diff --git "a/data/dev.conll" "b/data/dev.conll" --- "a/data/dev.conll" +++ "b/data/dev.conll" @@ -1,3 +1,15146 @@ +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +69 I-PRESENT_ILLNESS +a. I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-EXPLORATION +un I-EXPLORATION +PSA I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +de I-EXPLORATION +22 I-EXPLORATION +ng/ml. I-EXPLORATION +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sextantes I-PAST_MEDICAL_HISTORY +negativa. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +E-RME I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +inicialmente I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +situado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +prostática I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +izquierdo, I-EXPLORATION +morfológicamente I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +hiperplasia I-EXPLORATION +nodular, I-EXPLORATION +pero I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +espectroscópico I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +metabólica I-EXPLORATION +de I-EXPLORATION +este I-EXPLORATION +nódulo, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +colina I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +citrato, I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +neoplasia. I-EXPLORATION + I-EXPLORATION + +Un B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +19 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 +tras I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tráfico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +vehículo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +motor. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +urológico. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +aquejaba I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +severo. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +Glasgow I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +puntos, I-EXPLORATION +palpando I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +dolorosa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hipocondrio/flanco I-EXPLORATION +izquierdo I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +importante I-EXPLORATION +distensión I-EXPLORATION +abdominal. I-EXPLORATION +Presentaba I-EXPLORATION +macrohematuria I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +micción I-EXPLORATION +espontánea. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +mantuvo I-EXPLORATION +hemodinamicamente I-EXPLORATION +estable I-EXPLORATION +en I-EXPLORATION +todo I-EXPLORATION +momento, I-EXPLORATION +pero I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +inicial I-EXPLORATION +el I-EXPLORATION +hematocrito I-EXPLORATION +cayó I-EXPLORATION +10 I-EXPLORATION +puntos. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +(TC) I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +riñón I-EXPLORATION +en I-EXPLORATION +herradura I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fractura I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +unión I-EXPLORATION +entre I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +istmo, I-EXPLORATION +mostrando I-EXPLORATION +hemorragia I-EXPLORATION +activa I-EXPLORATION +y I-EXPLORATION +extenso I-EXPLORATION +hematoma I-EXPLORATION +retroperitoneal I-EXPLORATION +(10x7x23 I-EXPLORATION +cm) I-EXPLORATION +con I-EXPLORATION +ocupación I-EXPLORATION +pélvica, I-EXPLORATION +desplazando I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +intestino. I-EXPLORATION +Los I-EXPLORATION +cortes I-EXPLORATION +retardados I-EXPLORATION +mostraron I-EXPLORATION +extravasación I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +importante I-EXPLORATION +urinoma. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +arteriografía I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +doble I-EXPLORATION +pedículo I-EXPLORATION +para I-EXPLORATION +cada I-EXPLORATION +riñón I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +tronco I-EXPLORATION +lumbo-renal I-EXPLORATION +distal I-EXPLORATION +común I-EXPLORATION +que I-EXPLORATION +daba I-EXPLORATION +ramas I-EXPLORATION +accesorias I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +polos I-EXPLORATION +inferiores I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +riñones I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +istmo I-EXPLORATION +con I-EXPLORATION +extravasación I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +sangrado I-EXPLORATION +activo. I-EXPLORATION +Se B-TREATMENT +cateterizó I-TREATMENT +selectivamente I-TREATMENT +el I-TREATMENT +tronco I-TREATMENT +lumbo-renal, I-TREATMENT +accediendo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +rama I-TREATMENT +del I-TREATMENT +riñón I-TREATMENT +izquierdo I-TREATMENT +e I-TREATMENT +istmo I-TREATMENT +permitiendo I-TREATMENT +su I-TREATMENT +embolización I-TREATMENT +con I-TREATMENT +partículas I-TREATMENT +de I-TREATMENT +polivinilo I-TREATMENT +alcohol, I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +inmediatas. I-TREATMENT +Se I-TREATMENT +cateterizó I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +urinaria I-TREATMENT +retrógradamente I-TREATMENT +con I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +ureteral I-TREATMENT +recto I-TREATMENT +para I-TREATMENT +facilitar I-TREATMENT +el I-TREATMENT +drenaje I-TREATMENT +del I-TREATMENT +urinoma. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posteriores, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +asintomático I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +completa I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +hematuria, I-EVOLUTION +con I-EVOLUTION +hematocritos I-EVOLUTION +estables I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +que I-EVOLUTION +mostró I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +hemorragia, I-EVOLUTION +con I-EVOLUTION +completa I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +urinoma I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +fuga I-EVOLUTION +urinaria, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +el I-TREATMENT +tutor I-TREATMENT +ureteral. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +embolización, I-EVOLUTION +el I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +demostró I-EVOLUTION +una I-EVOLUTION +completa I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +hematoma. I-EVOLUTION +No I-EVOLUTION +presentó I-EVOLUTION +complicaciones I-EVOLUTION +tardías, I-EVOLUTION +manteniendo I-EVOLUTION +un I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +presión I-EVOLUTION +arterial I-EVOLUTION +completamente I-EVOLUTION +normales I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urología I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +testicular I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +es I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +escrotal I-EXPLORATION +realizada I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +transductor I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +frecuencia I-EXPLORATION +(10 I-EXPLORATION +Mhz) I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +MT I-EXPLORATION +bilateral. I-EXPLORATION +Debido B-TREATMENT +a I-TREATMENT +la I-TREATMENT +no I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +factores I-TREATMENT +de I-TREATMENT +riesgo I-TREATMENT +(criptorquidia, I-TREATMENT +atrofia, I-TREATMENT +infertilidad, I-TREATMENT +neoplasia I-TREATMENT +intratubular I-TREATMENT +de I-TREATMENT +células I-TREATMENT +germinales, I-TREATMENT +disgenesia I-TREATMENT +gonadal, I-TREATMENT +tumor I-TREATMENT +testicular I-TREATMENT +contralateral, I-TREATMENT +administración I-TREATMENT +exógena I-TREATMENT +de I-TREATMENT +estrógenos) I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +seguimiento I-TREATMENT +con I-TREATMENT +autoexploración I-TREATMENT +física I-TREATMENT +mensual I-TREATMENT +y I-TREATMENT +valoración I-TREATMENT +urológica I-TREATMENT +con I-TREATMENT +ecografía I-TREATMENT +escrotal I-TREATMENT +anual, I-TREATMENT +sin I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +biopsia. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +desarrollado I-EVOLUTION +un I-EVOLUTION +tumor I-EVOLUTION +invasivo I-EVOLUTION +de I-EVOLUTION +células I-EVOLUTION +germinales. