPLORATION tumor. I-EXPLORATION Negatividad I-EXPLORATION para I-EXPLORATION vimentina, I-EXPLORATION HMB45, I-EXPLORATION S-100. I-EXPLORATION Positividad I-EXPLORATION para I-EXPLORATION marcadores I-EXPLORATION vasculares I-EXPLORATION en I-EXPLORATION la I-EXPLORATION trama I-EXPLORATION vascular I-EXPLORATION y I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION actino. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS para I-PRESENT_ILLNESS solicitar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS realización I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS vasectomía. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION los I-EXPLORATION testes I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION y I-EXPLORATION tamaño I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION pene I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION torsión I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 60 I-EXPLORATION grados. I-EXPLORATION Hasta I-EXPLORATION la I-EXPLORATION fecha, I-EXPLORATION dicha I-EXPLORATION alteración I-EXPLORATION no I-EXPLORATION le I-EXPLORATION había I-EXPLORATION producido I-EXPLORATION sintomatología I-EXPLORATION alguna. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY suspendido I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY aspirina I-PAST_MEDICAL_HISTORY caracterizado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY eritema I-PAST_MEDICAL_HISTORY generalizado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY edema I-PAST_MEDICAL_HISTORY glótico. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY primera I-PAST_MEDICAL_HISTORY ocasión I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 1974 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY vuelve I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY repetir I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY única I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 1983, I-PAST_MEDICAL_HISTORY motivo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY nunca I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY vuelve I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY recibir I-PAST_MEDICAL_HISTORY aspirina. I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS en I-PRESENT_ILLNESS noviembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2010 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS angina I-PRESENT_ILLNESS inestable. I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION coronariografía I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION estenosis I-EXPLORATION significativa I-EXPLORATION en I-EXPLORATION arteria I-EXPLORATION descendente I-EXPLORATION anterior, I-EXPLORATION ante I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION procede I-EXPLORATION a I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION angioplastía I-EXPLORATION con I-EXPLORATION stent I-EXPLORATION en I-EXPLORATION dicho I-EXPLORATION vaso. I-EXPLORATION Por B-TREATMENT antecedentes I-TREATMENT de I-TREATMENT alergia I-TREATMENT a I-TREATMENT la I-TREATMENT aspirina I-TREATMENT se I-TREATMENT deja I-TREATMENT con I-TREATMENT clopidogrel I-TREATMENT y I-TREATMENT cilostazol. I-TREATMENT Tres B-EVOLUTION semanas I-EVOLUTION posterior I-EVOLUTION a I-EVOLUTION su I-EVOLUTION alta, I-EVOLUTION presenta I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION torácico I-EVOLUTION retroesternal I-EVOLUTION opresivo I-EVOLUTION prolongado I-EVOLUTION y B-EXPLORATION la I-EXPLORATION corona-riografía I-EXPLORATION demuestra I-EXPLORATION una I-EXPLORATION trombosis I-EXPLORATION intra-stent. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT angioplastía I-TREATMENT con I-TREATMENT balón, I-TREATMENT bajo I-TREATMENT infusión I-TREATMENT de I-TREATMENT tirofibán I-TREATMENT endovenoso, I-TREATMENT consiguiendo B-EVOLUTION un I-EVOLUTION buen I-EVOLUTION resultado I-EVOLUTION clínico. I-EVOLUTION Posterior B-TREATMENT a I-TREATMENT la I-TREATMENT intervención I-TREATMENT se I-TREATMENT realiza I-TREATMENT protocolo I-TREATMENT de I-TREATMENT desensibilización I-TREATMENT a I-TREATMENT aspirina, I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT Desde I-TREATMENT entonces I-TREATMENT se I-TREATMENT mantiene I-TREATMENT con I-TREATMENT aspirina I-TREATMENT y I-TREATMENT clopidrogel. I-TREATMENT Completado B-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION adherencia I-EVOLUTION a I-EVOLUTION la I-EVOLUTION terapia, I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION efectos I-EVOLUTION adversos, I-EVOLUTION y I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION sin I-EVOLUTION angina I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION HAAS. I-EVOLUTION I-EVOLUTION 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-DERIVED_FROM/TO de I-DERIVED_FROM/TO 48 I-DERIVED_FROM/TO años I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO al I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO detectarse I-DERIVED_FROM/TO ambulatoriamente I-DERIVED_FROM/TO una I-DERIVED_FROM/TO creatinina I-DERIVED_FROM/TO sérica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 7, I-DERIVED_FROM/TO 56mg/dl. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaba: I-EXPLORATION tensión I-EXPLORATION arterial: I-EXPLORATION 163/111mmHg, I-EXPLORATION peso: I-EXPLORATION 105kg, I-EXPLORATION talla: I-EXPLORATION 190cm, I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal: I-EXPLORATION 29kg/m2. I-EXPLORATION Leve I-EXPLORATION déficit I-EXPLORATION cognitivo. I-EXPLORATION Fenotipo I-EXPLORATION corporal I-EXPLORATION corpulento. I-EXPLORATION Facies I-EXPLORATION con I-EXPLORATION prognatismo I-EXPLORATION y I-EXPLORATION macroglosia. I-EXPLORATION Labios I-EXPLORATION gruesos, I-EXPLORATION arcos I-EXPLORATION superciliares I-EXPLORATION prominentes, I-EXPLORATION voz I-EXPLORATION grave. I-EXPLORATION Auscultación I-EXPLORATION normal. I-EXPLORATION Fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION normal. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION refería I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION su I-EXPLORATION morfología I-EXPLORATION corporal. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION mostraba I-EXPLORATION riñones I-EXPLORATION de I-EXPLORATION dimensiones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION límite I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION con I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION bilateral I-EXPLORATION marcadamente I-EXPLORATION adelgazado, I-EXPLORATION prácticamente I-EXPLORATION inexistente. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION presentaba I-EXPLORATION parámetros I-EXPLORATION bioquímicos I-EXPLORATION propios I-EXPLORATION de I-EXPLORATION la I-EXPLORATION uremia I-EXPLORATION con I-EXPLORATION serologías I-EXPLORATION víricas I-EXPLORATION negativas I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION inmunológicas I-EXPLORATION normales. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION practicaron I-EXPLORATION determinaciones I-EXPLORATION hormonales: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Cortisol: I-EXPLORATION 23mcg/dl I-EXPLORATION (6-28), I-EXPLORATION TSH: I-EXPLORATION 1, I-EXPLORATION 01mcUI/ml I-EXPLORATION (0,27-4,2). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Renina: I-EXPLORATION 29, I-EXPLORATION 7microUI/ml I-EXPLORATION (2,8-39,9). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Aldosterona: I-EXPLORATION 152, I-EXPLORATION 8pg/ml I-EXPLORATION (10-160). I-EXPLORATION I-EXPLORATION - I-EXPLORATION FSH: I-EXPLORATION 12, I-EXPLORATION 4mUI/ml I-EXPLORATION (1,5-12,4), I-EXPLORATION LH: I-EXPLORATION 8, I-EXPLORATION 4mUI/ml I-EXPLORATION (1,7-8,6). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Prolactina: I-EXPLORATION 553mUI/l I-EXPLORATION (86-324), I-EXPLORATION testosterona I-EXPLORATION total: I-EXPLORATION 1, I-EXPLORATION 99ng/ml I-EXPLORATION (2,5-8,4). I-EXPLORATION I-EXPLORATION - I-EXPLORATION GH: I-EXPLORATION 4, I-EXPLORATION 24ng/ml I-EXPLORATION (0-1). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Somatomedina I-EXPLORATION C I-EXPLORATION (IGF1): I-EXPLORATION 670ng/ml I-EXPLORATION (100-358). I-EXPLORATION I-EXPLORATION - I-EXPLORATION IGF1-BP3: I-EXPLORATION 7, I-EXPLORATION 59micro/ml I-EXPLORATION (3,3-6,7). I-EXPLORATION I-EXPLORATION - I-EXPLORATION ACTH: I-EXPLORATION 39pg/ml I-EXPLORATION (8-46). I-EXPLORATION I-EXPLORATION La B-TREATMENT hipertensión I-TREATMENT se I-TREATMENT controló I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT médico. I-TREATMENT Ante I-TREATMENT el I-TREATMENT deterioro I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal, I-TREATMENT cuya I-TREATMENT etiología I-TREATMENT no I-TREATMENT se I-TREATMENT pudo I-TREATMENT filiar, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT mediante I-TREATMENT hemodiálisis I-TREATMENT crónica. I-TREATMENT I-TREATMENT Se B-EXPLORATION practicó I-EXPLORATION un I-EXPLORATION primer I-EXPLORATION test I-EXPLORATION de I-EXPLORATION sobrecarga I-EXPLORATION oral I-EXPLORATION a I-EXPLORATION glucosa I-EXPLORATION (TSOG). I-EXPLORATION I-EXPLORATION Llegados I-EXPLORATION a I-EXPLORATION este I-EXPLORATION punto, I-EXPLORATION los I-EXPLORATION clínicos I-EXPLORATION sospechábamos, I-EXPLORATION en I-EXPLORATION función I-EXPLORATION del I-EXPLORATION fenotipo I-EXPLORATION y I-EXPLORATION del I-EXPLORATION perfil I-EXPLORATION hormonal I-EXPLORATION (aumento I-EXPLORATION de I-EXPLORATION GH, I-EXPLORATION IGF-1 I-EXPLORATION y I-EXPLORATION IGF1-BP3; I-EXPLORATION TSOG I-EXPLORATION sin I-EXPLORATION supresión I-EXPLORATION clara I-EXPLORATION de I-EXPLORATION la I-EXPLORATION GH), I-EXPLORATION una I-EXPLORATION acromegalia. I-EXPLORATION No B-TREATMENT pudo I-TREATMENT practicarse I-TREATMENT una I-TREATMENT resonancia I-TREATMENT magnética I-TREATMENT nuclear I-TREATMENT (RMN) I-TREATMENT hipofisaria I-TREATMENT ante I-TREATMENT la I-TREATMENT negativa I-TREATMENT del I-TREATMENT paciente I-TREATMENT y I-TREATMENT su I-TREATMENT familia. I-TREATMENT I-TREATMENT Cuatro I-TREATMENT meses I-TREATMENT después I-TREATMENT se I-TREATMENT realizó I-TREATMENT finalmente I-TREATMENT la I-TREATMENT RMN I-TREATMENT sin I-TREATMENT contraste I-TREATMENT paramagnético. I-TREATMENT La B-EXPLORATION hipófisis I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tallo I-EXPLORATION hipofisario I-EXPLORATION centrado. I-EXPLORATION Se B-TREATMENT practicó I-TREATMENT un I-TREATMENT nuevo I-TREATMENT TSOG, I-TREATMENT mostrando I-TREATMENT una I-TREATMENT GH I-TREATMENT basal I-TREATMENT normal, I-TREATMENT con I-TREATMENT aumento I-TREATMENT paradójico I-TREATMENT a I-TREATMENT los I-TREATMENT 30 I-TREATMENT minutos, I-TREATMENT pero I-TREATMENT con I-TREATMENT adecuada I-TREATMENT supresión I-TREATMENT a I-TREATMENT las I-TREATMENT dos I-TREATMENT horas. I-TREATMENT I-TREATMENT En B-EXPLORATION esa I-EXPLORATION fecha I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION IGF-1 I-EXPLORATION (340 I-EXPLORATION ng/ml) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION IGF1-BP3 I-EXPLORATION (6, I-EXPLORATION 3 I-EXPLORATION µg/ml) I-EXPLORATION se I-EXPLORATION habían I-EXPLORATION normalizado I-EXPLORATION también. I-EXPLORATION La I-EXPLORATION prolactina I-EXPLORATION continuaba I-EXPLORATION elevada I-EXPLORATION y I-EXPLORATION la I-EXPLORATION testosterona I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Actualmente B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION controles I-EVOLUTION periódicos I-EVOLUTION en I-EVOLUTION endocrinología I-EVOLUTION y I-EVOLUTION continúa I-EVOLUTION en I-EVOLUTION hemodiálisis. I-EVOLUTION I-EVOLUTION 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 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 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 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 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 Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos, I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY consultó I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sufrir I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY baja I-PAST_MEDICAL_HISTORY intensidad I-PAST_MEDICAL_HISTORY (pelotazo) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY genital. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION dolor I-EXPLORATION que I-EXPLORATION dificultaba I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION evidenciándose I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION asimétrico I-EXPLORATION testicular I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION lesiones I-EXPLORATION asociadas. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION ecotomografía I-EXPLORATION testicular I-EXPLORATION presentándose I-EXPLORATION a I-EXPLORATION control I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION transcurridos I-EXPLORATION 5 I-EXPLORATION meses, I-EXPLORATION constatándose I-EXPLORATION clínicamente I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION indurada I-EXPLORATION en I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION no I-EXPLORATION dolorosa I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION escrotal; I-EXPLORATION testículo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION pene I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION La I-EXPLORATION ultrasonografía I-EXPLORATION demostró I-EXPLORATION en I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION 18 I-EXPLORATION x I-EXPLORATION 19 I-EXPLORATION x I-EXPLORATION 15 I-EXPLORATION mm, I-EXPLORATION bien I-EXPLORATION delimitado, I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION hiperecogénicas I-EXPLORATION con I-EXPLORATION sombra I-EXPLORATION acústica I-EXPLORATION posterior. I-EXPLORATION El I-EXPLORATION testículo I-EXPLORATION derecho, I-EXPLORATION epidídimos I-EXPLORATION y I-EXPLORATION cordones I-EXPLORATION espermáticos I-EXPLORATION no I-EXPLORATION presentan I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION su I-EXPLORATION ecoestructura. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION serológico I-EXPLORATION para I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION (α-feto I-EXPLORATION proteína I-EXPLORATION y I-EXPLORATION hormona I-EXPLORATION gonadotropina I-EXPLORATION coriónica I-EXPLORATION sub-unidad I-EXPLORATION β) I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION complementó I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION pelvis, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION tórax I-EXPLORATION las I-EXPLORATION que I-EXPLORATION no I-EXPLORATION demostraron I-EXPLORATION lesiones I-EXPLORATION secundarias. I-EXPLORATION I-EXPLORATION Se B-TREATMENT efectuó I-TREATMENT enucleación I-TREATMENT del I-TREATMENT tumor I-TREATMENT y I-TREATMENT biopsia I-TREATMENT intra-operatoria. I-TREATMENT Se B-EXPLORATION examinó I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION testicular I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION g I-EXPLORATION de I-EXPLORATION 35 I-EXPLORATION x I-EXPLORATION 17 I-EXPLORATION x I-EXPLORATION 15 I-EXPLORATION mm I-EXPLORATION presentando I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION subcapsular I-EXPLORATION redondeada, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION amarillenta, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION grumosas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION arenoso. I-EXPLORATION El I-EXPLORATION corte I-EXPLORATION histológico I-EXPLORATION por I-EXPLORATION congelación I-EXPLORATION y I-EXPLORATION diferido I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION nidos I-EXPLORATION y I-EXPLORATION cordones I-EXPLORATION conformados I-EXPLORATION por I-EXPLORATION células I-EXPLORATION ovales I-EXPLORATION a I-EXPLORATION poligonales I-EXPLORATION de I-EXPLORATION núcleos I-EXPLORATION grandes, I-EXPLORATION excéntricos I-EXPLORATION y I-EXPLORATION con I-EXPLORATION nucléolo I-EXPLORATION prominente, I-EXPLORATION el I-EXPLORATION citoplasma I-EXPLORATION es I-EXPLORATION eosinófilo I-EXPLORATION y I-EXPLORATION abundante, I-EXPLORATION apreciándose I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION polimorfonuclear I-EXPLORATION neutrófilo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION central I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION linfocitos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION periferia I-EXPLORATION en I-EXPLORATION partes I-EXPLORATION formando I-EXPLORATION agregados I-EXPLORATION linfoides. I-EXPLORATION El I-EXPLORATION estroma I-EXPLORATION es I-EXPLORATION en I-EXPLORATION partes I-EXPLORATION hialino I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION degeneración I-EXPLORATION mixoide I-EXPLORATION y I-EXPLORATION abundantes I-EXPLORATION calcificaciones I-EXPLORATION dispuestas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION intersticial I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lumen I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nidos I-EXPLORATION tumorales, I-EXPLORATION concluyéndose I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION contemporánea I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Sertoli I-EXPLORATION calcificado. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION extensión I-EXPLORATION tumoral I-EXPLORATION intratubular, I-EXPLORATION figuras I-EXPLORATION mitóticas, I-EXPLORATION necrosis, I-EXPLORATION acentuada I-EXPLORATION atipía I-EXPLORATION citológica I-EXPLORATION ni I-EXPLORATION extensión I-EXPLORATION tumoral I-EXPLORATION extra-testicular. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION demostró I-EXPLORATION intensa I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION α-inhibina, I-EXPLORATION S-100 I-EXPLORATION y I-EXPLORATION vimentina; I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION (Ki-67) I-EXPLORATION bajo I-EXPLORATION (< I-EXPLORATION 1%). I-EXPLORATION I-EXPLORATION Se B-TREATMENT completó I-TREATMENT la I-TREATMENT cirugía I-TREATMENT realizándose I-TREATMENT orquiectomía I-TREATMENT radical. I-TREATMENT No B-EVOLUTION se I-EVOLUTION registraron I-EVOLUTION complicaciones I-EVOLUTION post-operatorias. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION post-cirugía, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION sano, I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION en I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION tórax-abdomen I-EVOLUTION y I-EVOLUTION pelvis; I-EVOLUTION descartándose I-EVOLUTION en I-EVOLUTION este I-EVOLUTION paciente I-EVOLUTION la I-EVOLUTION asociación I-EVOLUTION con I-EVOLUTION complejo I-EVOLUTION de I-EVOLUTION Carney I-EVOLUTION y I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION Peutz-Jeghers. I-EVOLUTION I-EVOLUTION 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 Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS chofer, B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento. I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS pantorrilla I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS poplítea I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS metros I-PRESENT_ILLNESS de I-PRESENT_ILLNESS marcha. I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY claudicación I-PAST_MEDICAL_HISTORY intermitente. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destaca I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION temperatura I-EXPLORATION en I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION pierna I-EXPLORATION y I-EXPLORATION pie I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION poplíteo I-EXPLORATION y I-EXPLORATION distal I-EXPLORATION en I-EXPLORATION esa I-EXPLORATION extremidad. I-EXPLORATION En I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION derecha I-EXPLORATION pulsos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION vascular I-EXPLORATION no I-EXPLORATION invasivo I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION clínico I-EXPLORATION de I-EXPLORATION obliteración I-EXPLORATION femoro-poplítea I-EXPLORATION izquierda, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION hospitaliza I-EXPLORATION para I-EXPLORATION angiografía. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION estudio I-EXPLORATION angiográfico I-EXPLORATION ; I-EXPLORATION observándose I-EXPLORATION en I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION izquierda I-EXPLORATION en I-EXPLORATION un I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION largo, I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION de I-EXPLORATION hasta I-EXPLORATION 93%, I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION lisa, I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION compresión I-EXPLORATION extrínseca. I-EXPLORATION Resto I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION arterial I-EXPLORATION sano, I-EXPLORATION sin I-EXPLORATION imágenes I-EXPLORATION endoluminales. I-EXPLORATION I-EXPLORATION Llama B-EVOLUTION la I-EVOLUTION atención I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION pulso I-EVOLUTION poplíteo I-EVOLUTION y I-EVOLUTION distal I-EVOLUTION en I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION afectada I-EVOLUTION al I-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION del I-EVOLUTION estudio. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION post I-EVOLUTION angiografía I-EVOLUTION se I-EVOLUTION indica I-EVOLUTION marcha I-EVOLUTION al I-EVOLUTION paciente, I-EVOLUTION reproduciendo I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION pantorrilla I-EVOLUTION izquierda. I-EVOLUTION Examinado B-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION se I-EXPLORATION pesquisa I-EXPLORATION nuevamente I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION poplíteo I-EXPLORATION y I-EXPLORATION distal. I-EXPLORATION Estudio I-EXPLORATION no I-EXPLORATION invasivo I-EXPLORATION PVR I-EXPLORATION (registro I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION pulsos) I-EXPLORATION y I-EXPLORATION PPG I-EXPLORATION muestra I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION curvas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION poplítea I-EXPLORATION a I-EXPLORATION distal I-EXPLORATION con I-EXPLORATION PPG I-EXPLORATION plano I-EXPLORATION en I-EXPLORATION ortejos.. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION hipótesis I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION atrapamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION que I-EXPLORATION no I-EXPLORATION muestra I-EXPLORATION compresión I-EXPLORATION extrínseca I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION por I-EXPLORATION estructura I-EXPLORATION alguna, I-EXPLORATION destacando I-EXPLORATION en I-EXPLORATION su I-EXPLORATION pared I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION hiperintensa I-EXPLORATION en I-EXPLORATION secuencia I-EXPLORATION T1que I-EXPLORATION determina I-EXPLORATION estenosis I-EXPLORATION y I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION hematoma. I-EXPLORATION Estudio I-EXPLORATION con I-EXPLORATION angiografía I-EXPLORATION por I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION (AngioTC I-EXPLORATION de I-EXPLORATION EEII) I-EXPLORATION muestra I-EXPLORATION en I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION izquierda, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION estenosis, I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION baja I-EXPLORATION densidad I-EXPLORATION en I-EXPLORATION su I-EXPLORATION pared, I-EXPLORATION sin I-EXPLORATION realce I-EXPLORATION con I-EXPLORATION el I-EXPLORATION contraste I-EXPLORATION endovenoso, I-EXPLORATION que I-EXPLORATION hace I-EXPLORATION plantear I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION degeneración I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION poplítea. I-EXPLORATION I-EXPLORATION Intervenido B-TREATMENT quirúrgicamente I-TREATMENT mediante I-TREATMENT abordaje I-TREATMENT posterior, I-TREATMENT se I-TREATMENT realiza I-TREATMENT puente I-TREATMENT poplíteo I-TREATMENT con I-TREATMENT vena I-TREATMENT safena I-TREATMENT invertida, I-TREATMENT resecando I-TREATMENT la I-TREATMENT arteria I-TREATMENT poplítea I-TREATMENT en I-TREATMENT su I-TREATMENT tercio I-TREATMENT medio, I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT aprecia I-TREATMENT de I-TREATMENT coloración I-TREATMENT violácea I-TREATMENT y I-TREATMENT contorno I-TREATMENT irregular. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION enviada I-EXPLORATION a I-EXPLORATION biopsia I-EXPLORATION concluye I-EXPLORATION “degeneración I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION la I-EXPLORATION media”. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION con I-EVOLUTION pulsos I-EVOLUTION conservados I-EVOLUTION y I-EVOLUTION simétricos I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION EEII, I-EVOLUTION sin I-EVOLUTION claudicación I-EVOLUTION intermitente I-EVOLUTION y I-EVOLUTION pudiendo I-EVOLUTION reintegrarse I-EVOLUTION rápidamente I-EVOLUTION a I-EVOLUTION sus I-EVOLUTION labores I-EVOLUTION habituales. I-EVOLUTION I-EVOLUTION En I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático, I-EVOLUTION con I-EVOLUTION examen I-EVOLUTION físico I-EVOLUTION y I-EVOLUTION estudio I-EVOLUTION vascular I-EVOLUTION no I-EVOLUTION invasivo I-EVOLUTION normal I-EVOLUTION a I-EVOLUTION un I-EVOLUTION año I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS intervenido B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hipospadias I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY correcta I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY micción I-PAST_MEDICAL_HISTORY confortable. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS al I-PRESENT_ILLNESS urólogo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS sordo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ingle I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS de I-PRESENT_ILLNESS testículo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION un I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION muy I-EXPLORATION aumentado I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION su I-EXPLORATION totalidad, I-EXPLORATION irregular I-EXPLORATION e I-EXPLORATION indurado I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION testicular I-EXPLORATION con I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION exploración I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION testicular I-EXPLORATION que I-EXPLORATION se I-EXPLORATION describe I-EXPLORATION como I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION quístico I-EXPLORATION con I-EXPLORATION tabiques I-EXPLORATION finos I-EXPLORATION y I-EXPLORATION un I-EXPLORATION granuloma I-EXPLORATION con I-EXPLORATION calcificaciones I-EXPLORATION intratesticular I-EXPLORATION y I-EXPLORATION fuera I-EXPLORATION del I-EXPLORATION testículo I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION otro I-EXPLORATION quiste I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION ecos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION a I-EXPLORATION descartar I-EXPLORATION quiste I-EXPLORATION epidermoide I-EXPLORATION o I-EXPLORATION hidatídico. I-EXPLORATION Los I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION alfa I-EXPLORATION fetoproteína I-EXPLORATION y I-EXPLORATION BHCG I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION TAC I-EXPLORATION solicitado I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION sólida I-EXPLORATION retroperitoneal I-EXPLORATION izquierda I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hilio I-EXPLORATION renal I-EXPLORATION lateroaórtica I-EXPLORATION y I-EXPLORATION prerrenal I-EXPLORATION de I-EXPLORATION 54x51x90 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION I-EXPLORATION Se B-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT una I-TREATMENT orquiectomía I-TREATMENT inguinal I-TREATMENT izquierda I-TREATMENT con I-TREATMENT resultado I-TREATMENT anatomo-patológico I-TREATMENT de I-TREATMENT teratoma I-TREATMENT maduro I-TREATMENT puro I-TREATMENT poco I-TREATMENT diferenciado I-TREATMENT limitado I-TREATMENT a I-TREATMENT testículo I-TREATMENT sin I-TREATMENT invasión I-TREATMENT vascular I-TREATMENT que I-TREATMENT afectaba I-TREATMENT a I-TREATMENT túnica I-TREATMENT albugínea I-TREATMENT pero I-TREATMENT no I-TREATMENT a I-TREATMENT vaginal, I-TREATMENT sin I-TREATMENT afectación I-TREATMENT de I-TREATMENT rete I-TREATMENT testis I-TREATMENT de I-TREATMENT 5x3x3 I-TREATMENT mm. I-TREATMENT de I-TREATMENT tamaño. I-TREATMENT El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO adyuvante. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Nos B-EXPLORATION encontramos I-EXPLORATION ante I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION testicular I-EXPLORATION no I-EXPLORATION seminomatoso I-EXPLORATION estadio I-EXPLORATION pT2 I-EXPLORATION N3, I-EXPLORATION M0 I-EXPLORATION según I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION TNM I-EXPLORATION y I-EXPLORATION en I-EXPLORATION estadio I-EXPLORATION II I-EXPLORATION c I-EXPLORATION sin I-EXPLORATION factores I-EXPLORATION de I-EXPLORATION mal I-EXPLORATION pronóstico. I-EXPLORATION En B-TREATMENT esta I-TREATMENT situación I-TREATMENT se I-TREATMENT plantean I-TREATMENT dos I-TREATMENT opciones, I-TREATMENT comenzar I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT y I-TREATMENT plantear I-TREATMENT resección I-TREATMENT si I-TREATMENT persistía I-TREATMENT masa I-TREATMENT residual I-TREATMENT o I-TREATMENT realizar I-TREATMENT una I-TREATMENT linfadenectomia I-TREATMENT retroperitoneal. I-TREATMENT I-TREATMENT Dada I-TREATMENT la I-TREATMENT negatividad I-TREATMENT de I-TREATMENT los I-TREATMENT marcadores I-TREATMENT tumorales I-TREATMENT y I-TREATMENT la I-TREATMENT anatomía I-TREATMENT patológica I-TREATMENT de I-TREATMENT la I-TREATMENT pieza I-TREATMENT testicular I-TREATMENT y I-TREATMENT la I-TREATMENT conocida I-TREATMENT quimioresistencia I-TREATMENT del I-TREATMENT teratoma I-TREATMENT maduro I-TREATMENT puro I-TREATMENT se I-TREATMENT decidió I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT linfadenectomía I-TREATMENT retroperitoneal I-TREATMENT por I-TREATMENT las I-TREATMENT posibilidades I-TREATMENT de I-TREATMENT ser I-TREATMENT curativa I-TREATMENT si I-TREATMENT la I-TREATMENT histología I-TREATMENT era I-TREATMENT coincidente I-TREATMENT con I-TREATMENT el I-TREATMENT primario I-TREATMENT sin I-TREATMENT existir I-TREATMENT otros I-TREATMENT componentes I-TREATMENT tumorales I-TREATMENT no I-TREATMENT seminomatosos. I-TREATMENT I-TREATMENT Se I-TREATMENT realizó I-TREATMENT linfadenectomía I-TREATMENT retroperitoneal I-TREATMENT hasta I-TREATMENT vasos I-TREATMENT iliacos I-TREATMENT obteniendo I-TREATMENT la I-TREATMENT pieza I-TREATMENT observada I-TREATMENT en I-TREATMENT Figura I-TREATMENT 2. I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION anatomo-patológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION teratoma I-EXPLORATION maduro I-EXPLORATION puro I-EXPLORATION con I-EXPLORATION los I-EXPLORATION componentes I-EXPLORATION de I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION capas I-EXPLORATION embrionarias I-EXPLORATION sin I-EXPLORATION invasión I-EXPLORATION linfovascular. I-EXPLORATION EL B-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION vigilancia I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION mediante I-EVOLUTION marcadores, I-EVOLUTION TAC I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION radiografía I-EVOLUTION de I-EVOLUTION tórax I-EVOLUTION periódicas. I-EVOLUTION I-EVOLUTION 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 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 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 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 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 Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS (39 I-PRESENT_ILLNESS ºC) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY recién I-PAST_MEDICAL_HISTORY nacido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gesta I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY controlado, I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY normal, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY término I-PAST_MEDICAL_HISTORY (40 I-PAST_MEDICAL_HISTORY semanas), I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY adecuado I-PAST_MEDICAL_HISTORY (3360 I-PAST_MEDICAL_HISTORY kg). I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY diagnosticaron I-PAST_MEDICAL_HISTORY miopía, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encuentra I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY oftalmología. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tracto I-PAST_MEDICAL_HISTORY urinario I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Escherichia I-PAST_MEDICAL_HISTORY coli, I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY ambulatorio, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY realizaron I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY posteriores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esta I-PAST_MEDICAL_HISTORY patología. I-PAST_MEDICAL_HISTORY Refiere I-PAST_MEDICAL_HISTORY poliuria I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY polidipsia I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY temprana I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY Antecedentes B-FAMILY_HISTORY familiares: I-FAMILY_HISTORY abuela I-FAMILY_HISTORY paterna I-FAMILY_HISTORY hipoacúsica, I-FAMILY_HISTORY primo I-FAMILY_HISTORY paterno I-FAMILY_HISTORY con I-FAMILY_HISTORY litiasis I-FAMILY_HISTORY renal, I-FAMILY_HISTORY padre I-FAMILY_HISTORY con I-FAMILY_HISTORY microhematuria. I-FAMILY_HISTORY Al B-EXPLORATION ingreso, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION eutrófica I-EXPLORATION (peso: I-EXPLORATION 17.400 I-EXPLORATION kg, I-EXPLORATION talla: I-EXPLORATION 104 I-EXPLORATION cm), I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION febril, I-EXPLORATION normotensa. I-EXPLORATION Por I-EXPLORATION presentar I-EXPLORATION orina I-EXPLORATION patológica I-EXPLORATION se I-EXPLORATION solicitan: I-EXPLORATION urocultivo, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION informa I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Escherichia I-EXPLORATION coli, I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION renal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION evidencian I-EXPLORATION imágenes I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION nefrocalcinosis. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION calcificaciones I-EXPLORATION renales. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION manifestaron I-EXPLORATION insuficiencia I-EXPLORATION renal I-EXPLORATION (depuración I-EXPLORATION de I-EXPLORATION creatinina I-EXPLORATION 50 I-EXPLORATION ml/min/1, I-EXPLORATION 73, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION calculó I-EXPLORATION por I-EXPLORATION fórmula), I-EXPLORATION hipercalciuria I-EXPLORATION (13 I-EXPLORATION mg/kg/d), I-EXPLORATION hipomagnesemia, I-EXPLORATION hipermagnesuria, I-EXPLORATION anemia I-EXPLORATION y I-EXPLORATION acidosis. I-EXPLORATION I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION cardiológica I-EXPLORATION y I-EXPLORATION otorrinolaringológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION oftalmología I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION "coriorretinitis I-EXPLORATION cicatrizal I-EXPLORATION macular, I-EXPLORATION coriopatía I-EXPLORATION miópica". I-EXPLORATION Se I-EXPLORATION arriba I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION por I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION hipercalciuria, I-EXPLORATION nefrocalcinosis, I-EXPLORATION hipomagnesemia, I-EXPLORATION hipermagnesuria I-EXPLORATION e I-EXPLORATION insuficiencia I-EXPLORATION renal, I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION patología I-EXPLORATION ocular I-EXPLORATION y I-EXPLORATION antecedentes I-EXPLORATION personales I-EXPLORATION y I-EXPLORATION familiares I-EXPLORATION compatibles. I-EXPLORATION Cumplió B-TREATMENT tratamiento I-TREATMENT para I-TREATMENT infección I-TREATMENT urinaria. I-TREATMENT Se I-TREATMENT indicó I-TREATMENT citrato I-TREATMENT de I-TREATMENT potasio, I-TREATMENT amiloride-hidroclorotiazida I-TREATMENT 25 I-TREATMENT mg/día, I-TREATMENT pidolato I-TREATMENT de I-TREATMENT magnesio I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT g/ I-TREATMENT día, I-TREATMENT ácido I-TREATMENT fólico I-TREATMENT 5 I-TREATMENT mg/día, I-TREATMENT sulfato I-TREATMENT ferroso I-TREATMENT 3 I-TREATMENT mg/ I-TREATMENT kg/día, I-TREATMENT dieta I-TREATMENT hiposódica I-TREATMENT controlada I-TREATMENT en I-TREATMENT proteínas I-TREATMENT y I-TREATMENT líquidos I-TREATMENT a I-TREATMENT demanda. I-TREATMENT Durante B-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION presentó I-EVOLUTION nueva I-EVOLUTION infección I-EVOLUTION urinaria I-EVOLUTION a I-EVOLUTION E. I-EVOLUTION coli, I-EVOLUTION se B-EXPLORATION realizó I-EXPLORATION cistouretrografía I-EXPLORATION miccional, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION y B-TREATMENT se I-TREATMENT inició I-TREATMENT profilaxis I-TREATMENT antibiótica I-TREATMENT con I-TREATMENT nitrofurantoína. I-TREATMENT Se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT hidroclorotiazida I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT meses I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT por I-TREATMENT brusco I-TREATMENT aumento I-TREATMENT de I-TREATMENT urea I-TREATMENT y I-TREATMENT creatinina, I-TREATMENT con I-TREATMENT mejoría I-TREATMENT posterior I-TREATMENT y I-TREATMENT mantenimiento I-TREATMENT de I-TREATMENT valores I-TREATMENT de I-TREATMENT calciuria I-TREATMENT dentro I-TREATMENT de I-TREATMENT la I-TREATMENT normalidad. I-TREATMENT Se B-EVOLUTION mantiene I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION el I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION la I-EVOLUTION medicación. I-EVOLUTION I-EVOLUTION 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 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 Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY salvo I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY cesáreas, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS fue I-PRESENT_ILLNESS remitida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION una I-EXPLORATION litiasis I-EXPLORATION renal I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION intravenosa I-EXPLORATION una I-EXPLORATION acodadura I-EXPLORATION del I-EXPLORATION uréter I-EXPLORATION derecho I-EXPLORATION en I-EXPLORATION su I-EXPLORATION tercio I-EXPLORATION superior I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION Asintomática, B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION A B-EXPLORATION los I-EXPLORATION dos I-EXPLORATION meses, I-EXPLORATION nuevo I-EXPLORATION ingreso I-EXPLORATION por I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION clínica I-EXPLORATION y I-EXPLORATION nueva I-EXPLORATION batería I-EXPLORATION de I-EXPLORATION pruebas: I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION comprueba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION litiasis I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION uréter I-EXPLORATION distal I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION pequeñas I-EXPLORATION calcificaciones I-EXPLORATION en I-EXPLORATION riñón I-EXPLORATION derecho; I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION confirma I-EXPLORATION lo I-EXPLORATION hallado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION y I-EXPLORATION además I-EXPLORATION descarta I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION uropatía I-EXPLORATION obstructiva. I-EXPLORATION En I-EXPLORATION todo I-EXPLORATION momento I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION Se B-TREATMENT trata I-TREATMENT la I-TREATMENT litiasis I-TREATMENT ureteral I-TREATMENT mediante I-TREATMENT ureteroscopia I-TREATMENT y I-TREATMENT lasertricia I-TREATMENT persistiendo I-TREATMENT la I-TREATMENT clínica I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT la I-TREATMENT eficacia I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT lo I-TREATMENT que I-TREATMENT motiva I-TREATMENT nuevo I-TREATMENT ingreso I-TREATMENT unos I-TREATMENT meses I-TREATMENT más I-TREATMENT tarde. I-TREATMENT Se B-EXPLORATION realiza I-EXPLORATION UIV I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION ectasia I-EXPLORATION ureteropielocalicial I-EXPLORATION derecha I-EXPLORATION hasta I-EXPLORATION cresta I-EXPLORATION iliaca. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION los I-EXPLORATION riñones I-EXPLORATION son I-EXPLORATION normales I-EXPLORATION pero I-EXPLORATION el I-EXPLORATION uréter I-EXPLORATION derecho I-EXPLORATION está I-EXPLORATION discretamente I-EXPLORATION dilatado I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION distal I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION identifica I-EXPLORATION un I-EXPLORATION quiste I-EXPLORATION ovárico I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION que I-EXPLORATION pudiera I-EXPLORATION estar I-EXPLORATION comprimiendo I-EXPLORATION parcialmente I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION distal I-EXPLORATION del I-EXPLORATION uréter I-EXPLORATION (vista I-EXPLORATION por I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION ginecología I-EXPLORATION no I-EXPLORATION precisa I-EXPLORATION tratamiento I-EXPLORATION alguno, I-EXPLORATION solamente I-EXPLORATION revisiones I-EXPLORATION periódicas). I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION pielografía I-EXPLORATION ascendente I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION se I-EXPLORATION ve I-EXPLORATION la I-EXPLORATION ectasia I-EXPLORATION ureteropielocalicial I-EXPLORATION sin I-EXPLORATION observar I-EXPLORATION claramente I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION ureteral; I-EXPLORATION se B-TREATMENT coloca I-TREATMENT un I-TREATMENT catéter I-TREATMENT doble I-TREATMENT J I-TREATMENT que I-TREATMENT es I-TREATMENT retirado I-TREATMENT a I-TREATMENT las I-TREATMENT 8 I-TREATMENT semanas I-TREATMENT sin I-TREATMENT apreciar I-TREATMENT la I-TREATMENT paciente I-TREATMENT mejoría I-TREATMENT clínica. I-TREATMENT Se B-EXPLORATION decide I-EXPLORATION hacer I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN) I-EXPLORATION que I-EXPLORATION nos I-EXPLORATION pueda I-EXPLORATION aportar I-EXPLORATION algún I-EXPLORATION dato I-EXPLORATION nuevo I-EXPLORATION que I-EXPLORATION justifique I-EXPLORATION los I-EXPLORATION síntomas; I-EXPLORATION dicha I-EXPLORATION RMN I-EXPLORATION nos I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION una I-EXPLORATION ectasia I-EXPLORATION ureteral I-EXPLORATION derecha I-EXPLORATION por I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION ovárica. I-EXPLORATION I-EXPLORATION Se B-TREATMENT programa I-TREATMENT para I-TREATMENT intervención I-TREATMENT quirúrgica: I-TREATMENT ligadura I-TREATMENT de I-TREATMENT vena I-TREATMENT ovárica I-TREATMENT más I-TREATMENT ureterolisis I-TREATMENT derecha I-TREATMENT por I-TREATMENT vía I-TREATMENT laparoscópica I-TREATMENT transabdominal. I-TREATMENT La I-TREATMENT paciente I-TREATMENT es I-TREATMENT colocada I-TREATMENT en I-TREATMENT ligero I-TREATMENT decúbito I-TREATMENT lateral I-TREATMENT izquierdo. I-TREATMENT Insuflación I-TREATMENT abdominal I-TREATMENT con I-TREATMENT CO2 I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT aguja I-TREATMENT de I-TREATMENT Veress I-TREATMENT y I-TREATMENT colocación I-TREATMENT de I-TREATMENT cuatro I-TREATMENT trócares, I-TREATMENT 2 I-TREATMENT de I-TREATMENT 5 I-TREATMENT mm I-TREATMENT - I-TREATMENT (uno I-TREATMENT subesternal I-TREATMENT y I-TREATMENT otro I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT lumbar I-TREATMENT entre I-TREATMENT la I-TREATMENT cresta I-TREATMENT iliaca I-TREATMENT y I-TREATMENT la I-TREATMENT 12ª I-TREATMENT costilla) I-TREATMENT - I-TREATMENT y I-TREATMENT 2 I-TREATMENT de I-TREATMENT 10 I-TREATMENT mm I-TREATMENT - I-TREATMENT (uno I-TREATMENT en I-TREATMENT el I-TREATMENT ombligo, I-TREATMENT donde I-TREATMENT se I-TREATMENT coloca I-TREATMENT la I-TREATMENT óptica, I-TREATMENT y I-TREATMENT el I-TREATMENT otro I-TREATMENT suprapúbico) I-TREATMENT -. I-TREATMENT Tras I-TREATMENT la I-TREATMENT incisión I-TREATMENT de I-TREATMENT la I-TREATMENT línea I-TREATMENT de I-TREATMENT Toldt I-TREATMENT y I-TREATMENT decolación I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT identificación I-TREATMENT del I-TREATMENT uréter I-TREATMENT lumbar I-TREATMENT y I-TREATMENT seguimiento I-TREATMENT del I-TREATMENT mismo I-TREATMENT hasta I-TREATMENT observar I-TREATMENT su I-TREATMENT paso I-TREATMENT entre I-TREATMENT la I-TREATMENT arteria I-TREATMENT iliaca I-TREATMENT y I-TREATMENT la I-TREATMENT vena I-TREATMENT ovárica, I-TREATMENT ésta I-TREATMENT última I-TREATMENT cruza I-TREATMENT por I-TREATMENT encima I-TREATMENT del I-TREATMENT uréter I-TREATMENT y I-TREATMENT se I-TREATMENT bifurca I-TREATMENT en I-TREATMENT 2 I-TREATMENT ramas I-TREATMENT que I-TREATMENT actúan I-TREATMENT a I-TREATMENT modo I-TREATMENT de I-TREATMENT pinza I-TREATMENT comprimiendo I-TREATMENT el I-TREATMENT uréter. I-TREATMENT Se I-TREATMENT libera I-TREATMENT la I-TREATMENT vena I-TREATMENT ovárica I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT ligadura I-TREATMENT y I-TREATMENT sección I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT Para I-TREATMENT finalizar, I-TREATMENT colocamos I-TREATMENT un I-TREATMENT drenaje I-TREATMENT tipo I-TREATMENT Redon I-TREATMENT sin I-TREATMENT aspiración I-TREATMENT a I-TREATMENT través I-TREATMENT del I-TREATMENT trócar I-TREATMENT lateral, I-TREATMENT se I-TREATMENT confirma I-TREATMENT la I-TREATMENT hemostasia, I-TREATMENT se I-TREATMENT evacúa I-TREATMENT el I-TREATMENT CO2 I-TREATMENT y I-TREATMENT se I-TREATMENT suturan I-TREATMENT los I-TREATMENT puertos I-TREATMENT de I-TREATMENT entrada. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION cursa I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION En I-EVOLUTION revisiones I-EVOLUTION posteriores, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION y I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION totalmente I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION UIV I-EVOLUTION de I-EVOLUTION control I-EVOLUTION ha I-EVOLUTION desaparecido I-EVOLUTION la I-EVOLUTION ectasia I-EVOLUTION y I-EVOLUTION acodadura I-EVOLUTION del I-EVOLUTION uréter I-EVOLUTION derecho. I-EVOLUTION I-EVOLUTION Una B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sana I-PAST_MEDICAL_HISTORY ingresó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general I-PRESENT_ILLNESS y I-PRESENT_ILLNESS alteración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pruebas I-PRESENT_ILLNESS hepáticas. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION decaída I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION pancitopenia I-EXPLORATION (hemoglobina I-EXPLORATION 10 I-EXPLORATION gr%, I-EXPLORATION leucocitos I-EXPLORATION 1.900/uL, I-EXPLORATION plaquetas I-EXPLORATION 43.000/mL) I-EXPLORATION y I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION (GOT I-EXPLORATION 1.800 I-EXPLORATION U/L, I-EXPLORATION GPT I-EXPLORATION 1.300 I-EXPLORATION U/L). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION enfermedades I-EXPLORATION infecciosas I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION (hemocultivo, I-EXPLORATION urocultivo, I-EXPLORATION virus I-EXPLORATION hepatotropos, I-EXPLORATION mycoplasma, I-EXPLORATION toxoplasma, I-EXPLORATION leptospira, I-EXPLORATION bartonella, I-EXPLORATION brucella, I-EXPLORATION rubéola, I-EXPLORATION sarampión, I-EXPLORATION VIH, I-EXPLORATION parvovirus I-EXPLORATION B19, I-EXPLORATION citomegalovirus I-EXPLORATION y I-EXPLORATION Epstein I-EXPLORATION Barr). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION reumatológico I-EXPLORATION donde I-EXPLORATION resultó I-EXPLORATION ANA I-EXPLORATION 1: I-EXPLORATION 40 I-EXPLORATION patrón I-EXPLORATION moteado I-EXPLORATION y I-EXPLORATION anti I-EXPLORATION DNA I-EXPLORATION por I-EXPLORATION FARR, I-EXPLORATION factor I-EXPLORATION reumatoide I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION ENA I-EXPLORATION negativos I-EXPLORATION con I-EXPLORATION complemento I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION continuó I-EXPLORATION con I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION en I-EXPLORATION deterioro. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION linfonodos I-EXPLORATION pequeños I-EXPLORATION difusos, I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION laminar I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION hepatoesplenomegalia. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION linfonodos I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION adenitis I-EXPLORATION no I-EXPLORATION específica. I-EXPLORATION Los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION ferritina I-EXPLORATION resultaron I-EXPLORATION en I-EXPLORATION 23.460 I-EXPLORATION U/L. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION medular I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION hiperplasia I-EXPLORATION linfoide I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION abundantes I-EXPLORATION hemofagocitos. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT protocolo I-TREATMENT HLH I-TREATMENT 04 I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínica, I-TREATMENT con I-TREATMENT normalización I-TREATMENT de I-TREATMENT pruebas I-TREATMENT hepáticas I-TREATMENT y I-TREATMENT descenso I-TREATMENT de I-TREATMENT la I-TREATMENT ferritina I-TREATMENT hasta I-TREATMENT valores I-TREATMENT normales. I-TREATMENT Al B-EVOLUTION momento I-EVOLUTION de I-EVOLUTION redactar I-EVOLUTION este I-EVOLUTION reporte I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION lleva I-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION dispone I-EVOLUTION de I-EVOLUTION hermanos I-EVOLUTION HLA I-EVOLUTION compatibles. I-EVOLUTION I-EVOLUTION Familia B-PRESENT_ILLNESS afectada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS madre. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Estudio I-PRESENT_ILLNESS molecular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hormonal. I-PRESENT_ILLNESS El B-FAMILY_HISTORY estudio I-FAMILY_HISTORY hormonal I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY tía I-FAMILY_HISTORY y I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY del I-FAMILY_HISTORY probando I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II. I-FAMILY_HISTORY 2 I-FAMILY_HISTORY y I-FAMILY_HISTORY II. I-FAMILY_HISTORY 3) I-FAMILY_HISTORY incluyó I-FAMILY_HISTORY una I-FAMILY_HISTORY prueba I-FAMILY_HISTORY de I-FAMILY_HISTORY ACTH, I-FAMILY_HISTORY cuyos I-FAMILY_HISTORY valores I-FAMILY_HISTORY de I-FAMILY_HISTORY 170H I-FAMILY_HISTORY Progesterona I-FAMILY_HISTORY basal I-FAMILY_HISTORY y I-FAMILY_HISTORY estimulado I-FAMILY_HISTORY fueron I-FAMILY_HISTORY normales, I-FAMILY_HISTORY no I-FAMILY_HISTORY permitiendo I-FAMILY_HISTORY aclarar I-FAMILY_HISTORY si I-FAMILY_HISTORY estos I-FAMILY_HISTORY sujetos I-FAMILY_HISTORY eran I-FAMILY_HISTORY heterocigotos I-FAMILY_HISTORY de I-FAMILY_HISTORY una I-FAMILY_HISTORY mutación I-FAMILY_HISTORY del I-FAMILY_HISTORY CYP21A2. I-FAMILY_HISTORY I-FAMILY_HISTORY El B-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION en I-EXPLORATION ADN I-EXPLORATION genómi-co I-EXPLORATION extraído I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION y I-EXPLORATION las I-EXPLORATION siete I-EXPLORATION mutaciones I-EXPLORATION más I-EXPLORATION frecuentes I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION CYP21A2 I-EXPLORATION fueron I-EXPLORATION estudiadas I-EXPLORATION con I-EXPLORATION PCR I-EXPLORATION alelo I-EXPLORATION específica I-EXPLORATION (Fardella, I-EXPLORATION 1998). I-EXPLORATION Este B-FAMILY_HISTORY estudio I-FAMILY_HISTORY demostró I-FAMILY_HISTORY en I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY paterna I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II.2, I-FAMILY_HISTORY II.4, I-FAMILY_HISTORY II.6) I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY Q318X I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY exón I-FAMILY_HISTORY 8, I-FAMILY_HISTORY que I-FAMILY_HISTORY consiste I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY cambio I-FAMILY_HISTORY de I-FAMILY_HISTORY una I-FAMILY_HISTORY glutamina I-FAMILY_HISTORY por I-FAMILY_HISTORY un I-FAMILY_HISTORY codón I-FAMILY_HISTORY de I-FAMILY_HISTORY stop. I-FAMILY_HISTORY Este I-FAMILY_HISTORY resultado I-FAMILY_HISTORY no I-FAMILY_HISTORY permitió I-FAMILY_HISTORY clasificar I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY materna I-FAMILY_HISTORY y I-FAMILY_HISTORY por I-FAMILY_HISTORY ende I-FAMILY_HISTORY decidir I-FAMILY_HISTORY sobre I-FAMILY_HISTORY la I-FAMILY_HISTORY necesidad I-FAMILY_HISTORY del I-FAMILY_HISTORY tratamiento I-FAMILY_HISTORY prenatal I-FAMILY_HISTORY en I-FAMILY_HISTORY estas I-FAMILY_HISTORY parejas. I-FAMILY_HISTORY I-FAMILY_HISTORY Posteriormente, B-EXPLORATION el I-EXPLORATION gen I-EXPLORATION CYP21A2fue I-EXPLORATION secuenciado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Sao I-EXPLORATION Paulo I-EXPLORATION según I-EXPLORATION las I-EXPLORATION técnicas I-EXPLORATION clásicas I-EXPLORATION (Wedell, I-EXPLORATION 1993). I-EXPLORATION Usando B-FAMILY_HISTORY esta I-FAMILY_HISTORY metodología, I-FAMILY_HISTORY se I-FAMILY_HISTORY encontró I-FAMILY_HISTORY en I-FAMILY_HISTORY uno I-FAMILY_HISTORY de I-FAMILY_HISTORY los I-FAMILY_HISTORY alelos I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY paterna I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II.2, I-FAMILY_HISTORY II.4, I-FAMILY_HISTORY II.6) I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY Q318X I-FAMILY_HISTORY junto I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY R483W, I-FAMILY_HISTORY la I-FAMILY_HISTORY que I-FAMILY_HISTORY consiste I-FAMILY_HISTORY en I-FAMILY_HISTORY la I-FAMILY_HISTORY sustitución I-FAMILY_HISTORY de I-FAMILY_HISTORY una I-FAMILY_HISTORY arginina I-FAMILY_HISTORY por I-FAMILY_HISTORY triptofano I-FAMILY_HISTORY (CGG>TGG). I-FAMILY_HISTORY En I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY materna I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II. I-FAMILY_HISTORY 1, I-FAMILY_HISTORY II.3, I-FAMILY_HISTORY II.5) I-FAMILY_HISTORY se I-FAMILY_HISTORY encontró I-FAMILY_HISTORY un I-FAMILY_HISTORY alelo I-FAMILY_HISTORY con I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY R483->frameshift, I-FAMILY_HISTORY también I-FAMILY_HISTORY conocida I-FAMILY_HISTORY como I-FAMILY_HISTORY R483delGGinsC, I-FAMILY_HISTORY la I-FAMILY_HISTORY cuál I-FAMILY_HISTORY consiste I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY cambio I-FAMILY_HISTORY de I-FAMILY_HISTORY los I-FAMILY_HISTORY nucleótidos I-FAMILY_HISTORY GG I-FAMILY_HISTORY por I-FAMILY_HISTORY C, I-FAMILY_HISTORY alterando I-FAMILY_HISTORY la I-FAMILY_HISTORY lectura I-FAMILY_HISTORY del I-FAMILY_HISTORY codón. I-FAMILY_HISTORY De I-FAMILY_HISTORY este I-FAMILY_HISTORY modo I-FAMILY_HISTORY se I-FAMILY_HISTORY certificó I-FAMILY_HISTORY que I-FAMILY_HISTORY los I-FAMILY_HISTORY seis I-FAMILY_HISTORY cónyuges I-FAMILY_HISTORY poseen I-FAMILY_HISTORY mutaciones I-FAMILY_HISTORY para I-FAMILY_HISTORY HSC I-FAMILY_HISTORY perdedora I-FAMILY_HISTORY de I-FAMILY_HISTORY sal, I-FAMILY_HISTORY y I-FAMILY_HISTORY por I-FAMILY_HISTORY lo I-FAMILY_HISTORY tanto, I-FAMILY_HISTORY se I-FAMILY_HISTORY encuentran I-FAMILY_HISTORY en I-FAMILY_HISTORY riesgo I-FAMILY_HISTORY de I-FAMILY_HISTORY tener I-FAMILY_HISTORY hijas I-FAMILY_HISTORY con I-FAMILY_HISTORY ambigüedad I-FAMILY_HISTORY genital. I-FAMILY_HISTORY I-FAMILY_HISTORY Consejo B-TREATMENT genético I-TREATMENT y I-TREATMENT manejo I-TREATMENT de I-TREATMENT los I-TREATMENT embarazos. I-TREATMENT Se I-TREATMENT procede I-TREATMENT a I-TREATMENT dar I-TREATMENT consejo I-TREATMENT genético I-TREATMENT a I-TREATMENT los I-TREATMENT tres I-TREATMENT matrimonios I-TREATMENT afectados. I-TREATMENT La B-EVOLUTION tía I-EVOLUTION paterna I-EVOLUTION (sujeto I-EVOLUTION II.2), I-EVOLUTION mujer I-EVOLUTION sana I-EVOLUTION de I-EVOLUTION 34 I-EVOLUTION años, I-EVOLUTION suspende I-EVOLUTION el I-EVOLUTION método I-EVOLUTION anticonceptivo I-EVOLUTION por I-EVOLUTION deseos I-EVOLUTION de I-EVOLUTION fertilidad I-EVOLUTION y I-EVOLUTION logra I-EVOLUTION concepción I-EVOLUTION espontánea I-EVOLUTION en I-EVOLUTION marzo I-EVOLUTION 2005. I-EVOLUTION Se B-TREATMENT explican I-TREATMENT los I-TREATMENT beneficios I-TREATMENT y I-TREATMENT riesgos I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT prenatal I-TREATMENT con I-TREATMENT corti-coides, I-TREATMENT los I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT entiende I-TREATMENT y I-TREATMENT acepta, I-TREATMENT firmando I-TREATMENT un I-TREATMENT consentimiento I-TREATMENT en I-TREATMENT que I-TREATMENT opta I-TREATMENT por I-TREATMENT realizar I-TREATMENT esta I-TREATMENT terapia. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT comenzó I-TREATMENT a I-TREATMENT las I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT de I-TREATMENT edad I-TREATMENT gestacional I-TREATMENT (EG) I-TREATMENT con I-TREATMENT dexametasona I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 20 I-TREATMENT µg/kg/día. I-TREATMENT I-TREATMENT A B-EXPLORATION las I-EXPLORATION 13 I-EXPLORATION semanas I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sexo I-EXPLORATION fetal I-EXPLORATION masculino I-EXPLORATION por I-EXPLORATION ultrasonografía I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resolución I-EXPLORATION (Voluson I-EXPLORATION 730, I-EXPLORATION General I-EXPLORATION Electric, I-EXPLORATION Austria, I-EXPLORATION transductor I-EXPLORATION transabdominal I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5-5 I-EXPLORATION MHz), I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION es I-EXPLORATION capaz I-EXPLORATION de I-EXPLORATION predecir I-EXPLORATION conectamente I-EXPLORATION el I-EXPLORATION sexo I-EXPLORATION fetal I-EXPLORATION con I-EXPLORATION 99% I-EXPLORATION de I-EXPLORATION certeza I-EXPLORATION después I-EXPLORATION de I-EXPLORATION 12+6 I-EXPLORATION semanas I-EXPLORATION EG I-EXPLORATION (Efrat, I-EXPLORATION 2006); I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION no I-EXPLORATION aceptó I-EXPLORATION técnicas I-EXPLORATION invasivas I-EXPLORATION de I-EXPLORATION diagnóstico I-EXPLORATION prenatal. I-EXPLORATION Se B-TREATMENT disminuyó I-TREATMENT progresivamente I-TREATMENT las I-TREATMENT dosis I-TREATMENT de I-TREATMENT esteroides, I-TREATMENT suspendiéndolo I-TREATMENT en I-TREATMENT forma I-TREATMENT completa I-TREATMENT a I-TREATMENT las I-TREATMENT 22 I-TREATMENT semanas. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION período I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION edema I-EVOLUTION e I-EVOLUTION hipertensión I-EVOLUTION arterial I-EVOLUTION que B-TREATMENT requirió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ametildo-pa. I-TREATMENT Los B-EVOLUTION síntomas I-EVOLUTION revirtieron I-EVOLUTION parcialmente I-EVOLUTION con I-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION de I-EVOLUTION terapia I-EVOLUTION corticoidal, I-EVOLUTION y I-EVOLUTION totalmente I-EVOLUTION posparto. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 39 I-EVOLUTION semanas I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION cesárea I-EVOLUTION y I-EVOLUTION se I-EVOLUTION obtuvo I-EVOLUTION recién I-EVOLUTION nacido I-EVOLUTION de I-EVOLUTION sexo I-EVOLUTION masculino, I-EVOLUTION con I-EVOLUTION peso I-EVOLUTION adecuado I-EVOLUTION y I-EVOLUTION examen I-EVOLUTION físico I-EVOLUTION normal. I-EVOLUTION Los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION 170HP I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION se I-EVOLUTION muestran I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Figura I-EVOLUTION IB. I-EVOLUTION I-EVOLUTION La I-EVOLUTION tía I-EVOLUTION materna I-EVOLUTION (sujeto I-EVOLUTION II.5) I-EVOLUTION de I-EVOLUTION 37 I-EVOLUTION años I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION embarazo I-EVOLUTION inicial I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION EG. I-EVOLUTION Se B-TREATMENT ofrece I-TREATMENT nuevamente I-TREATMENT tratamiento I-TREATMENT prenatal I-TREATMENT de I-TREATMENT HSC, I-TREATMENT y I-TREATMENT también I-TREATMENT se I-TREATMENT solicitó I-TREATMENT firma I-TREATMENT de I-TREATMENT consentimiento I-TREATMENT informado. I-TREATMENT La I-TREATMENT familia I-TREATMENT optó I-TREATMENT nuevamente I-TREATMENT por I-TREATMENT seguir I-TREATMENT este I-TREATMENT tratamiento. I-TREATMENT A I-TREATMENT las I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT de I-TREATMENT EG I-TREATMENT se I-TREATMENT inició I-TREATMENT dexametasona I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 20 I-TREATMENT Lig/kg/día. I-TREATMENT La B-EXPLORATION madre I-EXPLORATION no I-EXPLORATION aceptó I-EXPLORATION las I-EXPLORATION técnicas I-EXPLORATION invasivas I-EXPLORATION de I-EXPLORATION diagnóstico I-EXPLORATION prenatal I-EXPLORATION y I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sexo I-EXPLORATION fetal I-EXPLORATION mediante I-EXPLORATION ecografía I-EXPLORATION precoz. I-EXPLORATION En B-TREATMENT caso I-TREATMENT de I-TREATMENT que I-TREATMENT se I-TREATMENT tratara I-TREATMENT de I-TREATMENT un I-TREATMENT feto I-TREATMENT femenino I-TREATMENT continuarían I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT hasta I-TREATMENT el I-TREATMENT término I-TREATMENT del I-TREATMENT embarazo. I-TREATMENT A I-TREATMENT las I-TREATMENT 12 I-TREATMENT semanas I-TREATMENT se I-TREATMENT diagnosticó I-TREATMENT sexo I-TREATMENT fetal I-TREATMENT masculino I-TREATMENT y I-TREATMENT se I-TREATMENT programó I-TREATMENT suspensión I-TREATMENT de I-TREATMENT esteroides. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION efectos I-EVOLUTION adversos I-EVOLUTION a I-EVOLUTION la I-EVOLUTION dexametasona. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 40 I-EVOLUTION semanas I-EVOLUTION nació I-EVOLUTION niño I-EVOLUTION sano, I-EVOLUTION no I-EVOLUTION afectado. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS IMC B-PAST_MEDICAL_HISTORY 21, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY legrado I-PAST_MEDICAL_HISTORY uterino I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY aborto I-PAST_MEDICAL_HISTORY provocado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY trimestre, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 17 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS marzo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS con I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dismenorrea I-PRESENT_ILLNESS invalidante, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pesar I-PRESENT_ILLNESS del I-PRESENT_ILLNESS uso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS anticonceptivos I-PRESENT_ILLNESS orales, I-PRESENT_ILLNESS polimenorrea I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipermenorrea I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS ciclos I-PRESENT_ILLNESS menstruales, I-PRESENT_ILLNESS refriendo I-PRESENT_ILLNESS además I-PRESENT_ILLNESS dispareunia. I-PRESENT_ILLNESS Examen B-EXPLORATION físico I-EXPLORATION general I-EXPLORATION y I-EXPLORATION ginecológico I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION primera I-EXPLORATION consulta. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION ecotomografía I-EXPLORATION transvaginal I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION endometrial I-EXPLORATION ocupada I-EXPLORATION por I-EXPLORATION imagen I-EXPLORATION hiperecogénica I-EXPLORATION lineal I-EXPLORATION con I-EXPLORATION sombra I-EXPLORATION acústica I-EXPLORATION posterior, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION extensa I-EXPLORATION metaplasia I-EXPLORATION ósea. I-EXPLORATION I-EXPLORATION La I-EXPLORATION histeroscopía I-EXPLORATION mostró I-EXPLORATION cavidad I-EXPLORATION uterina I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION poco I-EXPLORATION distensible, I-EXPLORATION revestida I-EXPLORATION en I-EXPLORATION su I-EXPLORATION totalidad I-EXPLORATION por I-EXPLORATION múltiples I-EXPLORATION fragmentos I-EXPLORATION espiculados I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION ósea. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT extracción I-TREATMENT de I-TREATMENT éstos I-TREATMENT con I-TREATMENT asa I-TREATMENT de I-TREATMENT resectoscopio I-TREATMENT asistido I-TREATMENT con I-TREATMENT cucharilla I-TREATMENT N° I-TREATMENT 2 I-TREATMENT y I-TREATMENT pinza I-TREATMENT Randall, I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT Posteriormente B-EVOLUTION se I-EVOLUTION observó I-EVOLUTION cavidad I-EVOLUTION endometrial I-EVOLUTION sana I-EVOLUTION y I-EVOLUTION ostium I-EVOLUTION tubarios I-EVOLUTION permeables. I-EVOLUTION I-EVOLUTION Su B-EXPLORATION laparoscopía I-EXPLORATION exploradora I-EXPLORATION mostró I-EXPLORATION pelvis I-EXPLORATION sana, I-EXPLORATION útero I-EXPLORATION y I-EXPLORATION anexos I-EXPLORATION normales, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION relación I-EXPLORATION tubo I-EXPLORATION ovárica. I-EXPLORATION Trompas I-EXPLORATION permeables I-EXPLORATION con I-EXPLORATION índigo I-EXPLORATION carmín. I-EXPLORATION I-EXPLORATION Biopsia I-EXPLORATION operatoria I-EXPLORATION estuvo I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION fragmentos I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION óseo I-EXPLORATION maduro, I-EXPLORATION reconociéndose I-EXPLORATION además I-EXPLORATION colonias I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION Actinomyces. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION neoplasia. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION metaplasia I-EXPLORATION ósea I-EXPLORATION del I-EXPLORATION endometrio. I-EXPLORATION Se B-TREATMENT indicaron I-TREATMENT anticonceptivos I-TREATMENT orales I-TREATMENT hasta I-TREATMENT deseo I-TREATMENT de I-TREATMENT embarazo. I-TREATMENT I-TREATMENT Una B-EXPLORATION histerosonografía I-EXPLORATION tres I-EXPLORATION meses I-EXPLORATION post I-EXPLORATION cirugía I-EXPLORATION mostraba I-EXPLORATION cavidad I-EXPLORATION uterina I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION En B-TREATMENT agosto I-TREATMENT de I-TREATMENT 2008 I-TREATMENT consultó I-TREATMENT cursando I-TREATMENT embarazo I-TREATMENT espontáneo I-TREATMENT único I-TREATMENT de I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT de I-TREATMENT gestación I-TREATMENT confirmado I-TREATMENT ecográficamente. I-TREATMENT A I-TREATMENT las I-TREATMENT 39 I-TREATMENT semanas I-TREATMENT de I-TREATMENT gestación, I-TREATMENT se I-TREATMENT obtuvo I-TREATMENT un I-TREATMENT recién I-TREATMENT nacido I-TREATMENT sano I-TREATMENT de I-TREATMENT 3.380 I-TREATMENT g I-TREATMENT mediante I-TREATMENT operación I-TREATMENT cesárea I-TREATMENT por I-TREATMENT prueba I-TREATMENT de I-TREATMENT trabajo I-TREATMENT de I-TREATMENT parto I-TREATMENT fracasada. I-TREATMENT Durante I-TREATMENT la I-TREATMENT misma, I-TREATMENT se I-TREATMENT produjo I-TREATMENT inercia I-TREATMENT uterina I-TREATMENT que I-TREATMENT logró I-TREATMENT ser I-TREATMENT revertida I-TREATMENT con I-TREATMENT uso I-TREATMENT de I-TREATMENT retractores I-TREATMENT en I-TREATMENT altas I-TREATMENT dosis. I-TREATMENT I-TREATMENT 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 de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS para I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS litiasis I-PRESENT_ILLNESS piélica I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS nicturia I-PRESENT_ILLNESS 3-4, I-PRESENT_ILLNESS polaquiuria, I-PRESENT_ILLNESS escozor I-PRESENT_ILLNESS miccional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS aislados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematuria. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION el I-EXPLORATION sistemático I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION están I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION En I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION aparato I-EXPLORATION urinario, I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION radiopaca I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION izquierdo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION anecóica I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION hidronefrosis I-EXPLORATION e I-EXPLORATION importante I-EXPLORATION atrofia I-EXPLORATION cortical. I-EXPLORATION En I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION hidronefrosis I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION imágenes I-EXPLORATION ecogénicas I-EXPLORATION en I-EXPLORATION pelvis, I-EXPLORATION cálices I-EXPLORATION medios I-EXPLORATION e I-EXPLORATION inferiores I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION cálculos. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION urografía I-EXPLORATION intravenosa, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION distinguen I-EXPLORATION un I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION no I-EXPLORATION funcionante I-EXPLORATION y I-EXPLORATION una I-EXPLORATION bifidez I-EXPLORATION pieloureteral, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION litiasis I-EXPLORATION coraliforme I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pielón I-EXPLORATION inferior I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION TAC I-EXPLORATION abdomino-pélvico, I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION aparece I-EXPLORATION como I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION cavidad I-EXPLORATION quística, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION cortical I-EXPLORATION funcionante. I-EXPLORATION El I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION presenta I-EXPLORATION hipertrofia I-EXPLORATION compensadora, I-EXPLORATION con I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION quísticas I-EXPLORATION corticales I-EXPLORATION en I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION cálculos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION inferior. I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION practicar I-EXPLORATION punción I-EXPLORATION percutánea I-EXPLORATION bilateral, I-EXPLORATION observando I-EXPLORATION gran I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION al I-EXPLORATION uréter I-EXPLORATION y I-EXPLORATION bifidez I-EXPLORATION pieloureteral I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION litiasis I-EXPLORATION coraliforme I-EXPLORATION en I-EXPLORATION pielón I-EXPLORATION inferior. I-EXPLORATION Se B-TREATMENT deja I-TREATMENT colocada I-TREATMENT una I-TREATMENT sonda I-TREATMENT de I-TREATMENT nefrostomía I-TREATMENT en I-TREATMENT el I-TREATMENT lado I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT se I-TREATMENT instaura I-TREATMENT tratamiento I-TREATMENT antibiótico, I-TREATMENT al I-TREATMENT extraer I-TREATMENT orina I-TREATMENT purulenta I-TREATMENT en I-TREATMENT la I-TREATMENT descarga I-TREATMENT del I-TREATMENT pielón I-TREATMENT inferior. I-TREATMENT La B-EXPLORATION gammagrafía I-EXPLORATION renal I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION escasa I-EXPLORATION función I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION (11%). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cistoscopia I-EXPLORATION no I-EXPLORATION se I-EXPLORATION objetivan I-EXPLORATION neorformaciones I-EXPLORATION vesicales. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT estudios I-TREATMENT preoperatorios I-TREATMENT dentro I-TREATMENT de I-TREATMENT la I-TREATMENT normalidad I-TREATMENT el I-TREATMENT paciente I-TREATMENT es I-TREATMENT intervenido I-TREATMENT quirúrgicamente I-TREATMENT realizándose I-TREATMENT nefrolitotomía I-TREATMENT percutánea I-TREATMENT izquierda, I-TREATMENT con I-TREATMENT fragmentación I-TREATMENT de I-TREATMENT litiasis I-TREATMENT con I-TREATMENT lithoclast I-TREATMENT y I-TREATMENT extracción I-TREATMENT de I-TREATMENT fragmentos. I-TREATMENT A I-TREATMENT los I-TREATMENT quince I-TREATMENT días I-TREATMENT se I-TREATMENT lleva I-TREATMENT a I-TREATMENT cabo I-TREATMENT una I-TREATMENT nueva I-TREATMENT nefrolitotomía I-TREATMENT con I-TREATMENT el I-TREATMENT fin I-TREATMENT de I-TREATMENT eliminar I-TREATMENT todos I-TREATMENT los I-TREATMENT restos I-TREATMENT litiásicos. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION eliminando I-EVOLUTION orina I-EVOLUTION purulenta I-EVOLUTION por I-EVOLUTION sonda I-EVOLUTION de I-EVOLUTION nefrostomía I-EVOLUTION percutánea. I-EVOLUTION La B-EXPLORATION angiografía I-EXPLORATION por I-EXPLORATION sustracción I-EXPLORATION digital' I-EXPLORATION (DIVAS) I-EXPLORATION demuestra I-EXPLORATION una I-EXPLORATION escasa I-EXPLORATION vascularización I-EXPLORATION del I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION izquierdo. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT es I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT heminefrectomía I-TREATMENT polar I-TREATMENT inferior I-TREATMENT izquierda. I-TREATMENT En I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT inmediato I-TREATMENT se I-TREATMENT produce I-TREATMENT un I-TREATMENT empeoramiento I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal, I-TREATMENT con I-TREATMENT fiebre I-TREATMENT y I-TREATMENT leucocitosis, I-TREATMENT proceso I-TREATMENT compatible I-TREATMENT con I-TREATMENT sepsis I-TREATMENT de I-TREATMENT origen I-TREATMENT urinario I-TREATMENT que I-TREATMENT mejora I-TREATMENT con I-TREATMENT sueroterapia I-TREATMENT y I-TREATMENT antibioterapia I-TREATMENT parenteral. I-TREATMENT I-TREATMENT La B-EXPLORATION pieza I-EXPLORATION extirpada I-EXPLORATION corresponde I-EXPLORATION a I-EXPLORATION un I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 452 I-EXPLORATION gramos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION acompaña I-EXPLORATION de I-EXPLORATION abundante I-EXPLORATION grasa I-EXPLORATION intimamente I-EXPLORATION pegada I-EXPLORATION al I-EXPLORATION parenquima I-EXPLORATION renal. I-EXPLORATION Al I-EXPLORATION corte I-EXPLORATION el I-EXPLORATION parenquima I-EXPLORATION está I-EXPLORATION sustituido I-EXPLORATION por I-EXPLORATION grandes I-EXPLORATION cavidades I-EXPLORATION quísticas I-EXPLORATION ocupadas I-EXPLORATION por I-EXPLORATION un I-EXPLORATION material I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION blando. I-EXPLORATION Histológicamente I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION grandes I-EXPLORATION masas I-EXPLORATION sólidas, I-EXPLORATION nidos I-EXPLORATION y I-EXPLORATION regueros I-EXPLORATION infiltrantes I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION hábito I-EXPLORATION escamoso I-EXPLORATION que I-EXPLORATION presentan I-EXPLORATION grandes I-EXPLORATION núcleos I-EXPLORATION vesiculosos I-EXPLORATION e I-EXPLORATION irregulares I-EXPLORATION con I-EXPLORATION nucleolo I-EXPLORATION prominente, I-EXPLORATION citoplasma I-EXPLORATION amplio, I-EXPLORATION bien I-EXPLORATION definido, I-EXPLORATION eosinófilo I-EXPLORATION claro, I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION queratinización I-EXPLORATION individual I-EXPLORATION y I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION perlas I-EXPLORATION corneas. I-EXPLORATION I-EXPLORATION En I-EXPLORATION urografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION función I-EXPLORATION normal I-EXPLORATION del I-EXPLORATION hemirriñón I-EXPLORATION superior I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION uropatía I-EXPLORATION obstructiva. I-EXPLORATION I-EXPLORATION Un B-EVOLUTION año I-EVOLUTION y I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION ingresa I-EVOLUTION desde I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION hematuria I-EVOLUTION macroscópica. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION replección I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION derecha, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION corroborado I-EXPLORATION mediante I-EXPLORATION cistoscopia. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT resección I-TREATMENT transuretral I-TREATMENT de I-TREATMENT tumoración I-TREATMENT sólida I-TREATMENT en I-TREATMENT cara I-TREATMENT lateral I-TREATMENT derecha I-TREATMENT de I-TREATMENT vejiga, I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT anatomo-patológico I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT vesical I-TREATMENT con I-TREATMENT áreas I-TREATMENT de I-TREATMENT diferenciación I-TREATMENT escamosa I-TREATMENT que I-TREATMENT infiltra I-TREATMENT la I-TREATMENT muscular, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT es I-TREATMENT sometido I-TREATMENT a I-TREATMENT cistoprostatectomía I-TREATMENT radical I-TREATMENT con I-TREATMENT derivación I-TREATMENT urinaria I-TREATMENT de I-TREATMENT uréter I-TREATMENT izquierdo I-TREATMENT a I-TREATMENT sigma I-TREATMENT (Mainz I-TREATMENT II). I-TREATMENT En I-TREATMENT el I-TREATMENT mismo I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT practica I-TREATMENT una I-TREATMENT nefroureterectomía I-TREATMENT derecha, I-TREATMENT donde I-TREATMENT se I-TREATMENT observa I-TREATMENT un I-TREATMENT riñón I-TREATMENT hidronefrótico, I-TREATMENT con I-TREATMENT un I-TREATMENT síndrome I-TREATMENT de I-TREATMENT la I-TREATMENT unión I-TREATMENT pieloureteral I-TREATMENT por I-TREATMENT un I-TREATMENT vaso I-TREATMENT polar. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION escamosas, I-EXPLORATION estadio I-EXPLORATION pT3a, I-EXPLORATION pNx, I-EXPLORATION pMx. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fallece I-EVOLUTION cuatro I-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde, I-EVOLUTION con I-EVOLUTION metástasis I-EVOLUTION pulmonares I-EVOLUTION y I-EVOLUTION hepáticas. I-EVOLUTION I-EVOLUTION Los B-PRESENT_ILLNESS casos I-PRESENT_ILLNESS fueron I-PRESENT_ILLNESS recolectados I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS retrospectiva I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presentan I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Tabla1; I-PRESENT_ILLNESS sólo I-PRESENT_ILLNESS se I-PRESENT_ILLNESS detalla I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último. I-PRESENT_ILLNESS Eran I-PRESENT_ILLNESS hombres I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS media, I-PRESENT_ILLNESS 4/5 I-PRESENT_ILLNESS heterosexuales, I-PRESENT_ILLNESS todos I-PRESENT_ILLNESS VIH I-PRESENT_ILLNESS negativos. I-PRESENT_ILLNESS Presentaron I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS subagudo; I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS casos I-PRESENT_ILLNESS destacó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS apatía, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ánimo I-PRESENT_ILLNESS subido. I-PRESENT_ILLNESS Todos I-PRESENT_ILLNESS tenían I-PRESENT_ILLNESS amnesias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Korsakoff. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS existían I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS piramidales I-PRESENT_ILLNESS discretos; I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS retención I-PRESENT_ILLNESS de I-PRESENT_ILLNESS orina, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS uno I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ellos I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ataxia. I-PRESENT_ILLNESS Cuando I-PRESENT_ILLNESS se I-PRESENT_ILLNESS aplicaron I-PRESENT_ILLNESS las I-PRESENT_ILLNESS pruebas I-PRESENT_ILLNESS Minimental I-PRESENT_ILLNESS test I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Folstein I-PRESENT_ILLNESS (MM), I-PRESENT_ILLNESS que I-PRESENT_ILLNESS mide I-PRESENT_ILLNESS la I-PRESENT_ILLNESS eficiencia I-PRESENT_ILLNESS cognitiva I-PRESENT_ILLNESS global, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Frontal I-PRESENT_ILLNESS Assessment I-PRESENT_ILLNESS Battery I-PRESENT_ILLNESS (FAB), I-PRESENT_ILLNESS que I-PRESENT_ILLNESS evalúa I-PRESENT_ILLNESS las I-PRESENT_ILLNESS funciones I-PRESENT_ILLNESS frontales, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esta I-PRESENT_ILLNESS confirmó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS disejecutivo. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS existía I-PRESENT_ILLNESS laconismo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS o I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS afasia. I-PRESENT_ILLNESS Dos I-PRESENT_ILLNESS casos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS isquemia I-PRESENT_ILLNESS cerebral I-PRESENT_ILLNESS tenían I-PRESENT_ILLNESS factores I-PRESENT_ILLNESS de I-PRESENT_ILLNESS riesgo I-PRESENT_ILLNESS vascular. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-EXPLORATION líquido I-EXPLORATION cefaloraquídeo I-EXPLORATION (LCR) I-EXPLORATION fue I-EXPLORATION siempre I-EXPLORATION inflamatorio I-EXPLORATION y I-EXPLORATION con I-EXPLORATION VDRL I-EXPLORATION reactivo; I-EXPLORATION en I-EXPLORATION uno I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION El I-EXPLORATION electroencefalograma I-EXPLORATION (EEG) I-EXPLORATION estuvo I-EXPLORATION alterado I-EXPLORATION en I-EXPLORATION 3/3 I-EXPLORATION casos; I-EXPLORATION en I-EXPLORATION cambio I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION estructurales I-EXPLORATION no I-EXPLORATION siempre I-EXPLORATION fueron I-EXPLORATION anormales. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION caso I-EXPLORATION T I-EXPLORATION una I-EXPLORATION angiografía I-EXPLORATION (indicada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION cerebral I-EXPLORATION en I-EXPLORATION un I-EXPLORATION hombre I-EXPLORATION joven I-EXPLORATION con I-EXPLORATION VDRL I-EXPLORATION no I-EXPLORATION reactivo I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION antes I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION LCR) I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION vasculitis. I-EXPLORATION Todos B-TREATMENT recibieron I-TREATMENT altas I-TREATMENT dosis I-TREATMENT de I-TREATMENT penicilina I-TREATMENT sódica I-TREATMENT ev, I-TREATMENT pero B-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION fue I-EVOLUTION parcial I-EVOLUTION y I-EVOLUTION quedaron I-EVOLUTION con I-EVOLUTION secuelas I-EVOLUTION cognitivas. I-EVOLUTION I-EVOLUTION W B-PRESENT_ILLNESS tenía I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS era B-PAST_MEDICAL_HISTORY supervisor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ventas, I-PAST_MEDICAL_HISTORY soltero; I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia I-PAST_MEDICAL_HISTORY salvo I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY promiscuo; I-PAST_MEDICAL_HISTORY fumaba I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY bebía I-PAST_MEDICAL_HISTORY poco, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY consumía I-PAST_MEDICAL_HISTORY drogas. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS el I-PRESENT_ILLNESS 2° I-PRESENT_ILLNESS semestre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2008 I-PRESENT_ILLNESS aparecieron I-PRESENT_ILLNESS tendencia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS aislarse, I-PRESENT_ILLNESS olvidos, I-PRESENT_ILLNESS insomnio, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS libido, I-PRESENT_ILLNESS disartria, I-PRESENT_ILLNESS cefaleas. I-PRESENT_ILLNESS Existía I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mezcla I-PRESENT_ILLNESS de I-PRESENT_ILLNESS labilidad I-PRESENT_ILLNESS emocional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS apatía. I-PRESENT_ILLNESS Perdió I-PRESENT_ILLNESS su I-PRESENT_ILLNESS trabajo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS abril I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2009. I-PRESENT_ILLNESS En B-DERIVED_FROM/TO mayo I-DERIVED_FROM/TO un I-DERIVED_FROM/TO psiquiatra I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO neurólogo, I-DERIVED_FROM/TO quien I-DERIVED_FROM/TO pidió I-DERIVED_FROM/TO una I-DERIVED_FROM/TO batería I-DERIVED_FROM/TO de I-DERIVED_FROM/TO exámenes, I-DERIVED_FROM/TO entre I-DERIVED_FROM/TO ellos I-DERIVED_FROM/TO VDRL I-DERIVED_FROM/TO en I-DERIVED_FROM/TO sangre I-DERIVED_FROM/TO que I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO reactivo. I-DERIVED_FROM/TO El B-EXPLORATION examen I-EXPLORATION general I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION mostraba I-EXPLORATION alerta I-EXPLORATION y I-EXPLORATION colaboraba I-EXPLORATION al I-EXPLORATION examen; I-EXPLORATION destacaban I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION frontal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION afasia I-EXPLORATION no I-EXPLORATION fluente I-EXPLORATION mixta. I-EXPLORATION Existían I-EXPLORATION nistagmo I-EXPLORATION en I-EXPLORATION miradas I-EXPLORATION extremas, I-EXPLORATION paramimesis, I-EXPLORATION enganche I-EXPLORATION digital, I-EXPLORATION tics I-EXPLORATION de I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION hombros. I-EXPLORATION Una I-EXPLORATION discreta I-EXPLORATION ataxia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION marcha, I-EXPLORATION arreflexia I-EXPLORATION tendinosa I-EXPLORATION de I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION una I-EXPLORATION retención I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION configuraban I-EXPLORATION una I-EXPLORATION tabes I-EXPLORATION dorsal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION síndrome I-EXPLORATION frontal I-EXPLORATION se I-EXPLORATION expresaba I-EXPLORATION en I-EXPLORATION apatía, I-EXPLORATION abulia I-EXPLORATION y I-EXPLORATION conducta I-EXPLORATION de I-EXPLORATION imitación. I-EXPLORATION Fue I-EXPLORATION incapaz I-EXPLORATION de I-EXPLORATION comprender I-EXPLORATION escenas I-EXPLORATION complejas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION interpretar I-EXPLORATION proverbios; I-EXPLORATION perseveraba I-EXPLORATION con I-EXPLORATION frecuencia. I-EXPLORATION Tenía I-EXPLORATION defectos I-EXPLORATION atencionales I-EXPLORATION (cálculo, I-EXPLORATION retención I-EXPLORATION de I-EXPLORATION cifras, I-EXPLORATION inversión I-EXPLORATION de I-EXPLORATION series I-EXPLORATION automáticas) I-EXPLORATION y I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION afasia I-EXPLORATION no I-EXPLORATION fluente I-EXPLORATION mixta. I-EXPLORATION En I-EXPLORATION MM I-EXPLORATION obtuvo I-EXPLORATION 9/30 I-EXPLORATION puntos, I-EXPLORATION en I-EXPLORATION FAB I-EXPLORATION 3/18 I-EXPLORATION puntos; I-EXPLORATION fue I-EXPLORATION incapaz I-EXPLORATION de I-EXPLORATION abstraer. I-EXPLORATION Rindió I-EXPLORATION mejor I-EXPLORATION en I-EXPLORATION Matrices I-EXPLORATION Progresivas I-EXPLORATION Coloreadas I-EXPLORATION (MPC, I-EXPLORATION 25/36 I-EXPLORATION puntos) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION asociación I-EXPLORATION semántica I-EXPLORATION del I-EXPLORATION 4° I-EXPLORATION excluido I-EXPLORATION (acertó I-EXPLORATION en I-EXPLORATION 7/8 I-EXPLORATION ensayos). I-EXPLORATION No I-EXPLORATION existían I-EXPLORATION agnosias I-EXPLORATION visuales I-EXPLORATION ni I-EXPLORATION espaciales, I-EXPLORATION apraxia I-EXPLORATION constructiva, I-EXPLORATION ideatoria, I-EXPLORATION ideomotora I-EXPLORATION ni I-EXPLORATION del I-EXPLORATION vestir. I-EXPLORATION Tampoco I-EXPLORATION tenía I-EXPLORATION agnosia I-EXPLORATION digital I-EXPLORATION ni I-EXPLORATION desorientación I-EXPLORATION derecha-izquierda. I-EXPLORATION I-EXPLORATION El I-EXPLORATION LCR I-EXPLORATION mostró I-EXPLORATION pleocitosis I-EXPLORATION (130 I-EXPLORATION mononuclea-res, I-EXPLORATION 88% I-EXPLORATION de I-EXPLORATION linfocitos, I-EXPLORATION 10% I-EXPLORATION de I-EXPLORATION polinucleares I-EXPLORATION y I-EXPLORATION 2% I-EXPLORATION de I-EXPLORATION monocitos), I-EXPLORATION glucosa I-EXPLORATION 21 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION proteínas I-EXPLORATION 180 I-EXPLORATION mg/dL. I-EXPLORATION El I-EXPLORATION VRDL I-EXPLORATION fue I-EXPLORATION reactivo I-EXPLORATION 1/128. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral I-EXPLORATION mostró I-EXPLORATION atrofia I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION frontotemporal I-EXPLORATION izquierdo, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION EEG I-EXPLORATION actividad I-EXPLORATION irritativa I-EXPLORATION y I-EXPLORATION lenta I-EXPLORATION en I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION zona. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION fue I-EXPLORATION negativa, I-EXPLORATION y I-EXPLORATION otros I-EXPLORATION exámenes I-EXPLORATION humorales I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (función I-EXPLORATION hepática, I-EXPLORATION coagulación, I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION VHS, I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B12, I-EXPLORATION Na, I-EXPLORATION K I-EXPLORATION y I-EXPLORATION Cl, I-EXPLORATION perfil I-EXPLORATION bioquímico, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva, I-EXPLORATION PCR I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simple I-EXPLORATION en I-EXPLORATION LCR). I-EXPLORATION I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT penicilina I-TREATMENT sódica I-TREATMENT 4.000.000 I-TREATMENT ui I-TREATMENT ev I-TREATMENT c/4 I-TREATMENT horas I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días, I-TREATMENT betametasona I-TREATMENT 4 I-TREATMENT mg I-TREATMENT ev I-TREATMENT c/8 I-TREATMENT horas I-TREATMENT por I-TREATMENT 3 I-TREATMENT días I-TREATMENT y I-TREATMENT fenitoina I-TREATMENT 100 I-TREATMENT mg I-TREATMENT c/8 I-TREATMENT horas. I-TREATMENT El B-EVOLUTION tratamiento I-EVOLUTION fue I-EVOLUTION bien I-EVOLUTION tolerado I-EVOLUTION y I-EVOLUTION parcialmente I-EVOLUTION eficaz. I-EVOLUTION A B-EXPLORATION comienzos I-EXPLORATION de I-EXPLORATION 2010 I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION básico I-EXPLORATION era I-EXPLORATION normal, I-EXPLORATION en I-EXPLORATION MM I-EXPLORATION obtuvo I-EXPLORATION 28/30 I-EXPLORATION puntos, I-EXPLORATION en I-EXPLORATION MPC I-EXPLORATION 31/36, I-EXPLORATION en I-EXPLORATION FAB I-EXPLORATION 13/18. I-EXPLORATION Persistía I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION frontal, I-EXPLORATION con I-EXPLORATION actitud I-EXPLORATION pueril, I-EXPLORATION fallas I-EXPLORATION de I-EXPLORATION juicio I-EXPLORATION y I-EXPLORATION de I-EXPLORATION coherencia I-EXPLORATION del I-EXPLORATION discurso. I-EXPLORATION El I-EXPLORATION LCR I-EXPLORATION era I-EXPLORATION normal, I-EXPLORATION con I-EXPLORATION serología I-EXPLORATION reactiva I-EXPLORATION a I-EXPLORATION 1/32, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION unido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION crisis I-EXPLORATION convulsivas I-EXPLORATION llevó B-TREATMENT a I-TREATMENT un I-TREATMENT segundo I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT penicilina, I-TREATMENT de I-TREATMENT 21 I-TREATMENT días, I-TREATMENT y I-TREATMENT a I-TREATMENT indicar I-TREATMENT ácido I-TREATMENT valproico I-TREATMENT en I-TREATMENT vez I-TREATMENT de I-TREATMENT fenitoína. I-TREATMENT Fue B-EVOLUTION jubilado I-EVOLUTION por I-EVOLUTION invalidez I-EVOLUTION y I-EVOLUTION vive I-EVOLUTION con I-EVOLUTION sus I-EVOLUTION padres. I-EVOLUTION I-EVOLUTION 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 de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcoholismo I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Emergencia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Complejo I-PRESENT_ILLNESS Asistencial I-PRESENT_ILLNESS Barros I-PRESENT_ILLNESS Luco I-PRESENT_ILLNESS (CABL) I-PRESENT_ILLNESS con I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cadera I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS intensidad. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS se I-PRESENT_ILLNESS asoció I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuadrante I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS ipsilateral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lipotimia. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY enfermedades I-PAST_MEDICAL_HISTORY asociadas. I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 80/54 I-EXPLORATION mmHg, I-EXPLORATION pulso I-EXPLORATION 78 I-EXPLORATION x', I-EXPLORATION coloración I-EXPLORATION lívida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION infraumbilical I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION inferiores. I-EXPLORATION Se I-EXPLORATION aportaron I-EXPLORATION entonces I-EXPLORATION 1.000 I-EXPLORATION ce I-EXPLORATION de I-EXPLORATION solución I-EXPLORATION cristaloide I-EXPLORATION intravenosa I-EXPLORATION que I-EXPLORATION permitieron I-EXPLORATION normalizar I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION arterial. I-EXPLORATION El I-EXPLORATION abdomen I-EXPLORATION aparecía I-EXPLORATION distendido, I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION intenso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION hipocondrio, I-EXPLORATION flanco I-EXPLORATION y I-EXPLORATION fosa I-EXPLORATION ilíaca I-EXPLORATION derecha. I-EXPLORATION Presentaba, I-EXPLORATION además, I-EXPLORATION dolor I-EXPLORATION de I-EXPLORATION rebote I-EXPLORATION difuso, I-EXPLORATION resistencia I-EXPLORATION muscular I-EXPLORATION difusa I-EXPLORATION y I-EXPLORATION puño I-EXPLORATION percusión I-EXPLORATION derecha I-EXPLORATION positiva. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION obtuvo: I-EXPLORATION glicemla I-EXPLORATION de I-EXPLORATION 250 I-EXPLORATION mg/dl, I-EXPLORATION nitrógeno I-EXPLORATION ureico I-EXPLORATION de I-EXPLORATION 17 I-EXPLORATION mg/dl, I-EXPLORATION creatininemia I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 17 I-EXPLORATION mg/dl, I-EXPLORATION amilasa I-EXPLORATION 86 I-EXPLORATION U/1, I-EXPLORATION lipasa I-EXPLORATION 40 I-EXPLORATION U/1, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 2 I-EXPLORATION mg/1, I-EXPLORATION protrombine-mia I-EXPLORATION 83, I-EXPLORATION 5%; I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION tromboplastina I-EXPLORATION parcial I-EXPLORATION activado: I-EXPLORATION 28, I-EXPLORATION 1 I-EXPLORATION s, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 18.200/fxl, I-EXPLORATION hemoglobinemia I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION 7 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 39%. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION con I-EXPLORATION contraste, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION espontáneamente I-EXPLORATION hiperdensa I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hipocondrio I-EXPLORATION y I-EXPLORATION flanco I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION por I-EXPLORATION 12 I-EXPLORATION por I-EXPLORATION 9 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION que I-EXPLORATION desplazaba I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION derecho I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION periferia, I-EXPLORATION manteniendo I-EXPLORATION un I-EXPLORATION plano I-EXPLORATION de I-EXPLORATION clivaje I-EXPLORATION con I-EXPLORATION él. I-EXPLORATION Se I-EXPLORATION sugería I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION extenso I-EXPLORATION hematoma I-EXPLORATION mesentérico, I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartar I-EXPLORATION también I-EXPLORATION neoplasia I-EXPLORATION subyacente. I-EXPLORATION Al B-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION hemodinámicamente I-EVOLUTION estable, I-EVOLUTION afebril I-EVOLUTION y I-EVOLUTION con I-EVOLUTION menos I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION espontáneo, I-EVOLUTION sin I-EVOLUTION embargo, I-EVOLUTION el I-EVOLUTION hematocrito I-EVOLUTION de I-EVOLUTION control I-EVOLUTION descendió I-EVOLUTION a I-EVOLUTION 21%, I-EVOLUTION decidiéndose B-TREATMENT entonces I-TREATMENT transfundir I-TREATMENT 2 I-TREATMENT U I-TREATMENT de I-TREATMENT glóbulos I-TREATMENT rojos I-TREATMENT e I-TREATMENT intervenir I-TREATMENT quirúrgicamente I-TREATMENT al I-TREATMENT paciente. I-TREATMENT I-TREATMENT Se I-TREATMENT efectuó I-TREATMENT laparotomía I-TREATMENT exploradora, I-TREATMENT encontrándose I-TREATMENT un I-TREATMENT gran I-TREATMENT hematoma I-TREATMENT encapsulado I-TREATMENT retrope-ritoneal I-TREATMENT derecho, I-TREATMENT que I-TREATMENT se I-TREATMENT extendía I-TREATMENT desde I-TREATMENT el I-TREATMENT mesocolon I-TREATMENT transverso I-TREATMENT hasta I-TREATMENT la I-TREATMENT pelvis, I-TREATMENT sin I-TREATMENT observar I-TREATMENT lesión I-TREATMENT con I-TREATMENT sangrado I-TREATMENT activo. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT vaciamiento, I-TREATMENT aseo, I-TREATMENT instalación I-TREATMENT de I-TREATMENT drenajes I-TREATMENT en I-TREATMENT el I-TREATMENT retroperito-neo I-TREATMENT y I-TREATMENT toma I-TREATMENT de I-TREATMENT muestras I-TREATMENT para I-TREATMENT biopsia, I-TREATMENT la I-TREATMENT que, I-TREATMENT posteriormente, I-TREATMENT se I-TREATMENT informó I-TREATMENT como I-TREATMENT hematoma I-TREATMENT de I-TREATMENT mesenterio I-TREATMENT sin I-TREATMENT evidencias I-TREATMENT de I-TREATMENT neoplasia. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION satisfactoriamente I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION del I-EVOLUTION posoperatorio, I-EVOLUTION cuando I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION salida I-EVOLUTION de I-EVOLUTION líquido I-EVOLUTION fecal I-EVOLUTION por I-EVOLUTION los I-EVOLUTION drenajes, I-EVOLUTION realizándose I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION fístula I-EVOLUTION estercorácea. I-EVOLUTION Se B-TREATMENT decidió, I-TREATMENT entonces, I-TREATMENT conectar I-TREATMENT los I-TREATMENT tubulares I-TREATMENT a I-TREATMENT aspiración I-TREATMENT e I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT metronidazol I-TREATMENT más I-TREATMENT ciprofloxacina, I-TREATMENT con I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT consiguió I-TREATMENT buen I-TREATMENT control I-TREATMENT de I-TREATMENT la I-TREATMENT fístula, I-TREATMENT la I-TREATMENT cual I-TREATMENT evolucionó I-TREATMENT al I-TREATMENT cierre I-TREATMENT definitivo I-TREATMENT al I-TREATMENT vigésimo I-TREATMENT día I-TREATMENT desde I-TREATMENT la I-TREATMENT operación, I-TREATMENT dándose I-TREATMENT de I-TREATMENT alta I-TREATMENT en I-TREATMENT óptimas I-TREATMENT condiciones I-TREATMENT generales I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT herida. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION en I-EVOLUTION control I-EVOLUTION ambulatorio I-EVOLUTION en I-EVOLUTION policlínico I-EVOLUTION de I-EVOLUTION cirugía, I-EVOLUTION permaneciendo I-EVOLUTION asintomático I-EVOLUTION a I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION su I-EVOLUTION egreso. I-EVOLUTION I-EVOLUTION 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 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 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 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 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 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 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 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 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 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 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 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 Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY o B-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY importancia. I-FAMILY_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS septiembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS afebril, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tránsito I-PRESENT_ILLNESS intestinal. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION concluyente I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION e I-EXPLORATION imágenes. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION análisis I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 2 I-EXPLORATION mg/dL, I-EXPLORATION leucocitos I-EXPLORATION 8.080/mm3 I-EXPLORATION con I-EXPLORATION 67, I-EXPLORATION 8% I-EXPLORATION de I-EXPLORATION neutrófilos I-EXPLORATION y I-EXPLORATION amilasemia I-EXPLORATION normal. I-EXPLORATION Una I-EXPLORATION ecotomografía I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION sólido-quística I-EXPLORATION compleja I-EXPLORATION de I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION izquierdo I-EXPLORATION del I-EXPLORATION hígado. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION probable I-EXPLORATION colecistitis I-EXPLORATION aguda I-EXPLORATION y I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION focal I-EXPLORATION hepática I-EXPLORATION sospechosa I-EXPLORATION de I-EXPLORATION absceso. I-EXPLORATION Se B-TREATMENT efectuó I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT biopsia I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT hepática. I-TREATMENT No I-TREATMENT se I-TREATMENT identifican I-TREATMENT otras I-TREATMENT lesiones I-TREATMENT abdominales I-TREATMENT durante I-TREATMENT la I-TREATMENT exploración I-TREATMENT quirúrgica. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION demuestra I-EXPLORATION una I-EXPLORATION metástasis I-EXPLORATION hepática I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION neuroendocrino I-EXPLORATION con I-EXPLORATION inmunohistoquímica I-EXPLORATION concordante. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION PET/CT I-EXPLORATION con I-EXPLORATION 18FDG I-EXPLORATION de I-EXPLORATION cuerpo I-EXPLORATION entero I-EXPLORATION el I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION sólo I-EXPLORATION captación I-EXPLORATION fisiológica I-EXPLORATION en I-EXPLORATION diversos I-EXPLORATION órganos I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION un I-EXPLORATION incremento I-EXPLORATION significativo I-EXPLORATION del I-EXPLORATION metabolismo I-EXPLORATION glucídico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION metástasis I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION izquierdo I-EXPLORATION del I-EXPLORATION hígado I-EXPLORATION en I-EXPLORATION comparación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION hepático. I-EXPLORATION Una I-EXPLORATION colonoscopia I-EXPLORATION en I-EXPLORATION búsqueda I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION origen I-EXPLORATION fue I-EXPLORATION catalogada I-EXPLORATION como I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Tres I-EXPLORATION meses I-EXPLORATION más I-EXPLORATION tarde I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION PET/CT I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION nuevo I-EXPLORATION radiofármaco I-EXPLORATION 68Ga-DOTATATE I-EXPLORATION (CGM I-EXPLORATION Nuclear, I-EXPLORATION Santiago-Chile) I-EXPLORATION recientemente I-EXPLORATION incorporado I-EXPLORATION a I-EXPLORATION nuestro I-EXPLORATION centro. I-EXPLORATION El I-EXPLORATION control I-EXPLORATION de I-EXPLORATION calidad I-EXPLORATION del I-EXPLORATION producto I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION pureza I-EXPLORATION radioquímica I-EXPLORATION superior I-EXPLORATION al I-EXPLORATION 99%. I-EXPLORATION Se I-EXPLORATION inyectaron I-EXPLORATION por I-EXPLORATION vía I-EXPLORATION e.v. I-EXPLORATION 111 I-EXPLORATION MBq I-EXPLORATION (3 I-EXPLORATION mCi) I-EXPLORATION del I-EXPLORATION radiotrazador. I-EXPLORATION Cincuenta I-EXPLORATION minutos I-EXPLORATION más I-EXPLORATION tarde I-EXPLORATION se I-EXPLORATION registraron I-EXPLORATION imágenes I-EXPLORATION PET/ I-EXPLORATION CT I-EXPLORATION 3D I-EXPLORATION de I-EXPLORATION cuerpo I-EXPLORATION entero I-EXPLORATION en I-EXPLORATION un I-EXPLORATION aparato I-EXPLORATION Biograph I-EXPLORATION 6 I-EXPLORATION HiRez I-EXPLORATION P3D I-EXPLORATION (Siemens I-EXPLORATION Medical I-EXPLORATION Systems, I-EXPLORATION USA). I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION mostró, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intensa I-EXPLORATION captación I-EXPLORATION del I-EXPLORATION radiofármaco I-EXPLORATION en I-EXPLORATION la I-EXPLORATION metástasis I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION un I-EXPLORATION segundo I-EXPLORATION foco I-EXPLORATION de I-EXPLORATION sobreexpresión I-EXPLORATION de I-EXPLORATION receptores I-EXPLORATION de I-EXPLORATION SST I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION un I-EXPLORATION asa I-EXPLORATION de I-EXPLORATION íleon I-EXPLORATION distal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION ileocecal I-EXPLORATION altamente I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION corresponder I-EXPLORATION al I-EXPLORATION tumor I-EXPLORATION primario. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION otros I-EXPLORATION focos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT nueva I-TREATMENT cirugía I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT subcostal I-TREATMENT identificándose I-TREATMENT un I-TREATMENT nodulo I-TREATMENT de I-TREATMENT 16 I-TREATMENT mm I-TREATMENT en I-TREATMENT el I-TREATMENT íleon I-TREATMENT terminal, I-TREATMENT vecino I-TREATMENT a I-TREATMENT la I-TREATMENT válvula I-TREATMENT ileocecal, I-TREATMENT sin I-TREATMENT extensión I-TREATMENT regional I-TREATMENT macroscópica. I-TREATMENT Se I-TREATMENT efectúa I-TREATMENT resección I-TREATMENT del I-TREATMENT íleon I-TREATMENT terminal, I-TREATMENT ciego I-TREATMENT y I-TREATMENT apéndice I-TREATMENT cecal I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT subcostal I-TREATMENT ampliada. I-TREATMENT En I-TREATMENT el I-TREATMENT mismo I-TREATMENT acto I-TREATMENT se I-TREATMENT extirpa I-TREATMENT la I-TREATMENT metástasis I-TREATMENT hepática I-TREATMENT mediante I-TREATMENT hepatectomía I-TREATMENT izquierda. I-TREATMENT Como I-TREATMENT hallazgos I-TREATMENT intraoperatorio I-TREATMENT se I-TREATMENT identifica I-TREATMENT una I-TREATMENT segunda I-TREATMENT metástasis I-TREATMENT de I-TREATMENT 8 I-TREATMENT mm I-TREATMENT del I-TREATMENT segmento I-TREATMENT VII I-TREATMENT del I-TREATMENT hígado I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT reseca I-TREATMENT en I-TREATMENT cuña. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION neuroendocrino I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION del I-EXPLORATION íleon I-EXPLORATION terminal I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION mm I-EXPLORATION que I-EXPLORATION infiltraba I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION y I-EXPLORATION con I-EXPLORATION penetración I-EXPLORATION linfovascular, I-EXPLORATION 6 I-EXPLORATION linfonodos I-EXPLORATION regionales I-EXPLORATION sin I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION metástasis I-EXPLORATION hepáticas I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION neuroendocrino I-EXPLORATION de I-EXPLORATION también I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado, I-EXPLORATION la I-EXPLORATION ya I-EXPLORATION conocida I-EXPLORATION de I-EXPLORATION 4, I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION cm. I-EXPLORATION I-EXPLORATION 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 Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY positivo I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS decaimiento, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS conducta I-PRESENT_ILLNESS frontalizada. I-PRESENT_ILLNESS La B-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION resultó I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION VDRL, I-EXPLORATION toxoplasma I-EXPLORATION y I-EXPLORATION VEB I-EXPLORATION (por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION PCR). I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION hematológicos I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION leve I-EXPLORATION con I-EXPLORATION Hb I-EXPLORATION de I-EXPLORATION 10, I-EXPLORATION 3 I-EXPLORATION g/dL I-EXPLORATION (ref. I-EXPLORATION 13, I-EXPLORATION 5-17, I-EXPLORATION 5 I-EXPLORATION g/dL), I-EXPLORATION Hto I-EXPLORATION 30% I-EXPLORATION (ref. I-EXPLORATION 41-53%), I-EXPLORATION leucopenia I-EXPLORATION con I-EXPLORATION 3.100 I-EXPLORATION leucocitos/mm3 I-EXPLORATION (ref. I-EXPLORATION 4.500-11.000/mm3) I-EXPLORATION y I-EXPLORATION linfopenia I-EXPLORATION con I-EXPLORATION 800/mm3 I-EXPLORATION (ref. I-EXPLORATION 1.000-4.800/mm3). I-EXPLORATION LDH I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales I-EXPLORATION (133 I-EXPLORATION U/L I-EXPLORATION [ref. I-EXPLORATION 135-225 I-EXPLORATION U/L] I-EXPLORATION y I-EXPLORATION 0, I-EXPLORATION 1 I-EXPLORATION mg/dL I-EXPLORATION [ref. I-EXPLORATION 0-1 I-EXPLORATION mg/dL], I-EXPLORATION respectivamente). I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION además I-EXPLORATION severo I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION inmunosupresión I-EXPLORATION con I-EXPLORATION un I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION T I-EXPLORATION CD4 I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 9/mm3. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION revelaron I-EXPLORATION 2 I-EXPLORATION nódulos I-EXPLORATION córtico-subcorticales I-EXPLORATION en I-EXPLORATION zonas I-EXPLORATION frontal I-EXPLORATION media I-EXPLORATION y I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION inflamatorio. I-EXPLORATION No I-EXPLORATION había I-EXPLORATION compromiso I-EXPLORATION pulmonar I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION sitios I-EXPLORATION anatómicos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION estereotáxica I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION tejido I-EXPLORATION cerebral I-EXPLORATION con I-EXPLORATION gliosis I-EXPLORATION reactiva I-EXPLORATION y I-EXPLORATION extenso I-EXPLORATION infiltrado I-EXPLORATION celular I-EXPLORATION mixto, I-EXPLORATION predominantemente I-EXPLORATION perivascular I-EXPLORATION y I-EXPLORATION zonas I-EXPLORATION con I-EXPLORATION angiotropismo I-EXPLORATION y I-EXPLORATION angiodestruccción I-EXPLORATION compuestas I-EXPLORATION por I-EXPLORATION linfocitos I-EXPLORATION pequeños I-EXPLORATION inmunorreactivos I-EXPLORATION para I-EXPLORATION CD3 I-EXPLORATION (linfocitos I-EXPLORATION T). I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION abundantes I-EXPLORATION células I-EXPLORATION linfoides I-EXPLORATION atípicas I-EXPLORATION medianas I-EXPLORATION y I-EXPLORATION grandes, I-EXPLORATION de I-EXPLORATION núcleos I-EXPLORATION vesiculosos I-EXPLORATION y I-EXPLORATION pleomórficos I-EXPLORATION inmunorreactivas I-EXPLORATION para I-EXPLORATION CD20 I-EXPLORATION (linfocitos I-EXPLORATION B). I-EXPLORATION Los I-EXPLORATION linfocitos I-EXPLORATION mostraron I-EXPLORATION reacción I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION pequeña I-EXPLORATION de I-EXPLORATION ARN I-EXPLORATION asociado I-EXPLORATION al I-EXPLORATION VEB I-EXPLORATION EBER-1 I-EXPLORATION mediante I-EXPLORATION hibridización I-EXPLORATION in I-EXPLORATION situ. I-EXPLORATION Estas I-EXPLORATION células I-EXPLORATION mostraron I-EXPLORATION reacción I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION CD30, I-EXPLORATION CD68 I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION S-100. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION microorganismos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION con I-EXPLORATION tinciones I-EXPLORATION de I-EXPLORATION Gram, I-EXPLORATION PAS, I-EXPLORATION Ziehl-Neelsen I-EXPLORATION y I-EXPLORATION Warthin-Starry. I-EXPLORATION I-EXPLORATION La I-EXPLORATION citometría I-EXPLORATION de I-EXPLORATION flujo I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION cerebral I-EXPLORATION reveló I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION atípicas I-EXPLORATION medianas I-EXPLORATION de I-EXPLORATION estirpe I-EXPLORATION B I-EXPLORATION con I-EXPLORATION restricción I-EXPLORATION de I-EXPLORATION cadena I-EXPLORATION ligera I-EXPLORATION Kappa, I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION linfoproliferativo. I-EXPLORATION El I-EXPLORATION mielograma I-EXPLORATION y I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION conjunto, I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION GL I-EXPLORATION cerebral I-EXPLORATION grado I-EXPLORATION 3 I-EXPLORATION (linfoma I-EXPLORATION B I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes). I-EXPLORATION I-EXPLORATION El B-TREATMENT caso I-TREATMENT comunicado I-TREATMENT en I-TREATMENT el I-TREATMENT presente I-TREATMENT artículo I-TREATMENT fue I-TREATMENT confirmado I-TREATMENT como I-TREATMENT síndrome I-TREATMENT de I-TREATMENT inmunodeficiencia I-TREATMENT por I-TREATMENT virus I-TREATMENT VIH I-TREATMENT etapa I-TREATMENT C3 I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT antirretroviral. I-TREATMENT El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO solicitó I-DERIVED_FROM/TO posteriormente I-DERIVED_FROM/TO su I-DERIVED_FROM/TO traslado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO para I-DERIVED_FROM/TO continuar I-DERIVED_FROM/TO manejo. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY poliartralgias I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY activo. I-PAST_MEDICAL_HISTORY Refiere B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS sudo-ración I-PRESENT_ILLNESS nocturna, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS poliartralgias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS sensible. I-PRESENT_ILLNESS Relata B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hermana I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY EKF I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY contacto I-PAST_MEDICAL_HISTORY directo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY gato. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS le I-PRESENT_ILLNESS realizaron I-PRESENT_ILLNESS ecografía I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS que I-PRESENT_ILLNESS mostraba I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS linfonodos I-PRESENT_ILLNESS cervicales I-PRESENT_ILLNESS a I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Le B-TREATMENT indicaron I-TREATMENT amoxicilina-ácido I-TREATMENT clavulánico I-TREATMENT durante I-TREATMENT 5 I-TREATMENT días I-TREATMENT sin I-TREATMENT mejoría I-TREATMENT clínica I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT hospitalizó. I-TREATMENT En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION adenopatía I-EXPLORATION cervical I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION sensible I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION visceromegalia. I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION mostró I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 56 I-EXPLORATION mm/h I-EXPLORATION y I-EXPLORATION la I-EXPLORATION PCR I-EXPLORATION y I-EXPLORATION ferritina I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 77 I-EXPLORATION mg/L I-EXPLORATION y I-EXPLORATION 1.789 I-EXPLORATION ng/mL I-EXPLORATION respectivamente. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cuello, I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION constatar I-EXPLORATION adenopatías I-EXPLORATION cervicales I-EXPLORATION y I-EXPLORATION mediastínicas, I-EXPLORATION reveló I-EXPLORATION opacidades I-EXPLORATION pulmonares I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION esmerilado. I-EXPLORATION Paralelamente, I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION VIH, I-EXPLORATION VEB, I-EXPLORATION CMV, I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION sífilis I-EXPLORATION y I-EXPLORATION Toxoplasma I-EXPLORATION gondii. I-EXPLORATION La I-EXPLORATION IgM I-EXPLORATION para I-EXPLORATION Bartonella I-EXPLORATION hensenlae I-EXPLORATION fue I-EXPLORATION negativa, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION la I-EXPLORATION IgG I-EXPLORATION resultó I-EXPLORATION positiva I-EXPLORATION (1/64). I-EXPLORATION Se I-EXPLORATION indicó I-EXPLORATION azitromicina I-EXPLORATION lg I-EXPLORATION al I-EXPLORATION día I-EXPLORATION durante I-EXPLORATION 6 I-EXPLORATION días, I-EXPLORATION sin I-EXPLORATION respuesta. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunológico I-EXPLORATION fue I-EXPLORATION prácticamente I-EXPLORATION normal, I-EXPLORATION solamente I-EXPLORATION con I-EXPLORATION un I-EXPLORATION ANA I-EXPLORATION positivo I-EXPLORATION a I-EXPLORATION título I-EXPLORATION bajo I-EXPLORATION (1/40). I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION adenopatía I-EXPLORATION cervical. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION para I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION bacterias I-EXPLORATION resultaron I-EXPLORATION negativos, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION reveló I-EXPLORATION linfadenitis I-EXPLORATION necrotizante I-EXPLORATION histiocitaria. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT prednisona I-TREATMENT 30 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT tres I-TREATMENT semanas I-TREATMENT con I-TREATMENT disminución I-TREATMENT progresiva I-TREATMENT de I-TREATMENT las I-TREATMENT dosis I-TREATMENT completando I-TREATMENT 45 I-TREATMENT días I-TREATMENT de I-TREATMENT terapia. I-TREATMENT Los B-EVOLUTION síntomas I-EVOLUTION desaparecen I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION Dos B-EXPLORATION meses I-EXPLORATION después I-EXPLORATION asiste I-EXPLORATION a I-EXPLORATION control I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION esmerilado. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION pulmonar I-EXPLORATION revelando I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION neumonía I-EXPLORATION intersticial I-EXPLORATION usual I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION tardía. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION sintoma-tología I-EVOLUTION respiratoria I-EVOLUTION ni I-EVOLUTION alteraciones I-EVOLUTION significativas I-EVOLUTION en I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION de I-EVOLUTION función I-EVOLUTION pulmonar. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION (IMC) I-EXPLORATION de I-EXPLORATION 31, I-EXPLORATION 2, I-EXPLORATION que B-PRESENT_ILLNESS fue I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cáncer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS próstata I-PRESENT_ILLNESS en I-PRESENT_ILLNESS estadio I-PRESENT_ILLNESS T2a I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS examen I-PRESENT_ILLNESS (antígeno I-PRESENT_ILLNESS prostático I-PRESENT_ILLNESS específico I-PRESENT_ILLNESS [PSA], I-PRESENT_ILLNESS 3, I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS ng/ml). I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión, I-PAST_MEDICAL_HISTORY diabetes, I-PAST_MEDICAL_HISTORY hiperlipemia, I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cirrosis. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Antes B-TREATMENT de I-TREATMENT la I-TREATMENT cirugía, I-TREATMENT el I-TREATMENT paciente I-TREATMENT tenía I-TREATMENT vendaje I-TREATMENT espiral I-TREATMENT y I-TREATMENT dispositivos I-TREATMENT de I-TREATMENT compresión I-TREATMENT intermitente I-TREATMENT en I-TREATMENT ambas I-TREATMENT extremidades I-TREATMENT inferiores I-TREATMENT para I-TREATMENT prevenir I-TREATMENT trombosis I-TREATMENT venosa I-TREATMENT profunda I-TREATMENT (TVP). I-TREATMENT Tras I-TREATMENT administrar I-TREATMENT anestesia I-TREATMENT combinada I-TREATMENT general-espinal, I-TREATMENT el I-TREATMENT paciente I-TREATMENT fue I-TREATMENT colocado I-TREATMENT en I-TREATMENT posición I-TREATMENT de I-TREATMENT Trendelenburg I-TREATMENT y I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT PRL I-TREATMENT extraperitoneal, I-TREATMENT con I-TREATMENT preservación I-TREATMENT nerviosa I-TREATMENT bilateral. I-TREATMENT Su I-TREATMENT presión I-TREATMENT sanguínea I-TREATMENT en I-TREATMENT el I-TREATMENT momento I-TREATMENT de I-TREATMENT administrar I-TREATMENT la I-TREATMENT anestesia I-TREATMENT era I-TREATMENT de I-TREATMENT 150/80 I-TREATMENT mmHg I-TREATMENT y I-TREATMENT permaneció I-TREATMENT por I-TREATMENT debajo I-TREATMENT de I-TREATMENT este I-TREATMENT nivel I-TREATMENT durante I-TREATMENT todo I-TREATMENT el I-TREATMENT procedimiento. I-TREATMENT La I-TREATMENT operación I-TREATMENT duró I-TREATMENT 360 I-TREATMENT min I-TREATMENT y I-TREATMENT la I-TREATMENT pérdida I-TREATMENT de I-TREATMENT sangre I-TREATMENT fue I-TREATMENT de I-TREATMENT 1.000 I-TREATMENT ml. I-TREATMENT El I-TREATMENT sangrado I-TREATMENT ocurrió I-TREATMENT durante I-TREATMENT el I-TREATMENT control I-TREATMENT de I-TREATMENT pedículos I-TREATMENT vasculares I-TREATMENT y I-TREATMENT la I-TREATMENT disección I-TREATMENT del I-TREATMENT paquete I-TREATMENT neurovascular. I-TREATMENT La B-EXPLORATION patología I-EXPLORATION quirúrgica I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION próstata I-EXPLORATION de I-EXPLORATION 55 I-EXPLORATION g, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION en I-EXPLORATION estadio I-EXPLORATION T2a I-EXPLORATION y I-EXPLORATION una I-EXPLORATION puntuación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION de I-EXPLORATION Gleason I-EXPLORATION 6 I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION En B-EVOLUTION el I-EVOLUTION primer I-EVOLUTION día I-EVOLUTION posquirúrgico, I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION quejarse I-EVOLUTION de I-EVOLUTION entumecimiento I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION pierna I-EVOLUTION derecha, I-EVOLUTION que I-EVOLUTION estaba I-EVOLUTION inflamada I-EVOLUTION y I-EVOLUTION blanda I-EVOLUTION al I-EVOLUTION tacto. I-EVOLUTION Los B-EXPLORATION pulsos I-EXPLORATION pedios I-EXPLORATION estaban I-EXPLORATION presentes I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION bilateral. I-EXPLORATION Sospechamos I-EXPLORATION una I-EXPLORATION TVP I-EXPLORATION y I-EXPLORATION pedimos I-EXPLORATION una I-EXPLORATION prueba I-EXPLORATION Doppler, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION permeabilidad I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION venoso I-EXPLORATION profundo. I-EXPLORATION Su I-EXPLORATION creatinina I-EXPLORATION sérica I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION la I-EXPLORATION creatina I-EXPLORATION fosfocinasa I-EXPLORATION llegó I-EXPLORATION hasta I-EXPLORATION 23.000 I-EXPLORATION U/l. I-EXPLORATION Aunque B-TREATMENT el I-TREATMENT Doppler I-TREATMENT fue I-TREATMENT normal, I-TREATMENT se I-TREATMENT diagnosticó I-TREATMENT una I-TREATMENT TVP I-TREATMENT con I-TREATMENT rabdomiólisis I-TREATMENT secundaria I-TREATMENT y I-TREATMENT fallo I-TREATMENT renal I-TREATMENT sobre I-TREATMENT la I-TREATMENT base I-TREATMENT de I-TREATMENT los I-TREATMENT resultados I-TREATMENT clínicos, I-TREATMENT y I-TREATMENT se I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT heparina. I-TREATMENT I-TREATMENT En B-EVOLUTION los I-EVOLUTION días I-EVOLUTION posquirúrgicos I-EVOLUTION siguientes, I-EVOLUTION aunque I-EVOLUTION los I-EVOLUTION pulsos I-EVOLUTION pedios I-EVOLUTION seguían I-EVOLUTION siendo I-EVOLUTION palpables I-EVOLUTION y I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION sérica I-EVOLUTION y I-EVOLUTION creatina I-EVOLUTION fosfocinasa I-EVOLUTION mejoraban, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentaba I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION intermitente. I-EVOLUTION Se B-EXPLORATION repitieron I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION Doppler, I-EXPLORATION que I-EXPLORATION excluyeron I-EXPLORATION TVP I-EXPLORATION y I-EXPLORATION mostraron I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resistencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION tibiales I-EXPLORATION derechas. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT fasciotomía I-TREATMENT de I-TREATMENT cuatro I-TREATMENT compartimentos I-TREATMENT por I-TREATMENT el I-TREATMENT SC I-TREATMENT de I-TREATMENT la I-TREATMENT pierna. I-TREATMENT Los I-TREATMENT músculos I-TREATMENT sobresalían I-TREATMENT fácilmente I-TREATMENT a I-TREATMENT medida I-TREATMENT que I-TREATMENT se I-TREATMENT seccionaba I-TREATMENT la I-TREATMENT fascia I-TREATMENT suprayacente. I-TREATMENT Había I-TREATMENT áreas I-TREATMENT de I-TREATMENT necrosis I-TREATMENT focal I-TREATMENT que I-TREATMENT fueron I-TREATMENT eliminadas. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio, I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION fue I-EVOLUTION remitiendo I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION capaz I-EVOLUTION de I-EVOLUTION caminar I-EVOLUTION con I-EVOLUTION ayuda. I-EVOLUTION Las I-EVOLUTION heridas I-EVOLUTION se I-EVOLUTION cerraron I-EVOLUTION en I-EVOLUTION los I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION posteriores I-EVOLUTION a I-EVOLUTION la I-EVOLUTION fasciotomía. I-EVOLUTION I-EVOLUTION Seis I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION PRL, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION recuperó I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION capaz I-EVOLUTION de I-EVOLUTION caminar I-EVOLUTION sin I-EVOLUTION ayuda, I-EVOLUTION pero I-EVOLUTION aún I-EVOLUTION presenta I-EVOLUTION dolor I-EVOLUTION neuropático I-EVOLUTION en I-EVOLUTION el I-EVOLUTION empeine I-EVOLUTION del I-EVOLUTION pie I-EVOLUTION derecho. I-EVOLUTION Su I-EVOLUTION PSA I-EVOLUTION estaba I-EVOLUTION por I-EVOLUTION debajo I-EVOLUTION de I-EVOLUTION 0, I-EVOLUTION 04 I-EVOLUTION ng/ml, I-EVOLUTION usaba I-EVOLUTION pañal I-EVOLUTION diario I-EVOLUTION por I-EVOLUTION una I-EVOLUTION leve I-EVOLUTION incontinencia I-EVOLUTION por I-EVOLUTION esfuerzo I-EVOLUTION y I-EVOLUTION aún I-EVOLUTION no I-EVOLUTION había I-EVOLUTION recuperado I-EVOLUTION la I-EVOLUTION función I-EVOLUTION sexual. I-EVOLUTION I-EVOLUTION 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 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 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 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 Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY (HTA), I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY asociada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY subclínico. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS evaluó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS control I-PRESENT_ILLNESS de I-PRESENT_ILLNESS HTA I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diabetes I-PRESENT_ILLNESS mellitus. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION facies I-EXPLORATION cushingoide I-EXPLORATION y I-EXPLORATION relleno I-EXPLORATION de I-EXPLORATION huecos I-EXPLORATION supraclaviculares. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION cortisol I-EXPLORATION libre I-EXPLORATION urinario I-EXPLORATION (CLU): I-EXPLORATION 236 I-EXPLORATION ug/24 I-EXPLORATION h I-EXPLORATION (VN I-EXPLORATION hasta I-EXPLORATION 100 I-EXPLORATION ug/24 I-EXPLORATION h), I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Nugent I-EXPLORATION o I-EXPLORATION de I-EXPLORATION supresión I-EXPLORATION nocturna I-EXPLORATION con I-EXPLORATION dexametasona I-EXPLORATION (Dx) I-EXPLORATION 1 I-EXPLORATION mg: I-EXPLORATION 11, I-EXPLORATION 1 I-EXPLORATION ug/dl I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 1, I-EXPLORATION 8 I-EXPLORATION ug/dl), I-EXPLORATION ACTH I-EXPLORATION 32, I-EXPLORATION 1pg/ml I-EXPLORATION (VN I-EXPLORATION hasta I-EXPLORATION 46 I-EXPLORATION pg/ml). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION funcional: I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Dx/ I-EXPLORATION desmopresina, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION respuesta I-EXPLORATION de I-EXPLORATION cortisol I-EXPLORATION postestímulo, I-EXPLORATION sugiriendo I-EXPLORATION origen I-EXPLORATION hipofisiario. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION silla I-EXPLORATION turca I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION adenoma I-EXPLORATION posterolateral I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm, I-EXPLORATION que I-EXPLORATION determina I-EXPLORATION leve I-EXPLORATION remodelación I-EXPLORATION del I-EXPLORATION piso I-EXPLORATION selar. I-EXPLORATION Por B-TREATMENT distintas I-TREATMENT razones, I-TREATMENT la I-TREATMENT paciente I-TREATMENT no I-TREATMENT se I-TREATMENT realizó I-TREATMENT cirugía. I-TREATMENT En B-EXPLORATION controles I-EXPLORATION sucesivos I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION normalización I-EXPLORATION del I-EXPLORATION CLU I-EXPLORATION sin I-EXPLORATION mediar I-EXPLORATION tratamiento. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 3 I-EXPLORATION años I-EXPLORATION tuvo I-EXPLORATION un I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Nugent I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION ng/dl, I-EXPLORATION ACTH: I-EXPLORATION 54, I-EXPLORATION 8 I-EXPLORATION pg/ml I-EXPLORATION y I-EXPLORATION CLU: I-EXPLORATION 50, I-EXPLORATION 1 I-EXPLORATION ug/24 I-EXPLORATION h. I-EXPLORATION Una I-EXPLORATION nueva I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION silla I-EXPLORATION turca I-EXPLORATION mostró I-EXPLORATION adenoma I-EXPLORATION de I-EXPLORATION similares I-EXPLORATION características, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION intratumoral. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 7 I-EXPLORATION años I-EXPLORATION tiene I-EXPLORATION CLU I-EXPLORATION 28, I-EXPLORATION 8 I-EXPLORATION ug/24 I-EXPLORATION h, I-EXPLORATION la I-EXPLORATION diabetes I-EXPLORATION mellitus I-EXPLORATION mantiene I-EXPLORATION un I-EXPLORATION control I-EXPLORATION adecuado I-EXPLORATION para I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION (HbA1c: I-EXPLORATION 7, I-EXPLORATION 6%) I-EXPLORATION y I-EXPLORATION ha I-EXPLORATION disminuido I-EXPLORATION 10 I-EXPLORATION kilos I-EXPLORATION de I-EXPLORATION peso I-EXPLORATION desde I-EXPLORATION su I-EXPLORATION evaluación I-EXPLORATION inicial. I-EXPLORATION I-EXPLORATION Ambas B-EVOLUTION pacientes I-EVOLUTION aún I-EVOLUTION sobreviven, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 82 I-EVOLUTION y I-EVOLUTION 88 I-EVOLUTION años, I-EVOLUTION respectivamente I-EVOLUTION y I-EVOLUTION no I-EVOLUTION manifiestan I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION hiperfunción I-EVOLUTION endocrina. I-EVOLUTION I-EVOLUTION 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 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 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 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 Una B-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cirrosis I-PRESENT_ILLNESS fue B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO para I-DERIVED_FROM/TO evaluación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO trasplante I-DERIVED_FROM/TO hepático. I-DERIVED_FROM/TO Se B-EXPLORATION presentó I-EXPLORATION con I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION referido I-EXPLORATION como I-EXPLORATION de I-EXPLORATION reciente I-EXPLORATION comienzo, I-EXPLORATION aunque I-EXPLORATION por I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION y I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION estudios I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION una I-EXPLORATION hepatopatía I-EXPLORATION crónica. I-EXPLORATION Presentaba I-EXPLORATION estigmas I-EXPLORATION de I-EXPLORATION cronicidad I-EXPLORATION como I-EXPLORATION eritema I-EXPLORATION palmar, I-EXPLORATION telangiectasias, I-EXPLORATION circulación I-EXPLORATION colateral I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION esplenomegalia. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION un I-EXPLORATION hígado I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION con I-EXPLORATION heterogeneidad I-EXPLORATION y I-EXPLORATION bazo I-EXPLORATION con I-EXPLORATION diámetro I-EXPLORATION longitudinal I-EXPLORATION aumentado. I-EXPLORATION No B-TREATMENT recibía I-TREATMENT medicación I-TREATMENT antes I-TREATMENT de I-TREATMENT la I-TREATMENT admisión I-TREATMENT en I-TREATMENT nuestro I-TREATMENT hospital. I-TREATMENT En B-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY contexto I-PAST_MEDICAL_HISTORY social I-PAST_MEDICAL_HISTORY complejo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY poca I-PAST_MEDICAL_HISTORY percepción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY enfermedad, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY consultado I-PAST_MEDICAL_HISTORY previamente. I-PAST_MEDICAL_HISTORY Tampoco I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY periódico I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY salud. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION ingreso, I-EXPLORATION el I-EXPLORATION puntaje I-EXPLORATION de I-EXPLORATION gravedad I-EXPLORATION PELD I-EXPLORATION (Pediatric I-EXPLORATION End-Stage I-EXPLORATION Liver I-EXPLORATION Disease, I-EXPLORATION hepatopatía I-EXPLORATION terminal I-EXPLORATION pediátrica) I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 24, I-EXPLORATION con I-EXPLORATION bilirrubina I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION mg/dl, I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION relación I-EXPLORATION internacional I-EXPLORATION normalizada I-EXPLORATION (RIN) I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5, I-EXPLORATION albúmina I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION g/dl; I-EXPLORATION su I-EXPLORATION peso I-EXPLORATION y I-EXPLORATION talla I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION kg I-EXPLORATION y I-EXPLORATION 127 I-EXPLORATION cm, I-EXPLORATION respectivamente. I-EXPLORATION Mientras B-EVOLUTION esperaba I-EVOLUTION en I-EVOLUTION lista I-EVOLUTION de I-EVOLUTION trasplante I-EVOLUTION hepático, I-EVOLUTION desarrolló I-EVOLUTION encefalopatía I-EVOLUTION hepática I-EVOLUTION espontánea, I-EVOLUTION de I-EVOLUTION tipo I-EVOLUTION C, I-EVOLUTION grado I-EVOLUTION II-III1 I-EVOLUTION con I-EVOLUTION períodos I-EVOLUTION de I-EVOLUTION conducta I-EVOLUTION inapropiada I-EVOLUTION que I-EVOLUTION alternaban I-EVOLUTION con I-EVOLUTION confusión I-EVOLUTION y I-EVOLUTION excitación. I-EVOLUTION Previamente, I-EVOLUTION no I-EVOLUTION había I-EVOLUTION presentado I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION encefalopatía. I-EVOLUTION Su B-EXPLORATION amonio I-EXPLORATION sérico I-EXPLORATION aumentó I-EXPLORATION de I-EXPLORATION 139 I-EXPLORATION µg% I-EXPLORATION a I-EXPLORATION 324 I-EXPLORATION µg% I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION 19-82 I-EXPLORATION µg%). I-EXPLORATION Se I-EXPLORATION descartaron I-EXPLORATION factores I-EXPLORATION precipitantes I-EXPLORATION conocidos I-EXPLORATION de I-EXPLORATION encefalopatía I-EXPLORATION hepática, I-EXPLORATION como I-EXPLORATION medicaciones, I-EXPLORATION sangrado I-EXPLORATION gastrointestinal, I-EXPLORATION infecciones I-EXPLORATION bacterianas, I-EXPLORATION constipación, I-EXPLORATION fallo I-EXPLORATION renal, I-EXPLORATION desequilibrios I-EXPLORATION electrolíticos, I-EXPLORATION hipovolemia I-EXPLORATION o I-EXPLORATION hipoxemia. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION ascitis I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION abdominal. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT una I-TREATMENT dieta I-TREATMENT con I-TREATMENT restricción I-TREATMENT de I-TREATMENT proteínas I-TREATMENT (0, I-TREATMENT 8 I-TREATMENT g/kg/día) I-TREATMENT y I-TREATMENT lactulosa I-TREATMENT por I-TREATMENT vía I-TREATMENT oral I-TREATMENT (40 I-TREATMENT ml/día, I-TREATMENT divididos I-TREATMENT en I-TREATMENT 4 I-TREATMENT tomas), I-TREATMENT logrando I-TREATMENT 3-4 I-TREATMENT deposiciones I-TREATMENT blandas I-TREATMENT por I-TREATMENT día. I-TREATMENT A B-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION estas I-EVOLUTION medidas, I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION neurológico I-EVOLUTION no I-EVOLUTION mejoró I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION días. I-EVOLUTION Sobre B-TREATMENT la I-TREATMENT base I-TREATMENT de I-TREATMENT experiencias I-TREATMENT en I-TREATMENT pacientes I-TREATMENT adultos, I-TREATMENT se I-TREATMENT decidió I-TREATMENT agregar I-TREATMENT rifaximina I-TREATMENT (20 I-TREATMENT mg/kg/día, I-TREATMENT por I-TREATMENT vía I-TREATMENT oral, I-TREATMENT divididos I-TREATMENT en I-TREATMENT dos I-TREATMENT tomas), I-TREATMENT con I-TREATMENT previa I-TREATMENT firma I-TREATMENT del I-TREATMENT consentimiento I-TREATMENT informado I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT los I-TREATMENT padres. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION mostró I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION días, I-EVOLUTION sin I-EVOLUTION confusión I-EVOLUTION ni I-EVOLUTION excitación I-EVOLUTION y I-EVOLUTION con I-EVOLUTION ritmo I-EVOLUTION sueño/ I-EVOLUTION vigilia I-EVOLUTION normal. I-EVOLUTION La I-EVOLUTION concentración I-EVOLUTION de I-EVOLUTION amonio I-EVOLUTION descendió I-EVOLUTION gradualmente I-EVOLUTION (236 I-EVOLUTION µg% I-EVOLUTION y I-EVOLUTION 162 I-EVOLUTION µg%, I-EVOLUTION 4 I-EVOLUTION y I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION respectivamente). I-EVOLUTION No I-EVOLUTION presentó I-EVOLUTION cefaleas, I-EVOLUTION dolor I-EVOLUTION abdominal, I-EVOLUTION náuseas I-EVOLUTION ni I-EVOLUTION vómitos I-EVOLUTION relacionados I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION rifaximina. I-EVOLUTION Finalmente, B-TREATMENT la I-TREATMENT paciente I-TREATMENT recibió I-TREATMENT trasplante I-TREATMENT hepático I-TREATMENT pasado I-TREATMENT un I-TREATMENT mes I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT rifaximina, I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT I-TREATMENT 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 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 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 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 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 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 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 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 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 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 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 Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS en B-PAST_MEDICAL_HISTORY DP I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY octubre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2012 I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nefropatía I-PAST_MEDICAL_HISTORY diabética. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS con I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS líquido I-PRESENT_ILLNESS peritoneal I-PRESENT_ILLNESS turbio, I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS descenso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ultrafiltración. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY neoformación I-PAST_MEDICAL_HISTORY nasal. I-PAST_MEDICAL_HISTORY Los B-EXPLORATION resultados I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION eran: I-EXPLORATION aspecto I-EXPLORATION turbio, I-EXPLORATION 700 I-EXPLORATION leucocitos/μl I-EXPLORATION (mononucleares I-EXPLORATION 80% I-EXPLORATION y I-EXPLORATION polimorfonucleares I-EXPLORATION 20%), I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION del I-EXPLORATION predominio I-EXPLORATION de I-EXPLORATION mononucleares I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION terapia I-EXPLORATION antibiótica I-EXPLORATION empírica I-EXPLORATION con I-EXPLORATION vancomicina I-EXPLORATION y I-EXPLORATION ceftazidima I-EXPLORATION intraperitoneal. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION ni I-EXPLORATION masas; I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION salida I-EXPLORATION del I-EXPLORATION catéter I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION túnel I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION analíticos I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION destacaban: I-EXPLORATION leucocitos I-EXPLORATION 37000/mm3, I-EXPLORATION plaquetas I-EXPLORATION 640000/mm3, I-EXPLORATION hemoglobina I-EXPLORATION 10, I-EXPLORATION 3g/dl, I-EXPLORATION creatinina I-EXPLORATION 5, I-EXPLORATION 4mg/dl, I-EXPLORATION urea I-EXPLORATION 180mg/dl, I-EXPLORATION Na I-EXPLORATION 138mEq/l, I-EXPLORATION K I-EXPLORATION 4mEq/l, I-EXPLORATION calcio I-EXPLORATION 9, I-EXPLORATION 5mg/dl, I-EXPLORATION fósforo I-EXPLORATION 4, I-EXPLORATION 8mg/dl, I-EXPLORATION albúmina I-EXPLORATION 3, I-EXPLORATION 9mg/dl. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION días I-EXPLORATION después I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION cráneo, I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION para I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION nasal I-EXPLORATION en I-EXPLORATION los I-EXPLORATION días I-EXPLORATION siguientes, I-EXPLORATION siendo I-EXPLORATION informado I-EXPLORATION de I-EXPLORATION adenopatías I-EXPLORATION mediastínicas I-EXPLORATION y I-EXPLORATION retroperitoneales I-EXPLORATION diseminadas. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION nasal I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION linfoma I-EXPLORATION no-Hodgkin I-EXPLORATION de I-EXPLORATION células I-EXPLORATION B I-EXPLORATION grandes I-EXPLORATION y I-EXPLORATION la I-EXPLORATION citología I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION demostró I-EXPLORATION linfocitos I-EXPLORATION atípicos. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT inició I-TREATMENT su I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT y I-TREATMENT permaneció I-TREATMENT en I-TREATMENT la I-TREATMENT técnica I-TREATMENT de I-TREATMENT DP I-TREATMENT sin I-TREATMENT más I-TREATMENT incidencias I-TREATMENT dialíticas. I-TREATMENT I-TREATMENT La B-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION turbio I-EXPLORATION en I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION DP I-EXPLORATION generalmente I-EXPLORATION se I-EXPLORATION asocia I-EXPLORATION a I-EXPLORATION una I-EXPLORATION peritonitis. I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION bacteriana I-EXPLORATION se I-EXPLORATION requieren I-EXPLORATION al I-EXPLORATION menos I-EXPLORATION dos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION condiciones: I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION solo I-EXPLORATION o I-EXPLORATION acompañado I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION síntomas I-EXPLORATION abdominales, I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION con I-EXPLORATION más I-EXPLORATION de I-EXPLORATION 100 I-EXPLORATION leucocitos/μl, I-EXPLORATION siendo I-EXPLORATION más I-EXPLORATION del I-EXPLORATION 50% I-EXPLORATION polimorfonucleares, I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION o I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION que I-EXPLORATION demuestre I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION microorganismos1. I-EXPLORATION I-EXPLORATION Es I-EXPLORATION difícil I-EXPLORATION diferenciar I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION peritoneal I-EXPLORATION con I-EXPLORATION cultivo I-EXPLORATION negativo I-EXPLORATION de I-EXPLORATION una I-EXPLORATION inflamación I-EXPLORATION peritoneal I-EXPLORATION no I-EXPLORATION infecciosa I-EXPLORATION (peritonitis I-EXPLORATION estéril). I-EXPLORATION Un I-EXPLORATION cultivo I-EXPLORATION peritoneal I-EXPLORATION negativo I-EXPLORATION generalmente I-EXPLORATION se I-EXPLORATION debe I-EXPLORATION a I-EXPLORATION fallos I-EXPLORATION técnicos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION procesamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION el I-EXPLORATION manejo I-EXPLORATION resulta I-EXPLORATION complicado, I-EXPLORATION dado I-EXPLORATION que I-EXPLORATION existen I-EXPLORATION peritonitis I-EXPLORATION infecciosas I-EXPLORATION sin I-EXPLORATION crecimiento I-EXPLORATION bacteriano I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo. I-EXPLORATION Se I-EXPLORATION aconseja I-EXPLORATION revisar I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION cultivo I-EXPLORATION cuando I-EXPLORATION estos I-EXPLORATION sean I-EXPLORATION negativos I-EXPLORATION en I-EXPLORATION más I-EXPLORATION del I-EXPLORATION 20% I-EXPLORATION de I-EXPLORATION las I-EXPLORATION ocasiones I-EXPLORATION e I-EXPLORATION interrogar I-EXPLORATION por I-EXPLORATION el I-EXPLORATION uso I-EXPLORATION de I-EXPLORATION antibióticos I-EXPLORATION previos I-EXPLORATION al I-EXPLORATION paciente2. I-EXPLORATION Para I-EXPLORATION lograr I-EXPLORATION una I-EXPLORATION rapidez I-EXPLORATION diagnóstica I-EXPLORATION en I-EXPLORATION casos I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION estéril, I-EXPLORATION las I-EXPLORATION guías I-EXPLORATION de I-EXPLORATION DP I-EXPLORATION españolas I-EXPLORATION esquematizan I-EXPLORATION teniendo I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION o I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION en I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION células. I-EXPLORATION Un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION polimorfornucleares I-EXPLORATION puede I-EXPLORATION ser I-EXPLORATION por I-EXPLORATION inflamación I-EXPLORATION de I-EXPLORATION víscera I-EXPLORATION intraperitoneal I-EXPLORATION o I-EXPLORATION yuxtaperitoneal, I-EXPLORATION medicamentos I-EXPLORATION o I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION contaminado I-EXPLORATION por I-EXPLORATION endotoxinas. I-EXPLORATION Si I-EXPLORATION están I-EXPLORATION aumentados I-EXPLORATION los I-EXPLORATION eosinófilos, I-EXPLORATION se I-EXPLORATION sospechará I-EXPLORATION reacción I-EXPLORATION alérgica I-EXPLORATION al I-EXPLORATION material I-EXPLORATION de I-EXPLORATION diálisis, I-EXPLORATION medicamentos, I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION por I-EXPLORATION sangre I-EXPLORATION retrógrada I-EXPLORATION o I-EXPLORATION tras I-EXPLORATION peritonitis I-EXPLORATION por I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION parásitos. I-EXPLORATION El I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION mononucleares I-EXPLORATION puede I-EXPLORATION asociarse I-EXPLORATION a I-EXPLORATION icodextrina, I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION micobacterias, I-EXPLORATION hongos. I-EXPLORATION Si I-EXPLORATION además I-EXPLORATION hay I-EXPLORATION hematíes, I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION de I-EXPLORATION considerar: I-EXPLORATION ovulación, I-EXPLORATION menstruación I-EXPLORATION retrógrada, I-EXPLORATION rotura I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION ovárico, I-EXPLORATION líquido I-EXPLORATION hipertónico, I-EXPLORATION adherencias I-EXPLORATION peritoneales, I-EXPLORATION ejercicio I-EXPLORATION físico I-EXPLORATION y I-EXPLORATION trauma I-EXPLORATION por I-EXPLORATION catéter. I-EXPLORATION Con I-EXPLORATION elevados I-EXPLORATION mononucleares I-EXPLORATION y I-EXPLORATION células I-EXPLORATION malignas, I-EXPLORATION hay I-EXPLORATION que I-EXPLORATION pensar I-EXPLORATION en I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION o I-EXPLORATION metástasis I-EXPLORATION peritoneales. I-EXPLORATION Por I-EXPLORATION otra I-EXPLORATION parte, I-EXPLORATION en I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION puede I-EXPLORATION ser I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION un I-EXPLORATION incremento I-EXPLORATION de I-EXPLORATION fibrina I-EXPLORATION o I-EXPLORATION de I-EXPLORATION triglicéridos3, I-EXPLORATION 4. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION literatura I-EXPLORATION se I-EXPLORATION describen I-EXPLORATION algunos I-EXPLORATION casos I-EXPLORATION de I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION en I-EXPLORATION DP I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION procesos I-EXPLORATION tumorales, I-EXPLORATION entre I-EXPLORATION ellos, I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION renales I-EXPLORATION recurrente I-EXPLORATION diagnosticado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION citología I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION peritoneal5. I-EXPLORATION Otro I-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION peritonitis I-EXPLORATION estéril I-EXPLORATION con I-EXPLORATION un I-EXPLORATION antecedente I-EXPLORATION de I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION diagnosticado I-EXPLORATION diez I-EXPLORATION años I-EXPLORATION antes. I-EXPLORATION La I-EXPLORATION citología I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION permitió I-EXPLORATION observar I-EXPLORATION los I-EXPLORATION linfocitos I-EXPLORATION atípicos I-EXPLORATION y, I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION caso, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION invasión I-EXPLORATION peritoneal, I-EXPLORATION continuó I-EXPLORATION con I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION DP6. I-EXPLORATION I-EXPLORATION Como I-EXPLORATION conclusión I-EXPLORATION del I-EXPLORATION caso, I-EXPLORATION debemos I-EXPLORATION señalar I-EXPLORATION que I-EXPLORATION en I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION de I-EXPLORATION las I-EXPLORATION peritonitis I-EXPLORATION estériles I-EXPLORATION no I-EXPLORATION debemos I-EXPLORATION olvidar I-EXPLORATION la I-EXPLORATION posible I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION neoplásico. I-EXPLORATION I-EXPLORATION 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 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 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 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 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 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 Paciente B-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY vivido I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Amazonas I-PAST_MEDICAL_HISTORY (desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 28 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 35 I-PAST_MEDICAL_HISTORY años), I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY profesión I-PAST_MEDICAL_HISTORY médica, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY dispepsia I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY regular. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS nocturna I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Niega B-EXPLORATION fiebre, I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION tabaquismo, I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION fármacos I-EXPLORATION o I-EXPLORATION drogas I-EXPLORATION ilícitas. I-EXPLORATION I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION datos I-EXPLORATION significativos I-EXPLORATION al I-EXPLORATION exámen I-EXPLORATION físico. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION laboratorio, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION eritrosedimentación I-EXPLORATION globular I-EXPLORATION (VSG), I-EXPLORATION hormonas I-EXPLORATION tiroideas, I-EXPLORATION proteinograma I-EXPLORATION electroforético I-EXPLORATION y I-EXPLORATION complemento, I-EXPLORATION encontrándose I-EXPLORATION todos I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION orina I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION (3 I-EXPLORATION pares I-EXPLORATION de I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION orina). I-EXPLORATION Reacción I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION y I-EXPLORATION serologías I-EXPLORATION virales, I-EXPLORATION bacterianas I-EXPLORATION y I-EXPLORATION parasitarias I-EXPLORATION negativas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION agregaron I-EXPLORATION factor I-EXPLORATION reumatoideo, I-EXPLORATION factor I-EXPLORATION antinuclear, I-EXPLORATION ANCA I-EXPLORATION C I-EXPLORATION y I-EXPLORATION P, I-EXPLORATION siendo I-EXPLORATION todos I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION patología. I-EXPLORATION I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION dispepsia I-EXPLORATION y I-EXPLORATION pirosis, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION enfermedad I-EXPLORATION por I-EXPLORATION RGE I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION esofagitis I-EXPLORATION grado I-EXPLORATION dos. I-EXPLORATION Inició B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT omeprazol I-TREATMENT 40 I-TREATMENT mg/día, I-TREATMENT desapareciendo B-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION así I-EVOLUTION como I-EVOLUTION también I-EVOLUTION la I-EVOLUTION sudoración I-EVOLUTION nocturna, I-EVOLUTION y I-EVOLUTION reapareciendo I-EVOLUTION esta I-EVOLUTION última I-EVOLUTION al I-EVOLUTION suspender I-EVOLUTION el I-EVOLUTION fármaco. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION pHmetría I-EXPLORATION de I-EXPLORATION control I-EXPLORATION no I-EXPLORATION demostrando I-EXPLORATION reflujo. I-EXPLORATION I-EXPLORATION 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 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 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 Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY moderado, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS incremento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS perímetro I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS los I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS acompañante. I-PRESENT_ILLNESS En B-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION solicitadas I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION coagulación I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION Glucosa, I-EXPLORATION urea, I-EXPLORATION ácido I-EXPLORATION úrico, I-EXPLORATION creatinina, I-EXPLORATION calcio I-EXPLORATION total, I-EXPLORATION fósforo, I-EXPLORATION triglicéridos, I-EXPLORATION colesterol I-EXPLORATION LDL, I-EXPLORATION bilirrubina I-EXPLORATION total, I-EXPLORATION GOT, I-EXPLORATION GPT, I-EXPLORATION GGT, I-EXPLORATION LDH, I-EXPLORATION fosfatasa I-EXPLORATION alcalina, I-EXPLORATION amilasa, I-EXPLORATION proteínas I-EXPLORATION totales, I-EXPLORATION albúmina, I-EXPLORATION sodio, I-EXPLORATION potasio, I-EXPLORATION cloro, I-EXPLORATION ferritina, I-EXPLORATION transferrina, I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION y I-EXPLORATION folato I-EXPLORATION normales. I-EXPLORATION Colesterol I-EXPLORATION total I-EXPLORATION 243 I-EXPLORATION mg/dl I-EXPLORATION (110-200), I-EXPLORATION colesterol I-EXPLORATION HDL I-EXPLORATION 120 I-EXPLORATION mg/dl I-EXPLORATION (42-68), I-EXPLORATION hierro I-EXPLORATION 44 I-EXPLORATION microg/dl I-EXPLORATION (65-165); I-EXPLORATION Ca I-EXPLORATION 19, I-EXPLORATION 9, I-EXPLORATION 82, I-EXPLORATION 03 I-EXPLORATION U/l I-EXPLORATION (< I-EXPLORATION 40). I-EXPLORATION CEA, I-EXPLORATION PSA I-EXPLORATION y I-EXPLORATION alfa-fetoproteína I-EXPLORATION normales. I-EXPLORATION Velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION 41 I-EXPLORATION mm I-EXPLORATION (< I-EXPLORATION 14). I-EXPLORATION En I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION Ca I-EXPLORATION 19, I-EXPLORATION 9, I-EXPLORATION 91, I-EXPLORATION 23 I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION normales. I-EXPLORATION Resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION abdomino-pelvica: I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION multilobulada I-EXPLORATION abdomino I-EXPLORATION pelvica, I-EXPLORATION cuya I-EXPLORATION señal I-EXPLORATION a I-EXPLORATION excepción I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tabiques I-EXPLORATION es I-EXPLORATION preferentemente I-EXPLORATION grasa. I-EXPLORATION Las I-EXPLORATION dimensiones I-EXPLORATION máximas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION son I-EXPLORATION de I-EXPLORATION 26 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION cráneo I-EXPLORATION caudal, I-EXPLORATION 24, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION transverso I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 21 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION anteroposterior. I-EXPLORATION Cruza I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION y I-EXPLORATION produce I-EXPLORATION importante I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION al I-EXPLORATION que I-EXPLORATION rota I-EXPLORATION y I-EXPLORATION desplaza I-EXPLORATION cranealmente, I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION uropatía I-EXPLORATION obstructiva. I-EXPLORATION También I-EXPLORATION ejerce I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION izquierdo, I-EXPLORATION desplazándolo I-EXPLORATION contra I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION son I-EXPLORATION muy I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION liposarcoma. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT suprainfraumbilical I-TREATMENT donde I-TREATMENT se I-TREATMENT encontró I-TREATMENT una I-TREATMENT gran I-TREATMENT masa I-TREATMENT de I-TREATMENT aspecto I-TREATMENT lipomatoso I-TREATMENT desde I-TREATMENT la I-TREATMENT celda I-TREATMENT renal I-TREATMENT izquierda I-TREATMENT hasta I-TREATMENT espacio I-TREATMENT retrovesical. I-TREATMENT Se I-TREATMENT intentó I-TREATMENT extirpación I-TREATMENT en I-TREATMENT bloque I-TREATMENT con I-TREATMENT resección I-TREATMENT de I-TREATMENT fibras I-TREATMENT del I-TREATMENT psoas I-TREATMENT izquierdo I-TREATMENT infiltrado. I-TREATMENT I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION extraída I-EXPLORATION fue I-EXPLORATION en I-EXPLORATION su I-EXPLORATION descripción I-EXPLORATION macroscópica: I-EXPLORATION Pieza I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION x I-EXPLORATION 40 I-EXPLORATION x I-EXPLORATION 15 I-EXPLORATION cm. I-EXPLORATION con I-EXPLORATION un I-EXPLORATION peso I-EXPLORATION de I-EXPLORATION 6.300 I-EXPLORATION gr. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION coloración I-EXPLORATION amarillenta, I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION sección I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION que I-EXPLORATION mantiene I-EXPLORATION esta I-EXPLORATION coloración I-EXPLORATION con I-EXPLORATION finos I-EXPLORATION tractos I-EXPLORATION conectivos, I-EXPLORATION sin I-EXPLORATION apreciarse I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION clara I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION y I-EXPLORATION sí I-EXPLORATION una I-EXPLORATION distribución I-EXPLORATION en I-EXPLORATION lóbulos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION descripción I-EXPLORATION microscópica I-EXPLORATION las I-EXPLORATION secciones I-EXPLORATION histológicas I-EXPLORATION muestran I-EXPLORATION todas I-EXPLORATION ellas I-EXPLORATION un I-EXPLORATION mismo I-EXPLORATION aspecto: I-EXPLORATION en I-EXPLORATION su I-EXPLORATION mayor I-EXPLORATION parte I-EXPLORATION están I-EXPLORATION constituidas I-EXPLORATION por I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION con I-EXPLORATION células I-EXPLORATION adiposas I-EXPLORATION con I-EXPLORATION tamaño I-EXPLORATION grande I-EXPLORATION de I-EXPLORATION vacuola I-EXPLORATION grande I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION maduro. I-EXPLORATION Se I-EXPLORATION observa I-EXPLORATION también I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION núcleos I-EXPLORATION atípicos I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION focal, I-EXPLORATION con I-EXPLORATION citoplasma I-EXPLORATION vacuolado. I-EXPLORATION Estas I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION maduro I-EXPLORATION están I-EXPLORATION distribuidas I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION difusa I-EXPLORATION por I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION neoplasia, I-EXPLORATION y I-EXPLORATION los I-EXPLORATION focos I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION atípicos, I-EXPLORATION en I-EXPLORATION ocasiones I-EXPLORATION hipercromáticos I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION aislada. I-EXPLORATION Diagnóstico: I-EXPLORATION Liposarcoma I-EXPLORATION bien I-EXPLORATION diferenciado. I-EXPLORATION Una I-EXPLORATION nueva I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION Ca I-EXPLORATION 19, I-EXPLORATION 9, I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION quirúrgica I-EXPLORATION presenta I-EXPLORATION normalización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION (24, I-EXPLORATION 17 I-EXPLORATION U/l), I-EXPLORATION manteniéndose I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION normales. I-EXPLORATION Posteriormente B-TREATMENT se I-TREATMENT realiza I-TREATMENT radioterapia I-TREATMENT complementaria, I-TREATMENT presentando I-TREATMENT una I-TREATMENT evolución I-TREATMENT favorable I-TREATMENT y I-TREATMENT permaneciendo I-TREATMENT asintomático. I-TREATMENT La B-EXPLORATION RM I-EXPLORATION abdominopélvica I-EXPLORATION de I-EXPLORATION control I-EXPLORATION realizada I-EXPLORATION a I-EXPLORATION los I-EXPLORATION cinco I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION quirurgica I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION estado I-EXPLORATION postoperatorio I-EXPLORATION del I-EXPLORATION liposarcoma I-EXPLORATION retroperitoneal, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION macroscópica I-EXPLORATION de I-EXPLORATION lesión. I-EXPLORATION Así B-EVOLUTION este I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable, I-EVOLUTION permaneciendo I-EVOLUTION asintomático I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION transcurriendo I-EVOLUTION más I-EVOLUTION de I-EVOLUTION un I-EVOLUTION año I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS Dental I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Referencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Salud I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Peñalolén, I-PRESENT_ILLNESS Cordillera I-PRESENT_ILLNESS Oriente, I-PRESENT_ILLNESS Santiago, I-PRESENT_ILLNESS Chile. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS señaló I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS había I-PRESENT_ILLNESS crecido I-PRESENT_ILLNESS lentamente I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS año I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ella I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS detectó. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION clínica I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION el I-EXPLORATION labio I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION nodular, I-EXPLORATION irregular, I-EXPLORATION globuloso I-EXPLORATION (como I-EXPLORATION racimo), I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION indoloro, I-EXPLORATION y I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION más I-EXPLORATION o I-EXPLORATION menos I-EXPLORATION difusos I-EXPLORATION y I-EXPLORATION recubierto I-EXPLORATION por I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION anamnesis I-EXPLORATION no I-EXPLORATION se I-EXPLORATION pesquisaron I-EXPLORATION otros I-EXPLORATION procesos I-EXPLORATION ni I-EXPLORATION antecedentes I-EXPLORATION mórbidos I-EXPLORATION relevantes. I-EXPLORATION I-EXPLORATION Con B-TREATMENT la I-TREATMENT hipótesis I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT adenoma I-TREATMENT pleomorfo, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT realizar I-TREATMENT la I-TREATMENT biopsia I-TREATMENT excisional I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT local. I-TREATMENT Se I-TREATMENT logró I-TREATMENT extraer I-TREATMENT toda I-TREATMENT la I-TREATMENT tumoración I-TREATMENT además I-TREATMENT de I-TREATMENT tejido I-TREATMENT adyacente, I-TREATMENT ya I-TREATMENT que I-TREATMENT si I-TREATMENT bien I-TREATMENT se I-TREATMENT observaba I-TREATMENT algo I-TREATMENT de I-TREATMENT fibrosis I-TREATMENT periférica, I-TREATMENT ésta I-TREATMENT se I-TREATMENT entremezclaba I-TREATMENT con I-TREATMENT el I-TREATMENT tejido I-TREATMENT conjuntivo I-TREATMENT y I-TREATMENT capa I-TREATMENT muscular I-TREATMENT de I-TREATMENT los I-TREATMENT labios. I-TREATMENT La B-EXPLORATION muestra I-EXPLORATION fue I-EXPLORATION enviada I-EXPLORATION a I-EXPLORATION análisis I-EXPLORATION histopatológico. I-EXPLORATION I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION histopatológico I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION capsulada, I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION vasos I-EXPLORATION sanguíneos I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION engrosadas, I-EXPLORATION entremezclados I-EXPLORATION con I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION linfocitario I-EXPLORATION que I-EXPLORATION se I-EXPLORATION disponía I-EXPLORATION a I-EXPLORATION manera I-EXPLORATION de I-EXPLORATION I-EXPLORATION folículos I-EXPLORATION con I-EXPLORATION centros I-EXPLORATION germinativos, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION presencia I-EXPLORATION destacada I-EXPLORATION de I-EXPLORATION eosinófilos. I-EXPLORATION El I-EXPLORATION tejido I-EXPLORATION presentaba I-EXPLORATION múltiples I-EXPLORATION tabicaciones I-EXPLORATION por I-EXPLORATION haces I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION colágenas. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION histopatológico I-EXPLORATION correspondió I-EXPLORATION a I-EXPLORATION hiperplasia I-EXPLORATION angiolinfoidea I-EXPLORATION con I-EXPLORATION eosinofilia. I-EXPLORATION Los I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION los I-EXPLORATION distintos I-EXPLORATION parámetros I-EXPLORATION del I-EXPLORATION hemograma I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION controlada I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION se I-EVOLUTION procedió I-EVOLUTION al I-EVOLUTION retiro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sutura. I-EVOLUTION Luego I-EVOLUTION se I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION controlar I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION y I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION realizada I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION sin I-EVOLUTION observarse I-EVOLUTION recidiva. I-EVOLUTION I-EVOLUTION 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 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 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 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 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 Embarazada B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS procedente B-FAMILY_HISTORY de I-FAMILY_HISTORY Embarcación I-FAMILY_HISTORY (Salta), I-FAMILY_HISTORY que I-FAMILY_HISTORY cursaba I-FAMILY_HISTORY su I-FAMILY_HISTORY segunda I-FAMILY_HISTORY gesta I-FAMILY_HISTORY en I-FAMILY_HISTORY semana I-FAMILY_HISTORY 38 I-FAMILY_HISTORY sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY patológicos. I-FAMILY_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS (39,4°C), I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS internó I-PRESENT_ILLNESS para I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tratamiento. I-PRESENT_ILLNESS Al B-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION sangrado I-EVOLUTION de I-EVOLUTION mucosas, I-EVOLUTION en I-EVOLUTION zonas I-EVOLUTION de I-EVOLUTION venopuntura I-EVOLUTION y I-EVOLUTION deterioro I-EVOLUTION progresivo I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general. I-EVOLUTION Veinticuatro B-TREATMENT horas I-TREATMENT más I-TREATMENT tarde I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT cesárea I-TREATMENT de I-TREATMENT urgencia I-TREATMENT por I-TREATMENT sufrimiento I-TREATMENT fetal I-TREATMENT agudo, I-TREATMENT con I-TREATMENT una I-TREATMENT grave I-TREATMENT metrorragia I-TREATMENT posparto. I-TREATMENT La B-EVOLUTION madre I-EVOLUTION recibió I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION sostén I-EVOLUTION que I-EVOLUTION requirió I-EVOLUTION múltiples I-EVOLUTION transfusiones I-EVOLUTION sanguíneas. I-EVOLUTION Se I-EVOLUTION recuperó I-EVOLUTION favorablemente I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION h I-EVOLUTION posparto. I-EVOLUTION El I-EVOLUTION niño I-EVOLUTION nació I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 38 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION edad I-EVOLUTION gestacional, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION peso I-EVOLUTION de I-EVOLUTION 3900 I-EVOLUTION g I-EVOLUTION y I-EVOLUTION puntaje I-EVOLUTION de I-EVOLUTION Apgar I-EVOLUTION 4/4. I-EVOLUTION Durante I-EVOLUTION la I-EVOLUTION internación I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION cuidado I-EVOLUTION intensivo I-EVOLUTION neonatal I-EVOLUTION requirió I-EVOLUTION asistencia I-EVOLUTION respiratoria I-EVOLUTION mecánica I-EVOLUTION por I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION aspiración I-EVOLUTION meconial I-EVOLUTION e I-EVOLUTION hipertensión I-EVOLUTION pulmonar I-EVOLUTION y I-EVOLUTION luminoterapia I-EVOLUTION por I-EVOLUTION su I-EVOLUTION ictericia. I-EVOLUTION Al I-EVOLUTION 5to I-EVOLUTION día I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION (39°C), I-EVOLUTION hepatomegalia I-EVOLUTION y I-EVOLUTION un I-EVOLUTION exantema I-EVOLUTION evanescente I-EVOLUTION generalizado. I-EVOLUTION Pasadas I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION se I-EVOLUTION agregaron I-EVOLUTION hemorragias I-EVOLUTION por I-EVOLUTION sonda I-EVOLUTION nasogástrica I-EVOLUTION y I-EVOLUTION en I-EVOLUTION las I-EVOLUTION venopunturas. I-EVOLUTION El B-EXPLORATION hemograma I-EXPLORATION presentó I-EXPLORATION 5800 I-EXPLORATION glóbulos I-EXPLORATION blancos I-EXPLORATION (linfocitos I-EXPLORATION 43%, I-EXPLORATION neutrófilos I-EXPLORATION segmentados I-EXPLORATION 47%, I-EXPLORATION monocitos I-EXPLORATION 6%, I-EXPLORATION basófilos I-EXPLORATION 4%), I-EXPLORATION hematócrito I-EXPLORATION 34%, I-EXPLORATION hemoglobina I-EXPLORATION 11, I-EXPLORATION 2 I-EXPLORATION mg% I-EXPLORATION y I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION de I-EXPLORATION 13 I-EXPLORATION 000/mm³. I-EXPLORATION Con I-EXPLORATION diagnóstico I-EXPLORATION presuntivo I-EXPLORATION de I-EXPLORATION sepsis I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizaron I-EXPLORATION hemocultivos, I-EXPLORATION urocultivo I-EXPLORATION y I-EXPLORATION punción I-EXPLORATION lumbar. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION le I-EXPLORATION solicitó I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION IgM I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION dengue. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION indicaron I-EXPLORATION antibióticos I-EXPLORATION y I-EXPLORATION transfusiones I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION plaquetas. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION para I-EXPLORATION gérmenes I-EXPLORATION comunes I-EXPLORATION y I-EXPLORATION hongos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION informó I-EXPLORATION IgM I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION ELISA I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION dengue. I-EXPLORATION Para I-EXPLORATION la I-EXPLORATION confirmación I-EXPLORATION del I-EXPLORATION resultado I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION al I-EXPLORATION Instituto I-EXPLORATION Nacional I-EXPLORATION de I-EXPLORATION Enfermedades I-EXPLORATION Virales I-EXPLORATION Humanas I-EXPLORATION de I-EXPLORATION Pergamino, I-EXPLORATION quienes I-EXPLORATION certificaron I-EXPLORATION por I-EXPLORATION pruebas I-EXPLORATION serológicas I-EXPLORATION de I-EXPLORATION ELISA, I-EXPLORATION neutralización I-EXPLORATION y I-EXPLORATION detección I-EXPLORATION molecular I-EXPLORATION del I-EXPLORATION genoma I-EXPLORATION viral I-EXPLORATION (RT-PCR), I-EXPLORATION la I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION serotipo I-EXPLORATION DEN-1. I-EXPLORATION Se B-EVOLUTION administró I-EVOLUTION oxígeno I-EVOLUTION hasta I-EVOLUTION los I-EVOLUTION 26 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION comienzo I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION se I-EVOLUTION normalizó I-EVOLUTION el I-EVOLUTION recuento I-EVOLUTION de I-EVOLUTION plaquetas. I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION Como I-EVOLUTION consecuencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION asfixia I-EVOLUTION perinatal I-EVOLUTION relacionada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION forma I-EVOLUTION de I-EVOLUTION dengue I-EVOLUTION grave I-EVOLUTION de I-EVOLUTION la I-EVOLUTION madre, I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION presentó I-EVOLUTION encefalopatía I-EVOLUTION hipóxico-isquémica I-EVOLUTION y I-EVOLUTION compromiso I-EVOLUTION respiratorio I-EVOLUTION secuelar. I-EVOLUTION Se I-EVOLUTION le I-EVOLUTION realizaron I-EVOLUTION controles I-EVOLUTION clínicos I-EVOLUTION y I-EVOLUTION serológicos I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION y I-EVOLUTION 13 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION títulos I-EVOLUTION de I-EVOLUTION anticuerpos I-EVOLUTION IgG I-EVOLUTION antidengue, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION se I-EVOLUTION confirmó I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION infección I-EVOLUTION congénita. I-EVOLUTION Los B-EXPLORATION resultados I-EXPLORATION serológicos I-EXPLORATION mediante I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION ELISA I-EXPLORATION mostraron I-EXPLORATION títulos I-EXPLORATION positivos I-EXPLORATION elevados, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION RP I-EXPLORATION 1, I-EXPLORATION 92 I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 37 I-EXPLORATION para I-EXPLORATION dengue I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 8 I-EXPLORATION y I-EXPLORATION 13 I-EXPLORATION meses, I-EXPLORATION respectivamente. I-EXPLORATION Actualmente, B-EVOLUTION el I-EVOLUTION niño I-EVOLUTION realiza I-EVOLUTION estimulación I-EVOLUTION neurológica I-EVOLUTION y I-EVOLUTION tratamiento I-EVOLUTION preventivo I-EVOLUTION respiratorio I-EVOLUTION con I-EVOLUTION corticoides I-EVOLUTION inhalatorios, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION evolución. I-EVOLUTION I-EVOLUTION 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 Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS Pielonefritis I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY nefríticos I-PAST_MEDICAL_HISTORY izquierdos I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY estudiados I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY juventud. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION puñopercusión I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION positiva I-EXPLORATION y I-EXPLORATION un I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION con I-EXPLORATION hipertrofia I-EXPLORATION prostática I-EXPLORATION volumen I-EXPLORATION III/IV, I-EXPLORATION fibroadenomatosa I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION nódulos. I-EXPLORATION Analítica I-EXPLORATION sanguínea I-EXPLORATION con I-EXPLORATION bioquímica I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION PSA I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 4 I-EXPLORATION ng/ml I-EXPLORATION y I-EXPLORATION formula I-EXPLORATION sanguínea I-EXPLORATION con I-EXPLORATION leucocitosis I-EXPLORATION y I-EXPLORATION desviación I-EXPLORATION izquierda. I-EXPLORATION Analítica I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION con I-EXPLORATION nitritos I-EXPLORATION positivos I-EXPLORATION y I-EXPLORATION leucocituria. I-EXPLORATION Urocultivos I-EXPLORATION y I-EXPLORATION Hemocultivos I-EXPLORATION positivos I-EXPLORATION a I-EXPLORATION E. I-EXPLORATION Coli. I-EXPLORATION Rx I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION aparato I-EXPLORATION urinario I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION significativos. I-EXPLORATION Ecografía I-EXPLORATION con I-EXPLORATION ectasia I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION grado I-EXPLORATION II-III. I-EXPLORATION La I-EXPLORATION UIV I-EXPLORATION realizada I-EXPLORATION muestra I-EXPLORATION vía I-EXPLORATION urinaria I-EXPLORATION alta I-EXPLORATION derecha I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION y I-EXPLORATION retraso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION captación I-EXPLORATION y I-EXPLORATION eliminación I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION persiste I-EXPLORATION a I-EXPLORATION las I-EXPLORATION dos I-EXPLORATION horas. I-EXPLORATION Se I-EXPLORATION procede I-EXPLORATION a I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION nefrostomía I-EXPLORATION derivativa I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION posterior I-EXPLORATION pielografía I-EXPLORATION anterógrada, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION demuestra I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION en I-EXPLORATION uréter I-EXPLORATION iliaco I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION tumoración I-EXPLORATION ureteral I-EXPLORATION de I-EXPLORATION 3-4 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION uréter I-EXPLORATION en I-EXPLORATION anzuelo. I-EXPLORATION Citología I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION nefrostomía I-EXPLORATION negativa I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION objetivaba I-EXPLORATION dicha I-EXPLORATION lesión I-EXPLORATION como I-EXPLORATION confinada I-EXPLORATION al I-EXPLORATION órgano I-EXPLORATION origen. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT Nefroureterectomía I-TREATMENT izquierda I-TREATMENT previa I-TREATMENT desinserción I-TREATMENT endoscópica, I-TREATMENT siendo I-TREATMENT el I-TREATMENT resultado I-TREATMENT anatomopatológico I-TREATMENT de I-TREATMENT Papiloma I-TREATMENT invertido I-TREATMENT de I-TREATMENT uréter I-TREATMENT y I-TREATMENT riñón I-TREATMENT izquierdo I-TREATMENT con I-TREATMENT pielonefritis I-TREATMENT crónica. I-TREATMENT A B-EVOLUTION los I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION sufre I-EVOLUTION una I-EVOLUTION RAO I-EVOLUTION que I-EVOLUTION aconseja I-EVOLUTION la I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION Adenomectomía I-EVOLUTION Retropúbica I-EVOLUTION y I-EVOLUTION posteriormente I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION y I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION presenta I-EVOLUTION sendas I-EVOLUTION recidivas I-EVOLUTION vesicales I-EVOLUTION de I-EVOLUTION Carcinoma I-EVOLUTION transicional I-EVOLUTION de I-EVOLUTION vejiga I-EVOLUTION T1GII. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION vivo I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION urotelial I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION años I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION PI. I-EVOLUTION I-EVOLUTION 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 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 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 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 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 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 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 Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cefaleas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquismo. I-PAST_MEDICAL_HISTORY Desde B-PRESENT_ILLNESS hace I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS visión I-PRESENT_ILLNESS borrosa, I-PRESENT_ILLNESS notando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS alguna I-PRESENT_ILLNESS ocasión I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS visual I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemicampo I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS acompañándose I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefaleas I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedían I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS analgésico. I-PRESENT_ILLNESS Hace I-PRESENT_ILLNESS nueve I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS ictal I-PRESENT_ILLNESS transitorio I-PRESENT_ILLNESS hemisférico I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS desapareció I-PRESENT_ILLNESS pasados I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS minutos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mañana I-PRESENT_ILLNESS del I-PRESENT_ILLNESS presente I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS notó I-PRESENT_ILLNESS torpeza I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS desviación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS comisura I-PRESENT_ILLNESS bucal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS articulación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS palabra. I-PRESENT_ILLNESS Por I-PRESENT_ILLNESS este I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS valorada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS neurólogo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS objetivó I-PRESENT_ILLNESS paresia I-PRESENT_ILLNESS facial I-PRESENT_ILLNESS supranuclear I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS y I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS disartria, I-PRESENT_ILLNESS inestabilidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS con I-PRESENT_ILLNESS torpeza I-PRESENT_ILLNESS para I-PRESENT_ILLNESS movimientos I-PRESENT_ILLNESS finos I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipoestesia I-PRESENT_ILLNESS táctil I-PRESENT_ILLNESS y I-PRESENT_ILLNESS algésica I-PRESENT_ILLNESS facio-braquial I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS En B-EXPLORATION urgencias I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ECG, I-EXPLORATION en I-EXPLORATION ritmo I-EXPLORATION sinusal, I-EXPLORATION TAC I-EXPLORATION craneal I-EXPLORATION que I-EXPLORATION inicialmente I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION infarto I-EXPLORATION y I-EXPLORATION Doppler I-EXPLORATION de I-EXPLORATION troncos I-EXPLORATION supraaórticos I-EXPLORATION y I-EXPLORATION transcraneal I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION planta, I-EXPLORATION solicitándose I-EXPLORATION perfiles I-EXPLORATION analíticos I-EXPLORATION completos I-EXPLORATION incluyendo I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION hipercoagulabilidad, I-EXPLORATION ANAS, I-EXPLORATION c-ANCA, I-EXPLORATION p-ANCA, I-EXPLORATION DNA I-EXPLORATION nativo I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antimitocondriales. I-EXPLORATION También I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen: I-EXPLORATION RNM I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION ecocardiografía. I-EXPLORATION I-EXPLORATION La I-EXPLORATION RNM I-EXPLORATION mostró I-EXPLORATION infarto I-EXPLORATION isquémico I-EXPLORATION agudo I-EXPLORATION en I-EXPLORATION territorio I-EXPLORATION silviano I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cerebral I-EXPLORATION media I-EXPLORATION izquierda. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION antineutrófilos, I-EXPLORATION anticuerpos I-EXPLORATION antinucleares, I-EXPLORATION anticentrómero I-EXPLORATION y I-EXPLORATION antimitocondrias I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION trombofilia I-EXPLORATION tan I-EXPLORATION sólo I-EXPLORATION detectó I-EXPLORATION ligera I-EXPLORATION hiperfibrinogenemia. I-EXPLORATION I-EXPLORATION Finalmente I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION ecocardiografía, I-EXPLORATION prueba I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION crucial I-EXPLORATION al I-EXPLORATION proporcionar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION definitivo, I-EXPLORATION observándose I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION pedunculada I-EXPLORATION en I-EXPLORATION AI I-EXPLORATION que I-EXPLORATION prolapsaba I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION mitral I-EXPLORATION en I-EXPLORATION diástole, I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION un I-EXPLORATION mixoma I-EXPLORATION (35 I-EXPLORATION x I-EXPLORATION 26 I-EXPLORATION mm), I-EXPLORATION con I-EXPLORATION pedículo I-EXPLORATION en I-EXPLORATION región I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION oval. I-EXPLORATION I-EXPLORATION Se B-TREATMENT programó I-TREATMENT para I-TREATMENT cirugía I-TREATMENT realizándose I-TREATMENT previamente I-TREATMENT RNM I-TREATMENT cardiaca I-TREATMENT para I-TREATMENT determinar I-TREATMENT con I-TREATMENT mayor I-TREATMENT precisión I-TREATMENT las I-TREATMENT características I-TREATMENT morfológicas I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT auricular. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT atriotomía I-TREATMENT izquierda, I-TREATMENT extrayéndose I-TREATMENT el I-TREATMENT tumor I-TREATMENT en I-TREATMENT su I-TREATMENT totalidad, I-TREATMENT siendo I-TREATMENT éste I-TREATMENT de I-TREATMENT aspecto I-TREATMENT morulado. I-TREATMENT Se I-TREATMENT abrió I-TREATMENT también I-TREATMENT aurícula I-TREATMENT derecha I-TREATMENT y I-TREATMENT se I-TREATMENT resecó I-TREATMENT la I-TREATMENT zona I-TREATMENT de I-TREATMENT implantación, I-TREATMENT cerrándose I-TREATMENT posteriormente I-TREATMENT la I-TREATMENT comunicación I-TREATMENT interauricular I-TREATMENT creada. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION posquirúrgica I-EVOLUTION resultó I-EVOLUTION muy I-EVOLUTION satisfactoria, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION déficit I-EVOLUTION neurológico. I-EVOLUTION I-EVOLUTION 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 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 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 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 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 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 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 Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS producto B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY tercera I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 34 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY padre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY consanguíneos; I-PAST_MEDICAL_HISTORY con B-FAMILY_HISTORY dos I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY aparentemente I-FAMILY_HISTORY sanos; I-FAMILY_HISTORY sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY importancia. I-FAMILY_HISTORY Durante I-FAMILY_HISTORY todo I-FAMILY_HISTORY el I-FAMILY_HISTORY embarazo I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY cursó I-FAMILY_HISTORY con I-FAMILY_HISTORY tos I-FAMILY_HISTORY productiva, I-FAMILY_HISTORY persistente, I-FAMILY_HISTORY sin I-FAMILY_HISTORY predominio I-FAMILY_HISTORY de I-FAMILY_HISTORY horario, I-FAMILY_HISTORY tratada I-FAMILY_HISTORY con I-FAMILY_HISTORY nebulizaciones I-FAMILY_HISTORY con I-FAMILY_HISTORY salbutamol I-FAMILY_HISTORY y, I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY segundo I-FAMILY_HISTORY trimestre I-FAMILY_HISTORY de I-FAMILY_HISTORY gestación, I-FAMILY_HISTORY con I-FAMILY_HISTORY infecciones I-FAMILY_HISTORY vaginales I-FAMILY_HISTORY reiteradas I-FAMILY_HISTORY cuyo I-FAMILY_HISTORY manejo I-FAMILY_HISTORY se I-FAMILY_HISTORY desconoce. I-FAMILY_HISTORY El B-PAST_MEDICAL_HISTORY producto I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY obtenido I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 36 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gestación; I-PAST_MEDICAL_HISTORY peso: I-PAST_MEDICAL_HISTORY 2800 I-PAST_MEDICAL_HISTORY g, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY atresia I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY coanas I-PAST_MEDICAL_HISTORY (ABC), I-PAST_MEDICAL_HISTORY encefalocele, I-PAST_MEDICAL_HISTORY hidrocefalia, I-PAST_MEDICAL_HISTORY microftalmía I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY restos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bandas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY constricción I-PAST_MEDICAL_HISTORY oscuras I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dedos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY manos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pies; I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY datos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY características I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY placenta. I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY 5to I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY colocó I-PAST_MEDICAL_HISTORY válvula I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY derivación I-PAST_MEDICAL_HISTORY ventriculoperitoneal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY plastia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY encefalocele; I-PAST_MEDICAL_HISTORY a B-PRESENT_ILLNESS las I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS desarrolla I-PRESENT_ILLNESS neumonía I-PRESENT_ILLNESS nosocomial. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION actual, I-EXPLORATION peso: I-EXPLORATION 3150 I-EXPLORATION g I-EXPLORATION (percentil I-EXPLORATION 3); I-EXPLORATION talla: I-EXPLORATION 52 I-EXPLORATION cm I-EXPLORATION (percentil I-EXPLORATION 20); I-EXPLORATION plagiocefalia I-EXPLORATION frontotemporal I-EXPLORATION izquierda, I-EXPLORATION dolicocefalia, I-EXPLORATION cicatriz I-EXPLORATION de I-EXPLORATION plastia I-EXPLORATION en I-EXPLORATION región I-EXPLORATION occipital I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION y I-EXPLORATION válvula I-EXPLORATION de I-EXPLORATION pudens I-EXPLORATION en I-EXPLORATION región I-EXPLORATION temporal I-EXPLORATION derecha, I-EXPLORATION frontal I-EXPLORATION prominente; I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION cejas; I-EXPLORATION microftalmía I-EXPLORATION derecha; I-EXPLORATION puente I-EXPLORATION nasal I-EXPLORATION deprimido; I-EXPLORATION hiperplasia I-EXPLORATION gingival; I-EXPLORATION paladar I-EXPLORATION ojival; I-EXPLORATION pectus I-EXPLORATION excavatum; I-EXPLORATION hernia I-EXPLORATION umbilical; I-EXPLORATION marca I-EXPLORATION de I-EXPLORATION constricción I-EXPLORATION circular I-EXPLORATION por I-EXPLORATION bandas I-EXPLORATION en I-EXPLORATION región I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION antebrazo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION dedos I-EXPLORATION 2, I-EXPLORATION 3 I-EXPLORATION y I-EXPLORATION 4; I-EXPLORATION además I-EXPLORATION de I-EXPLORATION aplasia I-EXPLORATION ungueal I-EXPLORATION y I-EXPLORATION acrosindactilia I-EXPLORATION de I-EXPLORATION éstos; I-EXPLORATION mano I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION marca I-EXPLORATION de I-EXPLORATION constricción I-EXPLORATION circular I-EXPLORATION por I-EXPLORATION bandas I-EXPLORATION en I-EXPLORATION 4to I-EXPLORATION dedo I-EXPLORATION y I-EXPLORATION acrosindactilia I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION ungueal I-EXPLORATION de I-EXPLORATION dedos I-EXPLORATION 2do I-EXPLORATION y I-EXPLORATION 3ro; I-EXPLORATION pie I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION acrosindactilia I-EXPLORATION de I-EXPLORATION dedos I-EXPLORATION 2do I-EXPLORATION y I-EXPLORATION 3ro; I-EXPLORATION pie I-EXPLORATION izquierdo I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION dedos I-EXPLORATION 1ro, I-EXPLORATION 2do I-EXPLORATION y I-EXPLORATION 3ro, I-EXPLORATION acrosindactilia I-EXPLORATION y I-EXPLORATION marca I-EXPLORATION de I-EXPLORATION banda I-EXPLORATION de I-EXPLORATION constricción I-EXPLORATION de I-EXPLORATION 5to I-EXPLORATION dedo. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION normales; I-EXPLORATION el I-EXPLORATION cariotipo I-EXPLORATION con I-EXPLORATION resolución I-EXPLORATION de I-EXPLORATION 550 I-EXPLORATION bandas I-EXPLORATION y I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION bandeo I-EXPLORATION G I-EXPLORATION en I-EXPLORATION 40 I-EXPLORATION metafases I-EXPLORATION se I-EXPLORATION informó: I-EXPLORATION 46, I-EXPLORATION XY; I-EXPLORATION en I-EXPLORATION las I-EXPLORATION radiografías I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION 2da I-EXPLORATION falange I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 2da I-EXPLORATION y I-EXPLORATION 3era I-EXPLORATION falanges I-EXPLORATION distales I-EXPLORATION en I-EXPLORATION mano I-EXPLORATION izquierda; I-EXPLORATION pie I-EXPLORATION derecho, I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION falanges I-EXPLORATION medias I-EXPLORATION y I-EXPLORATION distales; I-EXPLORATION en I-EXPLORATION pie I-EXPLORATION izquierdo I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION falanges I-EXPLORATION distales. I-EXPLORATION Ecocardiograma I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION reveló: I-EXPLORATION microftalmía I-EXPLORATION derecha, I-EXPLORATION encefalocele I-EXPLORATION frontoparietal I-EXPLORATION y I-EXPLORATION megaventrículo I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION ABC I-EXPLORATION con I-EXPLORATION placa I-EXPLORATION atrésica I-EXPLORATION mixta I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION por I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada, I-EXPLORATION realizándose I-EXPLORATION corrección I-EXPLORATION vía I-EXPLORATION endoscópica I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 10 I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION edad. I-EXPLORATION I-EXPLORATION 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 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 Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sana, I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS previas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS ictericia, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS adinamia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS progresivo. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION hubo I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION transaminasas, I-EXPLORATION gamaglutamiltranspeptidasas, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION INR I-EXPLORATION y I-EXPLORATION disfunción I-EXPLORATION renal. I-EXPLORATION No B-PAST_MEDICAL_HISTORY hubo I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fármacos I-PAST_MEDICAL_HISTORY y B-EXPLORATION los I-EXPLORATION marcadores I-EXPLORATION virales I-EXPLORATION e I-EXPLORATION inmunológicos I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION exceptuando, I-EXPLORATION un I-EXPLORATION título I-EXPLORATION de I-EXPLORATION intensidad I-EXPLORATION menor I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION A. I-EXPLORATION Evolucionó B-TREATMENT rápidamente I-TREATMENT a I-TREATMENT sopor I-TREATMENT profundo, I-TREATMENT requirió I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasiva I-TREATMENT y B-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION encéfalo I-EXPLORATION (TC) I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION edema I-EXPLORATION encefálico I-EXPLORATION con I-EXPLORATION elementos I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION HIC. I-EXPLORATION La I-EXPLORATION monitorización I-EXPLORATION electroencefalográfica I-EXPLORATION mostró I-EXPLORATION ritmos I-EXPLORATION lentos I-EXPLORATION y I-EXPLORATION simétricos I-EXPLORATION bilaterales. I-EXPLORATION El I-EXPLORATION INR I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 0 I-EXPLORATION se I-EXPLORATION corrigió I-EXPLORATION a I-EXPLORATION 1, I-EXPLORATION 6 I-EXPLORATION con I-EXPLORATION 40 I-EXPLORATION ug/kg I-EXPLORATION de I-EXPLORATION Factor I-EXPLORATION VII I-EXPLORATION activado I-EXPLORATION recombinante I-EXPLORATION (rFVIIa) I-EXPLORATION previo I-EXPLORATION a I-EXPLORATION la I-EXPLORATION instalación I-EXPLORATION de I-EXPLORATION catéter I-EXPLORATION intraparenquimatoso I-EXPLORATION Raudemic® I-EXPLORATION para I-EXPLORATION medición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION intracraneana I-EXPLORATION (PIC) I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION encefálica. I-EXPLORATION Los I-EXPLORATION valores I-EXPLORATION iniciales I-EXPLORATION de I-EXPLORATION PIC I-EXPLORATION fluctuaron I-EXPLORATION entre I-EXPLORATION 20 I-EXPLORATION y I-EXPLORATION 25 I-EXPLORATION mmHg, I-EXPLORATION con I-EXPLORATION temperatura I-EXPLORATION cerebral I-EXPLORATION de I-EXPLORATION 37°C. I-EXPLORATION El I-EXPLORATION Doppler I-EXPLORATION transcraneano I-EXPLORATION determinó I-EXPLORATION velocidad I-EXPLORATION sistólica I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION pulsatibilidad I-EXPLORATION normales; I-EXPLORATION siendo I-EXPLORATION enlistada I-EXPLORATION para I-EXPLORATION trasplante I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION los I-EXPLORATION criterios I-EXPLORATION del I-EXPLORATION King's I-EXPLORATION College8. I-EXPLORATION I-EXPLORATION La B-TREATMENT HIC I-TREATMENT se I-TREATMENT tornó I-TREATMENT refractaria I-TREATMENT a I-TREATMENT medidas I-TREATMENT de I-TREATMENT primera I-TREATMENT línea, I-TREATMENT iniciándose I-TREATMENT hipotermia I-TREATMENT intravascular I-TREATMENT mediante I-TREATMENT catéter I-TREATMENT tipo I-TREATMENT ICY® I-TREATMENT vía I-TREATMENT femoral I-TREATMENT con I-TREATMENT máquina I-TREATMENT Alsius I-TREATMENT CoolGard®, I-TREATMENT disminuyendo I-TREATMENT la I-TREATMENT temperatura I-TREATMENT encefálica I-TREATMENT a I-TREATMENT 33oC. I-TREATMENT Recibió I-TREATMENT sedación I-TREATMENT con I-TREATMENT opiáceos I-TREATMENT (Fentanyl) I-TREATMENT e I-TREATMENT infusión I-TREATMENT continua I-TREATMENT de I-TREATMENT relajante I-TREATMENT muscular I-TREATMENT (vecuronium) I-TREATMENT para I-TREATMENT prevenir I-TREATMENT escalofríos; I-TREATMENT en B-EVOLUTION 3, I-EVOLUTION 5 I-EVOLUTION h I-EVOLUTION se I-EVOLUTION logró I-EVOLUTION la I-EVOLUTION meta I-EVOLUTION de I-EVOLUTION 33oC. I-EVOLUTION A B-TREATMENT las I-TREATMENT 72 I-TREATMENT h, I-TREATMENT se I-TREATMENT le I-TREATMENT ofreció I-TREATMENT un I-TREATMENT injerto I-TREATMENT hepático I-TREATMENT de I-TREATMENT donante I-TREATMENT cadavérico I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT trasplante I-TREATMENT ortotópico I-TREATMENT bajo I-TREATMENT hipotermia I-TREATMENT intravascular I-TREATMENT activa. I-TREATMENT Posteriormente B-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidados I-EVOLUTION intensivos, I-EVOLUTION y I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION comprobar I-EVOLUTION la I-EVOLUTION perfusión I-EVOLUTION del I-EVOLUTION injerto, I-EVOLUTION se I-EVOLUTION reinició I-EVOLUTION recalentamiento I-EVOLUTION lento I-EVOLUTION controlado I-EVOLUTION alcanzando I-EVOLUTION la I-EVOLUTION normotermia I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 76 I-EVOLUTION h I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION continua I-EVOLUTION en I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION de I-EVOLUTION función I-EVOLUTION hepática, I-EVOLUTION completando I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION manera I-EVOLUTION 122 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION hipotermia I-EVOLUTION a I-EVOLUTION 33oC. I-EVOLUTION Desarrolló I-EVOLUTION mioneuropatía I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION crítico I-EVOLUTION y I-EVOLUTION permaneció I-EVOLUTION en I-EVOLUTION ventilación I-EVOLUTION mecánica I-EVOLUTION durante I-EVOLUTION 15 I-EVOLUTION días, I-EVOLUTION requiriendo B-TREATMENT de I-TREATMENT traqueostomía I-TREATMENT percutánea I-TREATMENT para I-TREATMENT facilitar I-TREATMENT el I-TREATMENT destete I-TREATMENT del I-TREATMENT ventilador I-TREATMENT mecánico. I-TREATMENT I-TREATMENT Luego I-TREATMENT de I-TREATMENT un I-TREATMENT despertar I-TREATMENT lento, I-TREATMENT se I-TREATMENT retiró I-TREATMENT la I-TREATMENT cánula I-TREATMENT de I-TREATMENT traqueostomía I-TREATMENT al I-TREATMENT día I-TREATMENT 37. I-TREATMENT Recibió B-EVOLUTION el I-EVOLUTION alta I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION 69 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION nutritivas, I-EVOLUTION neurológicas I-EVOLUTION y I-EVOLUTION ligada I-EVOLUTION a I-EVOLUTION un I-EVOLUTION programa I-EVOLUTION de I-EVOLUTION rehabilitación I-EVOLUTION física. I-EVOLUTION Actualmente I-EVOLUTION asiste I-EVOLUTION a I-EVOLUTION sus I-EVOLUTION estudios I-EVOLUTION secundarios I-EVOLUTION y I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION en I-EVOLUTION control I-EVOLUTION ambulatorio. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY artritis I-PAST_MEDICAL_HISTORY reumatoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY leflunomida, I-PAST_MEDICAL_HISTORY deflazacort I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antiinflamatorios I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY esteroideos I-PAST_MEDICAL_HISTORY (AINEs), I-PAST_MEDICAL_HISTORY es B-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Inflamación I-DERIVED_FROM/TO Ocular I-DERIVED_FROM/TO por I-DERIVED_FROM/TO cuadro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ojo I-DERIVED_FROM/TO derecho I-DERIVED_FROM/TO rojo I-DERIVED_FROM/TO y I-DERIVED_FROM/TO doloroso I-DERIVED_FROM/TO de I-DERIVED_FROM/TO dos I-DERIVED_FROM/TO semanas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO asociado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO empeoramiento I-DERIVED_FROM/TO clínico I-DERIVED_FROM/TO y I-DERIVED_FROM/TO de I-DERIVED_FROM/TO laboratorio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO enfermedad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO base. I-DERIVED_FROM/TO I-DERIVED_FROM/TO La B-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION inicial I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 6 I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION (OD) I-EXPLORATION y I-EXPLORATION 1 I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION (OI). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION biomicroscopía I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION ingurgitación I-EXPLORATION vascular I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION engrosamiento I-EXPLORATION escleral I-EXPLORATION temporal I-EXPLORATION superior I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION escleritis I-EXPLORATION anterior I-EXPLORATION difusa I-EXPLORATION severa. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION AO. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT esteroideo I-TREATMENT oral I-TREATMENT con I-TREATMENT prednisona I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg/kg/día, I-TREATMENT manteniendo I-TREATMENT el I-TREATMENT resto I-TREATMENT del I-TREATMENT tratamiento, I-TREATMENT sin I-TREATMENT obtener I-TREATMENT mejoría I-TREATMENT clínica I-TREATMENT tras I-TREATMENT tres I-TREATMENT semanas I-TREATMENT de I-TREATMENT seguimiento. I-TREATMENT Una B-EXPLORATION vez I-EXPLORATION realizadas I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION un I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION se B-TREATMENT decidió I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT Infliximab I-TREATMENT (Remicade®, I-TREATMENT Schering-Plough, I-TREATMENT Welwyn I-TREATMENT Garden I-TREATMENT City, I-TREATMENT UK) I-TREATMENT en I-TREATMENT tres I-TREATMENT dosis I-TREATMENT intravenosas I-TREATMENT de I-TREATMENT 3 I-TREATMENT mg/kg/día I-TREATMENT en I-TREATMENT las I-TREATMENT semanas I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT y I-TREATMENT 6. I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION dosis I-EVOLUTION se I-EVOLUTION objetivó I-EVOLUTION una I-EVOLUTION reducción I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ingurgitación I-EVOLUTION vascular I-EVOLUTION y I-EVOLUTION del I-EVOLUTION edema I-EVOLUTION escleral I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION tercera I-EVOLUTION se I-EVOLUTION obtuvo I-EVOLUTION una I-EVOLUTION desaparición I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION la I-EVOLUTION inflamación I-EVOLUTION escleral, I-EVOLUTION quedando I-EVOLUTION un I-EVOLUTION cierto I-EVOLUTION adelgazamiento I-EVOLUTION residual I-EVOLUTION con I-EVOLUTION transparencia I-EVOLUTION del I-EVOLUTION tejido I-EVOLUTION uveal I-EVOLUTION subyacente. I-EVOLUTION Paralelamente, I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION en I-EVOLUTION los I-EVOLUTION signos I-EVOLUTION y I-EVOLUTION síntomas I-EVOLUTION articulares, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION actividad I-EVOLUTION global I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION representada I-EVOLUTION por I-EVOLUTION el I-EVOLUTION Disease I-EVOLUTION Activity I-EVOLUTION Score I-EVOLUTION (DAS I-EVOLUTION 28), I-EVOLUTION obteniéndose I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION un I-EVOLUTION 40% I-EVOLUTION en I-EVOLUTION el I-EVOLUTION DAS I-EVOLUTION 28. I-EVOLUTION I-EVOLUTION Tras I-EVOLUTION un I-EVOLUTION período I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION no I-EVOLUTION se I-EVOLUTION han I-EVOLUTION detectado I-EVOLUTION recidivas I-EVOLUTION en I-EVOLUTION la I-EVOLUTION inflamación I-EVOLUTION escleral. I-EVOLUTION La B-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION es I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos I-EXPLORATION (AO). I-EXPLORATION La B-TREATMENT paciente I-TREATMENT sigue I-TREATMENT en I-TREATMENT la I-TREATMENT actualidad I-TREATMENT tratamiento I-TREATMENT sistémico I-TREATMENT únicamente I-TREATMENT con I-TREATMENT prednisona I-TREATMENT 7, I-TREATMENT 5 I-TREATMENT mg/día, I-TREATMENT leflunomida I-TREATMENT y I-TREATMENT AINEs. I-TREATMENT I-TREATMENT