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +76 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +varón, I-PRESENT_ILLNESS +blanco, I-PRESENT_ILLNESS +antecedentes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nefrectomía I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +litiasis I-PAST_MEDICAL_HISTORY +coraliforme I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dicho I-PAST_MEDICAL_HISTORY +riñón, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +(HTA), I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3-4 I-PAST_MEDICAL_HISTORY +puros I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día. I-PAST_MEDICAL_HISTORY +Comienza B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +lumbar I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +ascendente, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +notando I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +urinario, I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +traído I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +familiares I-PRESENT_ILLNESS +porque I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +orina, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +anorexia. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +constata I-EXPLORATION +sequedad I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas, I-EXPLORATION +auscultación I-EXPLORATION +cardíaca: I-EXPLORATION +ruidos I-EXPLORATION +cardíacos I-EXPLORATION +taquicárdicos, I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +165/ I-EXPLORATION +90, I-EXPLORATION +abdomen I-EXPLORATION +blando, I-EXPLORATION +ligeramente I-EXPLORATION +distendido, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +difusamente, I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +compresión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +lumbar I-EXPLORATION +izquierda, I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +próstata I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +superficie I-EXPLORATION +regular, I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +fibroadenomatosa, I-EXPLORATION +grado I-EXPLORATION +II, I-EXPLORATION +genitales I-EXPLORATION +externos I-EXPLORATION +normales, I-EXPLORATION +meato I-EXPLORATION +uretral I-EXPLORATION +amplio. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +destaca I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +creatinina I-EXPLORATION +sérica I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +ng/ml. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +hidronefrosis I-EXPLORATION +(H) I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +(RI) I-EXPLORATION +por I-EXPLORATION +compresión I-EXPLORATION +del I-EXPLORATION +uréter I-EXPLORATION +izquierdo I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +(T?) I-EXPLORATION +posiblemente I-EXPLORATION +aneurismática I-EXPLORATION +izquierda, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +toma I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +vistas I-EXPLORATION +ecográficas, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +arteriografía I-EXPLORATION +traslumbar I-EXPLORATION +detectándose I-EXPLORATION +aneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +ilíaca I-EXPLORATION +externa I-EXPLORATION +izquierda, I-EXPLORATION +que I-EXPLORATION +compromete I-EXPLORATION +y I-EXPLORATION +desplaza I-EXPLORATION +hacia I-EXPLORATION +fuera I-EXPLORATION +al I-EXPLORATION +uréter I-EXPLORATION +izquierdo, I-EXPLORATION +por B-TREATMENT +todo I-TREATMENT +lo I-TREATMENT +anterior I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +nefrostomía I-TREATMENT +derivativa I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +interconsulta I-TREATMENT +con I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Angiología I-TREATMENT +los I-TREATMENT +que I-TREATMENT +realizaron I-TREATMENT +reparación I-TREATMENT +del I-TREATMENT +aneurisma. I-TREATMENT +Evolucionó B-EVOLUTION +satisfactoriamente, I-EVOLUTION +con I-EVOLUTION +retirada I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +nefrostomía I-EVOLUTION +y I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +anuria I-EVOLUTION +obstructiva. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 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 +acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +externas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +bulto I-PRESENT_ILLNESS +peneano I-PRESENT_ILLNESS +ventral I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +progresivo. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +salida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +material I-PRESENT_ILLNESS +blanquecino I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +meato I-PRESENT_ILLNESS +uretral I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +comprimir I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lesión, I-PRESENT_ILLNESS +logrando I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tensión I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +nódulo, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +miccional I-PRESENT_ILLNESS +acompañante I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +poco I-PRESENT_ILLNESS +confortable I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +relaciones I-PRESENT_ILLNESS +sexuales. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +nódulo I-EXPLORATION +elástico I-EXPLORATION +esferoidal I-EXPLORATION +parauretral I-EXPLORATION +subglandar I-EXPLORATION +ventral I-EXPLORATION +lateralizado I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +derecha, I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +móvil I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +quística. I-EXPLORATION + I-EXPLORATION +Como I-EXPLORATION +exploraciones I-EXPLORATION +complementarias I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizan: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear: I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +quísticas I-EXPLORATION +de I-EXPLORATION +2x2x1, I-EXPLORATION +8cm I-EXPLORATION +basal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +extremo I-EXPLORATION +distal I-EXPLORATION +del I-EXPLORATION +pene I-EXPLORATION +con I-EXPLORATION +compresión I-EXPLORATION +y I-EXPLORATION +distorsión I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +cavernoso I-EXPLORATION +del I-EXPLORATION +lado I-EXPLORATION +derecho. I-EXPLORATION +Se I-EXPLORATION +observa I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +fina I-EXPLORATION +línea I-EXPLORATION +hiperintensa, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +dirige I-EXPLORATION +a I-EXPLORATION +contactar I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +uretra I-EXPLORATION +anterior I-EXPLORATION +peneana I-EXPLORATION +con I-EXPLORATION +posible I-EXPLORATION +comunicación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +quística I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +uretra. I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Uretrografía I-EXPLORATION +retrógrada I-EXPLORATION +y I-EXPLORATION +miccional: I-EXPLORATION +con I-EXPLORATION +canal I-EXPLORATION +uretral I-EXPLORATION +anterior I-EXPLORATION +normal. I-EXPLORATION +Elongación I-EXPLORATION +uretra-prostática. I-EXPLORATION +Vejiga I-EXPLORATION +trabeculada I-EXPLORATION +con I-EXPLORATION +apertura I-EXPLORATION +correcta I-EXPLORATION +del I-EXPLORATION +cuello I-EXPLORATION +vesical I-EXPLORATION +y I-EXPLORATION +paso I-EXPLORATION +fácil I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +por I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +uretra. I-EXPLORATION +Ausencia I-EXPLORATION +de I-EXPLORATION +residuo I-EXPLORATION +potmiccional. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +formación I-TREATMENT +quística I-TREATMENT +muy I-TREATMENT +fija I-TREATMENT +a I-TREATMENT +cuerpo I-TREATMENT +cavernoso I-TREATMENT +derecho I-TREATMENT +sin I-TREATMENT +observar I-TREATMENT +comunicación I-TREATMENT +alguna I-TREATMENT +con I-TREATMENT +uretra, I-TREATMENT +pero I-TREATMENT +con I-TREATMENT +clara I-TREATMENT +dependencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT +Al I-TREATMENT +abrir I-TREATMENT +el I-TREATMENT +quiste I-TREATMENT +sale I-TREATMENT +un I-TREATMENT +material I-TREATMENT +líquido I-TREATMENT +color I-TREATMENT +blanquecino, I-TREATMENT +no I-TREATMENT +maloliente I-TREATMENT +y I-TREATMENT +con I-TREATMENT +detritus. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +conectivo I-EXPLORATION +con I-EXPLORATION +ligero I-EXPLORATION +infiltrado I-EXPLORATION +mononuclear, I-EXPLORATION +revestido I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +escamoso I-EXPLORATION +queratinizante. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +actualmente I-EVOLUTION +está I-EVOLUTION +asintomático, I-EVOLUTION +con I-EVOLUTION +micción I-EVOLUTION +correcta I-EVOLUTION +y I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +erecciones I-EVOLUTION +normales I-EVOLUTION +y I-EVOLUTION +satisfactorias. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +próstata I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +bloqueo I-PAST_MEDICAL_HISTORY +androgénico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +radioterapia. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +año I-EXPLORATION +siguiente I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +mediante I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +extratesticular I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +saco I-EXPLORATION +escrotal I-EXPLORATION +derecho. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +T.A.C. I-EXPLORATION +se I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +extratesticular I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +saco I-EXPLORATION +escrotal I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +componente I-EXPLORATION +graso I-EXPLORATION +y I-EXPLORATION +otro I-EXPLORATION +componente I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas.. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de B-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +procedencia I-PAST_MEDICAL_HISTORY +urbana I-PAST_MEDICAL_HISTORY +(campesino) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +raza I-PAST_MEDICAL_HISTORY +blanca. I-PAST_MEDICAL_HISTORY +Que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +genitales. I-PRESENT_ILLNESS +Tiene B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +26 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +lesión I-PAST_MEDICAL_HISTORY +maligna I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pene I-PAST_MEDICAL_HISTORY +(carcinoma I-PAST_MEDICAL_HISTORY +epidermoide), I-PAST_MEDICAL_HISTORY +realizándole I-PAST_MEDICAL_HISTORY +amputación I-PAST_MEDICAL_HISTORY +parcial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pene I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +vaciamiento I-PAST_MEDICAL_HISTORY +linfático I-PAST_MEDICAL_HISTORY +inguinal I-PAST_MEDICAL_HISTORY +bilateral. I-PAST_MEDICAL_HISTORY +Pocos B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +genitales, I-PRESENT_ILLNESS +tanto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +bolsas I-PRESENT_ILLNESS +escrotales I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pene. I-PRESENT_ILLNESS +Por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +escolar I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lejanía I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vivienda I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +servicios I-PRESENT_ILLNESS +médicos, I-PRESENT_ILLNESS +sumados I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +despreocupación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +familiares, I-PRESENT_ILLNESS +hacen I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +acuda I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta, I-PRESENT_ILLNESS +viviendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esta I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +mucho I-PRESENT_ILLNESS +tiempo, I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +trastornos I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +orinar, I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +dolor, I-PRESENT_ILLNESS +sólo I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +genitales I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +imposibilitaba I-PRESENT_ILLNESS +deambular, I-PRESENT_ILLNESS +pues I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +llegaba I-PRESENT_ILLNESS +casi I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +rodillas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Examen B-EXPLORATION +Físico: I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +encuentra I-EXPLORATION +gran I-EXPLORATION +tumoración I-EXPLORATION +genital I-EXPLORATION +que I-EXPLORATION +comprende I-EXPLORATION +ambas I-EXPLORATION +bolsas I-EXPLORATION +escrotales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +pene, I-EXPLORATION +este I-EXPLORATION +ultimo I-EXPLORATION +había I-EXPLORATION +sido I-EXPLORATION +amputado I-EXPLORATION +parcialmente I-EXPLORATION +y I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +circunferencia I-EXPLORATION +de I-EXPLORATION +ochos I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +dividido I-EXPLORATION +en I-EXPLORATION +dos I-EXPLORATION +grandes I-EXPLORATION +labios, I-EXPLORATION +gruesos I-EXPLORATION +y I-EXPLORATION +duros, I-EXPLORATION +que I-EXPLORATION +al I-EXPLORATION +separarlos I-EXPLORATION +dejaba I-EXPLORATION +ver I-EXPLORATION +la I-EXPLORATION +uretra. I-EXPLORATION +Todo I-EXPLORATION +esto I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +volumen I-EXPLORATION +escrotal I-EXPLORATION +de I-EXPLORATION +cerca I-EXPLORATION +de I-EXPLORATION +cuarenta I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +transversal, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +piel I-EXPLORATION +muy I-EXPLORATION +gruesa, I-EXPLORATION +rugosa, I-EXPLORATION +de I-EXPLORATION +diferentes I-EXPLORATION +colores I-EXPLORATION +desde I-EXPLORATION +amarillo I-EXPLORATION +grisáceo I-EXPLORATION +hasta I-EXPLORATION +zonas I-EXPLORATION +violáceas, I-EXPLORATION +característico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +paquidermo. I-EXPLORATION +En I-EXPLORATION +su I-EXPLORATION +parte I-EXPLORATION +superior I-EXPLORATION +se I-EXPLORATION +estrechaba I-EXPLORATION +de I-EXPLORATION +donde I-EXPLORATION +colgaba I-EXPLORATION +el I-EXPLORATION +resto. I-EXPLORATION + I-EXPLORATION +Regiones I-EXPLORATION +inguinales I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Miembros I-EXPLORATION +inferiores I-EXPLORATION +normales, I-EXPLORATION +no I-EXPLORATION +edemas. I-EXPLORATION +Complementarios: I-EXPLORATION +Hematológicos, I-EXPLORATION +normales. I-EXPLORATION +Imagenológicos: I-EXPLORATION +Radiológicos. I-EXPLORATION +Radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +pelvis I-EXPLORATION +ósea I-EXPLORATION +(masa I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +definidos, I-EXPLORATION +sin I-EXPLORATION +calcificaciones I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior). I-EXPLORATION + I-EXPLORATION +Ultrasonográficos I-EXPLORATION +y I-EXPLORATION +Tomografía I-EXPLORATION +(No I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +actividad I-EXPLORATION +tumoral). I-EXPLORATION + I-EXPLORATION +Material B-TREATMENT +y I-TREATMENT +método I-TREATMENT + I-TREATMENT +En I-TREATMENT +estas I-TREATMENT +condiciones I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +llevar I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +al I-TREATMENT +quirófano I-TREATMENT +y I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +previamente I-TREATMENT +cistostomía I-TREATMENT +suprapúbica I-TREATMENT +e I-TREATMENT +inmediatamente I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +total I-TREATMENT +de I-TREATMENT +ambas I-TREATMENT +bolsas I-TREATMENT +escrotales, I-TREATMENT +con I-TREATMENT +todo I-TREATMENT +su I-TREATMENT +contenido, I-TREATMENT +encontrando I-TREATMENT +los I-TREATMENT +elementos I-TREATMENT +del I-TREATMENT +cordón I-TREATMENT +espermático I-TREATMENT +englobados I-TREATMENT +en I-TREATMENT +un I-TREATMENT +tejido I-TREATMENT +fibroso, I-TREATMENT +encartonado, I-TREATMENT +rugoso, I-TREATMENT +con I-TREATMENT +vasos I-TREATMENT +de I-TREATMENT +neoformación, I-TREATMENT +algunos I-TREATMENT +de I-TREATMENT +ellos I-TREATMENT +de I-TREATMENT +gran I-TREATMENT +calibre. I-TREATMENT +También I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +amputación I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +de I-TREATMENT +pene I-TREATMENT +ya I-TREATMENT +descrita, I-TREATMENT +la I-TREATMENT +uretra I-TREATMENT +se I-TREATMENT +anastomosa I-TREATMENT +a I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +raíz I-TREATMENT +del I-TREATMENT +escroto I-TREATMENT +con I-TREATMENT +características I-TREATMENT +normales. I-TREATMENT + I-TREATMENT +Descripción B-EXPLORATION +anatómica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza: I-EXPLORATION +14 I-EXPLORATION +kilogramos I-EXPLORATION +de I-EXPLORATION +peso, I-EXPLORATION +y I-EXPLORATION +mide I-EXPLORATION +39 I-EXPLORATION +x I-EXPLORATION +35 I-EXPLORATION +x I-EXPLORATION +18 I-EXPLORATION +centímetros. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 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 +dignos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mención I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +ecografía I-PRESENT_ILLNESS +ginecológica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +rutinario I-PRESENT_ILLNESS +nos I-PRESENT_ILLNESS +viene I-PRESENT_ILLNESS +remitida I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +sobreelevada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +lateral I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +enferma I-EXPLORATION +no I-EXPLORATION +presenta I-EXPLORATION +ninguna I-EXPLORATION +sintomatología I-EXPLORATION +urológica I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +cistoscopia I-EXPLORATION +revela I-EXPLORATION +un I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +con I-EXPLORATION +mucosa I-EXPLORATION +indemne. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +la I-TREATMENT +resección I-TREATMENT +transuretral I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +leiomioma I-TREATMENT +vesical. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +igual I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +caso I-EVOLUTION +anterior I-EVOLUTION +la I-EVOLUTION +enferma I-EVOLUTION +permanece I-EVOLUTION +asintomática I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 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 +HTA, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +depresivo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +estreñimiento I-PAST_MEDICAL_HISTORY +crónico. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +urológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Remitida B-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Digestivo, I-DERIVED_FROM/TO +aportando I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +TAC I-DERIVED_FROM/TO +abdomino-pélvico, I-DERIVED_FROM/TO +realizado I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +patología I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +base, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +observaba I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +masa I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +aspecto I-DERIVED_FROM/TO +sólido I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +polo I-DERIVED_FROM/TO +superior I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +riñón I-DERIVED_FROM/TO +izquierdo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +4, I-DERIVED_FROM/TO +9 I-DERIVED_FROM/TO +x I-DERIVED_FROM/TO +3, I-DERIVED_FROM/TO +6 I-DERIVED_FROM/TO +cm I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +infiltraba I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +grasa I-DERIVED_FROM/TO +perirrenal, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +presencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +dos I-DERIVED_FROM/TO +adenopatías I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +hilio I-DERIVED_FROM/TO +renal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +1, I-DERIVED_FROM/TO +5 I-DERIVED_FROM/TO +cm. I-DERIVED_FROM/TO +Posible I-DERIVED_FROM/TO +afectación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +vena I-DERIVED_FROM/TO +renal I-DERIVED_FROM/TO +izquierda. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +UIV, I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +era I-EXPLORATION +normal; I-EXPLORATION +mientras I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +anulación I-EXPLORATION +funcional, I-EXPLORATION +apreciándose I-EXPLORATION +al I-EXPLORATION +cabo I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +horas I-EXPLORATION +un I-EXPLORATION +discreto I-EXPLORATION +nefrograma, I-EXPLORATION +sin I-EXPLORATION +llegar I-EXPLORATION +a I-EXPLORATION +visualizarse I-EXPLORATION +en I-EXPLORATION +ningún I-EXPLORATION +momento I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +superoexterno I-EXPLORATION +del I-EXPLORATION +mismo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Angio-RM, I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +afectaba I-EXPLORATION +a I-EXPLORATION +1/3 I-EXPLORATION +medio I-EXPLORATION +y I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +en I-EXPLORATION +glándula I-EXPLORATION +suprarrenal I-EXPLORATION +ipsilateral, I-EXPLORATION +adenopatías I-EXPLORATION +locorregionales I-EXPLORATION +y I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +renal I-EXPLORATION +izquierda, I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +renal, I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +nefrectomía I-TREATMENT +radical I-TREATMENT +izquierda I-TREATMENT +mediante I-TREATMENT +lumbotomía, I-TREATMENT +apreciando I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +un I-TREATMENT +bloque I-TREATMENT +adenopático I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +hilio I-TREATMENT +renal. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +descripción I-EXPLORATION +macroscópica I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico, I-EXPLORATION +destacó I-EXPLORATION +una I-EXPLORATION +pieza I-EXPLORATION +de I-EXPLORATION +nefrectomía I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +cm, I-EXPLORATION +que I-EXPLORATION +su I-EXPLORATION +mayor I-EXPLORATION +parte I-EXPLORATION +se I-EXPLORATION +perdía I-EXPLORATION +la I-EXPLORATION +delimitación I-EXPLORATION +córtico I-EXPLORATION +-medular, I-EXPLORATION +apreciándose I-EXPLORATION +masas I-EXPLORATION +grisáceas I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +firme I-EXPLORATION +que I-EXPLORATION +sustituían I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +difusa I-EXPLORATION +e I-EXPLORATION +irregular I-EXPLORATION +gran I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +renal. I-EXPLORATION +Por I-EXPLORATION +otro I-EXPLORATION +lado, I-EXPLORATION +la I-EXPLORATION +descripción I-EXPLORATION +microscópica, I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +maligna I-EXPLORATION +formada I-EXPLORATION +por I-EXPLORATION +estructuras I-EXPLORATION +tubulares I-EXPLORATION +y I-EXPLORATION +ductales I-EXPLORATION +atípicas I-EXPLORATION +que I-EXPLORATION +infiltraba I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +perirrenal I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +alcanzando I-EXPLORATION +el I-EXPLORATION +borde I-EXPLORATION +quirúrgico. I-EXPLORATION +Estas I-EXPLORATION +estructuras I-EXPLORATION +mostraron I-EXPLORATION +positividad I-EXPLORATION +inmunohistoquímica I-EXPLORATION +para I-EXPLORATION +keratinas: I-EXPLORATION +CAM I-EXPLORATION +5.2; I-EXPLORATION +AE1 I-EXPLORATION +- I-EXPLORATION +AE2 I-EXPLORATION +y I-EXPLORATION +34 I-EXPLORATION +BE12. I-EXPLORATION +Estableciendo, I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +manera, I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +ductos I-EXPLORATION +colectores I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +renal I-EXPLORATION +del I-EXPLORATION +borde I-EXPLORATION +quirúrgico. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +un I-TREATMENT +mes I-TREATMENT +y I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía, I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +valorada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Oncología, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +comenzar I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +con I-TREATMENT +Carboplatino I-TREATMENT +AUC I-TREATMENT +4 I-TREATMENT +día I-TREATMENT +1º I-TREATMENT ++ I-TREATMENT +Gencitabina I-TREATMENT +1250 I-TREATMENT +mg/m2 I-TREATMENT +días I-TREATMENT +1º I-TREATMENT +y I-TREATMENT +8º I-TREATMENT +cada I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +cisplatino I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +su I-TREATMENT +nefrotoxicidad I-TREATMENT +y I-TREATMENT +a I-TREATMENT +tratarse I-TREATMENT +de I-TREATMENT +una I-TREATMENT +paciente I-TREATMENT +monorrena I-TREATMENT +con I-TREATMENT +un I-TREATMENT +ClCr I-TREATMENT +< I-TREATMENT +30. I-TREATMENT + I-TREATMENT +Tras B-EXPLORATION +el I-EXPLORATION +4º I-EXPLORATION +ciclo I-EXPLORATION +de I-EXPLORATION +QMT I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreció: I-EXPLORATION +lesión I-EXPLORATION +tumoral I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +renal I-EXPLORATION +izquierda, I-EXPLORATION +que I-EXPLORATION +infiltraba I-EXPLORATION +arteria I-EXPLORATION +mesentérica I-EXPLORATION +superior, I-EXPLORATION +músculo I-EXPLORATION +psoas I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +probablemente I-EXPLORATION +también I-EXPLORATION +aorta, I-EXPLORATION +acompañada I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hepática I-EXPLORATION +en I-EXPLORATION +segmento I-EXPLORATION +4 I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +metástasis. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +sometida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +cirugía I-PRESENT_ILLNESS +ginecológica I-PRESENT_ILLNESS +(histerectomía I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +doble I-PRESENT_ILLNESS +anexectomía). I-PRESENT_ILLNESS +Tras I-PRESENT_ILLNESS +dicha I-PRESENT_ILLNESS +intervención, I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +lumbar I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +requerido I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urología. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +urografía I-EXPLORATION +intravenosa I-EXPLORATION +observamos I-EXPLORATION +una I-EXPLORATION +concentración I-EXPLORATION +y I-EXPLORATION +eliminación I-EXPLORATION +renal I-EXPLORATION +izquierda I-EXPLORATION +normal, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +derecho I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +eliminación I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +riñón, I-EXPLORATION +así I-EXPLORATION +mismo I-EXPLORATION +se I-EXPLORATION +visualizan I-EXPLORATION +múltiples I-EXPLORATION +'clips' I-EXPLORATION +quirúrgicos. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +una I-TREATMENT +afectación I-TREATMENT +ureteral I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +colocaci��n I-TREATMENT +de I-TREATMENT +catéter I-TREATMENT +doble I-TREATMENT +J I-TREATMENT +derecho, I-TREATMENT +consiguiéndose I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +con I-TREATMENT +cierta I-TREATMENT +dificultad. I-TREATMENT + I-TREATMENT +En I-TREATMENT +control I-TREATMENT +intraoperatorio I-TREATMENT +se I-TREATMENT +visualiza I-TREATMENT +correcta I-TREATMENT +colocación I-TREATMENT +del I-TREATMENT +catéter, I-TREATMENT +desapareciendo I-TREATMENT +entonces I-TREATMENT +la I-TREATMENT +clínica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT +Diez B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +dicho I-EVOLUTION +procedimiento I-EVOLUTION +la I-EVOLUTION +enferma I-EVOLUTION +comienza I-EVOLUTION +nuevamente I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +lumbar I-EVOLUTION +derecho I-EVOLUTION +y I-EVOLUTION +fiebre, I-EVOLUTION +se B-EXPLORATION +realiza I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +una I-EXPLORATION +migración I-EXPLORATION +proximal I-EXPLORATION +del I-EXPLORATION +catéter I-EXPLORATION +doble I-EXPLORATION +J. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +recolocación I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +mediante I-TREATMENT +ureteroscopia, I-TREATMENT +siendo I-TREATMENT +imposible I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma, I-TREATMENT +al I-TREATMENT +no I-TREATMENT +poder I-TREATMENT +alcanzar I-TREATMENT +luz I-TREATMENT +ureteral I-TREATMENT +proximal I-TREATMENT +al I-TREATMENT +cruce I-TREATMENT +con I-TREATMENT +la I-TREATMENT +ilíaca. I-TREATMENT +Optándose I-TREATMENT +entonces I-TREATMENT +por I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +nefrostomía I-TREATMENT +percutánea I-TREATMENT +y I-TREATMENT +retirada I-TREATMENT +por I-TREATMENT +dicha I-TREATMENT +vía I-TREATMENT +del I-TREATMENT +catéter. I-TREATMENT + I-TREATMENT +Resuelto I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +inicial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +colocación I-TREATMENT +anterógrada I-TREATMENT +de I-TREATMENT +catéter I-TREATMENT +ureteral I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +nefrostomía, I-TREATMENT +permitiendo I-TREATMENT +la I-TREATMENT +retirada I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +viene I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +colelitiasis, I-PRESENT_ILLNESS +antecedentes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hiato I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +analítica I-EXPLORATION +es I-EXPLORATION +irrelevante, I-EXPLORATION +salvo I-EXPLORATION +el I-EXPLORATION +colesterol I-EXPLORATION +total I-EXPLORATION +levemente I-EXPLORATION +elevado. I-EXPLORATION +Marcadores I-EXPLORATION +tumorales I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +ecográfico I-EXPLORATION +del I-EXPLORATION +abdomen, I-EXPLORATION +sugiere I-EXPLORATION +un I-EXPLORATION +conglomerado I-EXPLORATION +adenopático, I-EXPLORATION +si I-EXPLORATION +bien I-EXPLORATION +no I-EXPLORATION +pueden I-EXPLORATION +descartar I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +páncreas. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +abdominopélvico I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +intravenoso I-EXPLORATION +que I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cms I-EXPLORATION +en I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +páncreas, I-EXPLORATION +que I-EXPLORATION +capta I-EXPLORATION +el I-EXPLORATION +contraste I-EXPLORATION +intravenoso I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +intensa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +precoz, I-EXPLORATION +sugiriendo I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +hipervascular, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +tumor I-EXPLORATION +endocrino. I-EXPLORATION +La I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +es I-EXPLORATION +normal, I-EXPLORATION +consistente I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente. I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +practica I-TREATMENT +una I-TREATMENT +pancreatectomía, I-TREATMENT +colecistectomía I-TREATMENT +y I-TREATMENT +coledocorrafia I-TREATMENT +en I-TREATMENT +Abril I-TREATMENT +de I-TREATMENT +2007. I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +5 I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +bien, I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +otras I-EVOLUTION +metástasis. I-EVOLUTION +Ni B-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +acto I-EXPLORATION +quirúrgico I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +disección I-EXPLORATION +macroscópica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +adenopatías. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +páncreas I-EXPLORATION +encontramos I-EXPLORATION +3 I-EXPLORATION +nódulos I-EXPLORATION +bien I-EXPLORATION +delimitados I-EXPLORATION +que I-EXPLORATION +miden I-EXPLORATION +respectivamente I-EXPLORATION +4 I-EXPLORATION +cms., I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +0.7 I-EXPLORATION +cms., I-EXPLORATION +cuyas I-EXPLORATION +superficies I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +son I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +blanda, I-EXPLORATION +aspecto I-EXPLORATION +homogéneo I-EXPLORATION +y I-EXPLORATION +coloración I-EXPLORATION +amarillenta. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +nódulos I-EXPLORATION +tumorales I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +pacientes, I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +cuadro I-EXPLORATION +microscópico I-EXPLORATION +similar I-EXPLORATION +constituido I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +población I-EXPLORATION +celular I-EXPLORATION +homogénea, I-EXPLORATION +de I-EXPLORATION +citoplasmas I-EXPLORATION +claros, I-EXPLORATION +con I-EXPLORATION +atipia I-EXPLORATION +nuclear I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +grados I-EXPLORATION +3 I-EXPLORATION +(caso I-EXPLORATION +1) I-EXPLORATION +y I-EXPLORATION +1 I-EXPLORATION +(caso I-EXPLORATION +2) I-EXPLORATION +de I-EXPLORATION +Fuhrman, I-EXPLORATION +mostrando I-EXPLORATION +las I-EXPLORATION +tumoraciones I-EXPLORATION +una I-EXPLORATION +marcada I-EXPLORATION +red I-EXPLORATION +vascular. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +inmunohistoquímicos I-EXPLORATION +mostraron I-EXPLORATION +positividad I-EXPLORATION +a I-EXPLORATION +citoqueratina, I-EXPLORATION +vimentina, I-EXPLORATION +antígeno I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +epitelial I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +CD10 I-EXPLORATION +y I-EXPLORATION +negatividad I-EXPLORATION +a I-EXPLORATION +citoqueratinas I-EXPLORATION +7 I-EXPLORATION +y I-EXPLORATION +20, I-EXPLORATION +cromogranina, I-EXPLORATION +tiroglobulina, I-EXPLORATION +sinaptofisina, I-EXPLORATION +HMB45 I-EXPLORATION +y I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario. I-EXPLORATION +Se I-EXPLORATION +emitió I-EXPLORATION +un I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +renal I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +claras I-EXPLORATION +y B-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +revisar I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +historias I-PAST_MEDICAL_HISTORY +clínicas I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontró I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ambos I-PAST_MEDICAL_HISTORY +pacientes I-PAST_MEDICAL_HISTORY +habían I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +diagnosticados I-PAST_MEDICAL_HISTORY +17 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +células I-PAST_MEDICAL_HISTORY +claras I-PAST_MEDICAL_HISTORY +(hipernefroma), I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +apreciándose I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ninguno I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +casos I-PAST_MEDICAL_HISTORY +infiltración I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +vena I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cápsula I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +riñón. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY + +Paciente B-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +macroscópica, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +acompañante. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +quirúrgicos I-PAST_MEDICAL_HISTORY +irrelevantes. I-PAST_MEDICAL_HISTORY +Ex-fumadora. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +ecografía I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +vesical I-EXPLORATION +revela I-EXPLORATION +una I-EXPLORATION +ectasia I-EXPLORATION +pielocalicial I-EXPLORATION +moderada I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +sólida, I-EXPLORATION +sésil, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +endovesical I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +La I-EXPLORATION +cistoscopia I-EXPLORATION +(se I-EXPLORATION +realiza I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +acto I-EXPLORATION +quirúrgico) I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +sésil I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +derecha. I-EXPLORATION +La I-EXPLORATION +palpación I-EXPLORATION +bi-manual I-EXPLORATION +no I-EXPLORATION +existe I-EXPLORATION +fijación. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +revela I-EXPLORATION +adenocarcinoma I-EXPLORATION +invasivo, I-EXPLORATION +no I-EXPLORATION +excluyendo I-EXPLORATION +origen I-EXPLORATION +ginecológico, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +examen I-EXPLORATION +ginecológico I-EXPLORATION +completo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +revela I-EXPLORATION +negativo. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +no I-EXPLORATION +muestra I-EXPLORATION +metástasis. I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +efectúa I-TREATMENT +exanteración I-TREATMENT +pélvica I-TREATMENT +anterior I-TREATMENT +y I-TREATMENT +ureterostomia I-TREATMENT +cutánea I-TREATMENT +transileal I-TREATMENT +tipo I-TREATMENT +Bricker. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +describe I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +patrón I-EXPLORATION +en I-EXPLORATION +parte I-EXPLORATION +papilar I-EXPLORATION +en I-EXPLORATION +parte I-EXPLORATION +túbulo-quístico I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +grado I-EXPLORATION +citológico, I-EXPLORATION +pT3aN0. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +tuvo I-EVOLUTION +una I-EVOLUTION +recuperación I-EVOLUTION +satisfactoria, I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +per-operatorias. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +pos-operatorio I-EVOLUTION +no I-EVOLUTION +revela I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +ni I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +imagen I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +neoplasia I-EVOLUTION +o I-EVOLUTION +de I-EVOLUTION +complicaciones I-EVOLUTION +resultantes I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +dislipemia, I-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +hipertrófica I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +apnea I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +sueño. I-PAST_MEDICAL_HISTORY +Insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +nefroangioesclerosis, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +trasplantado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +1998 I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +fosa I-PAST_MEDICAL_HISTORY +ilíaca I-PAST_MEDICAL_HISTORY +derecha, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +incidencias. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +injerto I-PAST_MEDICAL_HISTORY +normofuncionante I-PAST_MEDICAL_HISTORY +(creatinina I-PAST_MEDICAL_HISTORY +sérica: I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +mg/dL I-PAST_MEDICAL_HISTORY +basal) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sigue I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Prednisona I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Ciclosporina I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +(CsA). I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2006, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +detecta I-PAST_MEDICAL_HISTORY +lesión I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +labio I-PAST_MEDICAL_HISTORY +inferior I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +extirpada, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +resultado I-PAST_MEDICAL_HISTORY +anatomopatológico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carcinoma I-PAST_MEDICAL_HISTORY +epidermoide I-PAST_MEDICAL_HISTORY +microinfiltrante. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +realiza I-PAST_MEDICAL_HISTORY +modificación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +inmunosupresión, I-PAST_MEDICAL_HISTORY +sustituyéndose I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +CsA I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Tacrolimus. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +mayo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2007 I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +detecta I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rutina I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +masa I-PAST_MEDICAL_HISTORY +sólida I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cortical I-PAST_MEDICAL_HISTORY +anterior, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +media I-PAST_MEDICAL_HISTORY +superior, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diámetro I-PAST_MEDICAL_HISTORY +mayor. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encuentra I-PAST_MEDICAL_HISTORY +asintomático I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +función I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +injerto I-PAST_MEDICAL_HISTORY +conservada. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realiza I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +confirmación, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +lesión I-EXPLORATION +focal I-EXPLORATION +y I-EXPLORATION +sólida I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +media I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +injerto. I-EXPLORATION +Tras B-TREATMENT +punción-aspiración I-TREATMENT +que I-TREATMENT +confirma I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +como I-TREATMENT +carcinoma I-TREATMENT +de I-TREATMENT +células I-TREATMENT +renales, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +cirugía I-TREATMENT +conservadora I-TREATMENT +de I-TREATMENT +nefronas I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +buena I-TREATMENT +funcionalidad I-TREATMENT +del I-TREATMENT +injerto I-TREATMENT +y I-TREATMENT +las I-TREATMENT +características I-TREATMENT +favorables I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT +Bajo I-TREATMENT +isquemia I-TREATMENT +fría I-TREATMENT +y I-TREATMENT +con I-TREATMENT +control I-TREATMENT +ecográfico I-TREATMENT +intraoperatorio, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +nefrectomía I-TREATMENT +parcial I-TREATMENT +con I-TREATMENT +abordaje I-TREATMENT +intracapsular, I-TREATMENT +enviándose B-EXPLORATION +lecho I-EXPLORATION +tumoral I-EXPLORATION +para I-EXPLORATION +análisis I-EXPLORATION +patológico I-EXPLORATION +intraoperatorio I-EXPLORATION +que I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +negatividad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +márgenes I-EXPLORATION +quirúrgicos. I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +definitivo I-EXPLORATION +del I-EXPLORATION +análisis I-EXPLORATION +confirmó I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +renales I-EXPLORATION +estadio I-EXPLORATION +pT1 I-EXPLORATION +G1, I-EXPLORATION +extirpado I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +totalidad. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +satisfactoria, I-EVOLUTION +presentando I-EVOLUTION +una I-EVOLUTION +discreta I-EVOLUTION +elevación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +creatinina I-EVOLUTION +hasta I-EVOLUTION +4, I-EVOLUTION +2 I-EVOLUTION +mg/dl I-EVOLUTION +con I-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +ésta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +basales I-EVOLUTION +al I-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +postoperatorio. I-EVOLUTION +Actualmente, I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +14 I-EVOLUTION +meses, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +existen I-EVOLUTION +datos I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +tumoral I-EVOLUTION +ni I-EVOLUTION +metástasis I-EVOLUTION +a I-EVOLUTION +distancia. I-EVOLUTION +La I-EVOLUTION +función I-EVOLUTION +del I-EVOLUTION +injerto I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +estable I-EVOLUTION +con I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +creatinina I-EVOLUTION +de I-EVOLUTION +2, I-EVOLUTION +3 I-EVOLUTION +mg/dl. I-EVOLUTION +Se B-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +inmunosupresión I-TREATMENT +previa I-TREATMENT +con I-TREATMENT +Prednisona I-TREATMENT +y I-TREATMENT +se I-TREATMENT +añadió I-TREATMENT +Sirolimus. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +conocida I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ADO. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +raiz I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +serle I-PRESENT_ILLNESS +descubierta I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +HTA, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +1975, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +iniciaron I-PRESENT_ILLNESS +estudios I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +incluyeron I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +práctica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +UIV I-PRESENT_ILLNESS +minutada I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +evidenció I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +RI. I-PRESENT_ILLNESS +Siguió B-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +angiografía I-EXPLORATION +que I-EXPLORATION +demostraba I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm. I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +mesorrenal I-EXPLORATION +e I-EXPLORATION +hiliar I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +fístula I-EXPLORATION +arteriovenosa I-EXPLORATION +que I-EXPLORATION +ocasionaba I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +laguna I-EXPLORATION +vascular I-EXPLORATION +pseudoaneurismática. I-EXPLORATION +En I-EXPLORATION +fases I-EXPLORATION +venosas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +notable I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arcada I-EXPLORATION +exorrenal. I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +evidencia I-TREATMENT +de I-TREATMENT +riñón I-TREATMENT +contralateral I-TREATMENT +normal I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +nefrectomía I-TREATMENT +radical I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +linfadenectomía I-TREATMENT +reducida I-TREATMENT +renoaórtica. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +demostró I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +claras I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +cm., I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +sólido I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +granulomatosas. I-EXPLORATION +Las I-EXPLORATION +adenopatías I-EXPLORATION +fueron I-EXPLORATION +negativas I-EXPLORATION +presentando I-EXPLORATION +únicamente I-EXPLORATION +histiocitosis I-EXPLORATION +sinusal. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +asintomática I-EVOLUTION +hasta I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +exploración I-EVOLUTION +ecográfica, I-EVOLUTION +en I-EVOLUTION +1982, I-EVOLUTION +se I-EVOLUTION +descubre I-EVOLUTION +masa I-EVOLUTION +tumoral I-EVOLUTION +de I-EVOLUTION +polo I-EVOLUTION +superior I-EVOLUTION +del I-EVOLUTION +RD I-EVOLUTION +restante. I-EVOLUTION +Pensando B-EXPLORATION +ya I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +imperiosidad I-EXPLORATION +de I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +cirugía I-EXPLORATION +conservadora I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +estudio I-EXPLORATION +angiográfico I-EXPLORATION +completo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arquitectura I-EXPLORATION +vascular I-EXPLORATION +del I-EXPLORATION +órgano. I-EXPLORATION +Ello I-EXPLORATION +nos I-EXPLORATION +permitió I-EXPLORATION +ver I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +recibía I-EXPLORATION +dos I-EXPLORATION +ramas I-EXPLORATION +arteriales I-EXPLORATION +directas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +renal I-EXPLORATION +muy I-EXPLORATION +extrasinusales I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +dos I-EXPLORATION +que I-EXPLORATION +irrigaban I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +renal I-EXPLORATION +sano I-EXPLORATION +que I-EXPLORATION +limitaba I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +deberíamos I-EXPLORATION +sacrificar I-EXPLORATION +en I-EXPLORATION +aras I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +radicalidad I-EXPLORATION +necesaria. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +7.07.82 I-TREATMENT +practicamos, I-TREATMENT +bajo I-TREATMENT +hipotemia I-TREATMENT +in I-TREATMENT +situ I-TREATMENT +y I-TREATMENT +perfusión I-TREATMENT +con I-TREATMENT +Collins, I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +renal I-TREATMENT +con I-TREATMENT +ligadura I-TREATMENT +de I-TREATMENT +esas I-TREATMENT +cuatro I-TREATMENT +ramas I-TREATMENT +ya I-TREATMENT +programadas I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +mapa I-TREATMENT +vascular. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +renal I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +claras I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +cms, I-EXPLORATION +en I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +perirrenal I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +ganglios I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +los I-EVOLUTION +años I-EVOLUTION +siguientes I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +ingresó I-EVOLUTION +en I-EVOLUTION +Medicina I-EVOLUTION +Interna I-EVOLUTION +por I-EVOLUTION +descompensaciones I-EVOLUTION +diabéticas I-EVOLUTION +sucesivas I-EVOLUTION +aprovechando I-EVOLUTION +para I-EVOLUTION +mantener I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +patología I-EVOLUTION +renal I-EVOLUTION +mediante I-EVOLUTION +TAC I-EVOLUTION +que I-EVOLUTION +fueron I-EVOLUTION +normales. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +un I-EVOLUTION +último I-EVOLUTION +reingreso I-EVOLUTION +en I-EVOLUTION +MI I-EVOLUTION +por I-EVOLUTION +anemia I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +HDA I-EVOLUTION +por I-EVOLUTION +ulcus I-EVOLUTION +sangrante I-EVOLUTION +y I-EVOLUTION +delgadez I-EVOLUTION +extrema, I-EVOLUTION +se I-EVOLUTION +objetivó I-EVOLUTION +por I-EVOLUTION +TAC I-EVOLUTION +masa I-EVOLUTION +retroperitoneal I-EVOLUTION +pancreática. I-EVOLUTION +No I-EVOLUTION +pudimos I-EVOLUTION +dilucidar I-EVOLUTION +el I-EVOLUTION +origen I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +falleciendo I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +y I-EVOLUTION +8 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +respectivas I-EVOLUTION +cirugías I-EVOLUTION +renales. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +polaquiuria, I-PRESENT_ILLNESS +disuria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hesitancia. I-PRESENT_ILLNESS +Adicionalmente I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +informó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +Kg. I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +refirió I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +síntomas. I-PRESENT_ILLNESS +Con B-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +de I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +con I-FAMILY_HISTORY +carcinoma I-FAMILY_HISTORY +de I-FAMILY_HISTORY +próstata, I-FAMILY_HISTORY +no B-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +documento I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inmunodeficiencias I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +prueba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ELISA I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +negativa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +oportunidades. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +documentó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +próstata I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +volumen, I-EXPLORATION +irregular I-EXPLORATION +y I-EXPLORATION +dura, I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +alteraciones. I-EXPLORATION +Por I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +realizo, I-EXPLORATION +Antígeno I-EXPLORATION +Prostático I-EXPLORATION +Específico I-EXPLORATION +(APE) I-EXPLORATION +(7, I-EXPLORATION +17 I-EXPLORATION +ng/ml), I-EXPLORATION +creatinina I-EXPLORATION +(0, I-EXPLORATION +83 I-EXPLORATION +mg/dl), I-EXPLORATION +y I-EXPLORATION +uroanálisis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +mas I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +eritrocitos I-EXPLORATION +por I-EXPLORATION +campo I-EXPLORATION +de I-EXPLORATION +alto I-EXPLORATION +poder. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +Doppler I-EXPLORATION +prostática I-EXPLORATION +mostró I-EXPLORATION +leve I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +39 I-EXPLORATION +cm3 I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +peso I-EXPLORATION +estimado I-EXPLORATION +de I-EXPLORATION +34 I-EXPLORATION +gramos, I-EXPLORATION +observándose I-EXPLORATION +adecuado I-EXPLORATION +contraste I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +periférica I-EXPLORATION +y I-EXPLORATION +transicional, I-EXPLORATION +con I-EXPLORATION +ecogenicidad I-EXPLORATION +homogénea I-EXPLORATION +y I-EXPLORATION +bordes I-EXPLORATION +capsulares I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +vascularización I-EXPLORATION +anormales. I-EXPLORATION +Teniendo I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +los I-EXPLORATION +anteriores I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +por I-EXPLORATION +sextantes, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +múltiples I-EXPLORATION +granulomas I-EXPLORATION +constituidos I-EXPLORATION +por I-EXPLORATION +histiocitos I-EXPLORATION +epitelioides, I-EXPLORATION +rodeados I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +collar I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +acompañados I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +gigantes I-EXPLORATION +multinucleadas I-EXPLORATION +tipo I-EXPLORATION +Langhans, I-EXPLORATION +en I-EXPLORATION +algunos I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +granulomas I-EXPLORATION +se I-EXPLORATION +reconoció I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +caseificación. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Ziel-Nielsen I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +micobacterias. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +radiográfico, I-EXPLORATION +ni I-EXPLORATION +tomográfico I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +evidencia I-EXPLORATION +microbiológica I-EXPLORATION +de I-EXPLORATION +micobacterias I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +seriado I-EXPLORATION +del I-EXPLORATION +esputo, I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +lavado I-EXPLORATION +broncoalveolar. I-EXPLORATION +Con I-EXPLORATION +los I-EXPLORATION +anteriores I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +el I-EXPLORATION +diagnostico I-EXPLORATION +de I-EXPLORATION +tuberculosis I-EXPLORATION +prostática I-EXPLORATION +primaria, I-EXPLORATION +iniciando B-TREATMENT +tratamiento I-TREATMENT +antituberculoso I-TREATMENT +con I-TREATMENT +Rifampicina, I-TREATMENT +Isoniazida I-TREATMENT +y I-TREATMENT +Estreptomicina I-TREATMENT +durante I-TREATMENT +6 I-TREATMENT +semanas, I-TREATMENT +posterior I-TREATMENT +al I-TREATMENT +cual I-TREATMENT +presentó I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sintomatología I-TREATMENT +con I-TREATMENT +solo I-TREATMENT +un I-TREATMENT +episodio I-TREATMENT +de I-TREATMENT +obstrucción I-TREATMENT +miccional I-TREATMENT +al I-TREATMENT +inicio I-TREATMENT +del I-TREATMENT +tratamiento. I-TREATMENT +Actualmente B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +tuberculosa I-EVOLUTION +activa. I-EVOLUTION + I-EVOLUTION +Estrategia I-EVOLUTION +de I-EVOLUTION +búsqueda I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +literatura I-EVOLUTION + I-EVOLUTION +Se I-EVOLUTION +realizó I-EVOLUTION +una I-EVOLUTION +búsqueda I-EVOLUTION +estructurada I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +literatura, I-EVOLUTION +utilizando I-EVOLUTION +la I-EVOLUTION +base I-EVOLUTION +de I-EVOLUTION +datos I-EVOLUTION +MedLine, I-EVOLUTION +a I-EVOLUTION +través I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +portal I-EVOLUTION +Web I-EVOLUTION +PubMed, I-EVOLUTION +desde I-EVOLUTION +enero I-EVOLUTION +de I-EVOLUTION +1915 I-EVOLUTION +hasta I-EVOLUTION +Abril I-EVOLUTION +de I-EVOLUTION +2008, I-EVOLUTION +utilizando I-EVOLUTION +inicialmente I-EVOLUTION +los I-EVOLUTION +términos I-EVOLUTION +"Prostate I-EVOLUTION +tuberculosis" I-EVOLUTION +obteniendo I-EVOLUTION +153 I-EVOLUTION +artículos I-EVOLUTION +originales. I-EVOLUTION +Posteriormente I-EVOLUTION +se I-EVOLUTION +adiciono I-EVOLUTION +el I-EVOLUTION +termino I-EVOLUTION +"Primary" I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +anteriores I-EVOLUTION +términos, I-EVOLUTION +lo I-EVOLUTION +cual I-EVOLUTION +arrojo I-EVOLUTION +15 I-EVOLUTION +artículos I-EVOLUTION +adicionales, I-EVOLUTION +para I-EVOLUTION +un I-EVOLUTION +total I-EVOLUTION +de I-EVOLUTION +168 I-EVOLUTION +artículos, I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +cuales I-EVOLUTION +se I-EVOLUTION +seleccionaron I-EVOLUTION +aquellas I-EVOLUTION +publicaciones I-EVOLUTION +consideradas I-EVOLUTION +relevantes I-EVOLUTION +por I-EVOLUTION +parte I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +autores I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +discusión I-EVOLUTION +del I-EVOLUTION +tema. I-EVOLUTION +Además I-EVOLUTION +se I-EVOLUTION +tomó I-EVOLUTION +literatura I-EVOLUTION +proveniente I-EVOLUTION +de I-EVOLUTION +libros I-EVOLUTION +y I-EVOLUTION +otras I-EVOLUTION +publicaciones. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +24/07/1992, I-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 +Hospital I-PRESENT_ILLNESS +Clínico I-PRESENT_ILLNESS +Regional I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Valdivia, I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +sufrido I-PRESENT_ILLNESS +trauma I-PRESENT_ILLNESS +toracoabdominal I-PRESENT_ILLNESS +cerrado I-PRESENT_ILLNESS +(aplastamiento I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +muralla I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +concreto I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +camión). I-PRESENT_ILLNESS +Al B-EXPLORATION +examen, I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +conciente, I-EXPLORATION +orientado I-EXPLORATION +temporoespacialmente, I-EXPLORATION +pálido, I-EXPLORATION +taquicárdico I-EXPLORATION +(pulso I-EXPLORATION +112x' I-EXPLORATION +débil), I-EXPLORATION +hipotenso I-EXPLORATION +(PA I-EXPLORATION +70/50 I-EXPLORATION +mmHg), I-EXPLORATION +respiración I-EXPLORATION +paradojal, I-EXPLORATION +destacando I-EXPLORATION +múltiples I-EXPLORATION +erosiones I-EXPLORATION +toracoabdominales, I-EXPLORATION +crepitaciones I-EXPLORATION +costales I-EXPLORATION +múltiples, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +y I-EXPLORATION +deformidad I-EXPLORATION +del I-EXPLORATION +antebrazo I-EXPLORATION +izquierdo, I-EXPLORATION +abolición I-EXPLORATION +del I-EXPLORATION +murmullo I-EXPLORATION +pulmonar I-EXPLORATION +en I-EXPLORATION +base I-EXPLORATION +derecha, I-EXPLORATION +abdomen I-EXPLORATION +sensible I-EXPLORATION +y I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +matidez I-EXPLORATION +hepática. I-EXPLORATION +Se I-EXPLORATION +efectuó I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +líquido I-EXPLORATION +libre, I-EXPLORATION +sin I-EXPLORATION +identificar I-EXPLORATION +lesión I-EXPLORATION +hepática. I-EXPLORATION + I-EXPLORATION +Una I-EXPLORATION +vez I-EXPLORATION +estabilizado, I-EXPLORATION +fue I-EXPLORATION +a I-EXPLORATION +pabellón, I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +2 I-EXPLORATION +h I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +ingreso, I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +diagnósticos I-EXPLORATION +de I-EXPLORATION +trauma I-EXPLORATION +toracoabdominal I-EXPLORATION +complicado, I-EXPLORATION +probable I-EXPLORATION +rotura I-EXPLORATION +de I-EXPLORATION +víscera I-EXPLORATION +hueca, I-EXPLORATION +fractura I-EXPLORATION +de I-EXPLORATION +antebrazo I-EXPLORATION +izquierdo, I-EXPLORATION +fractura I-EXPLORATION +esternal, I-EXPLORATION +tórax I-EXPLORATION +volante I-EXPLORATION +y I-EXPLORATION +hemoneumotórax I-EXPLORATION +derecho. I-EXPLORATION +Se B-TREATMENT +instaló I-TREATMENT +pleurostomía I-TREATMENT +derecha, I-TREATMENT +dando I-TREATMENT +salida I-TREATMENT +a I-TREATMENT +aire I-TREATMENT +y I-TREATMENT +sangre. I-TREATMENT +Se I-TREATMENT +abordó I-TREATMENT +vía I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +supraumbilical, I-TREATMENT +encontrando I-TREATMENT +hemoperitoneo I-TREATMENT +de I-TREATMENT +3 I-TREATMENT +l, I-TREATMENT +se I-TREATMENT +identificó I-TREATMENT +lesión I-TREATMENT +hepática I-TREATMENT +única, I-TREATMENT +paralela I-TREATMENT +a I-TREATMENT +ligamento I-TREATMENT +falciforme, I-TREATMENT +que I-TREATMENT +seccionaba I-TREATMENT +al I-TREATMENT +hígado I-TREATMENT +en I-TREATMENT +dos. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +control I-TREATMENT +del I-TREATMENT +sangrado I-TREATMENT +con I-TREATMENT +maniobra I-TREATMENT +de I-TREATMENT +Pringle, I-TREATMENT +identificando I-TREATMENT +origen I-TREATMENT +de I-TREATMENT +sangrado I-TREATMENT +en I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +supra I-TREATMENT +y I-TREATMENT +retrohepática. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +shunt I-TREATMENT +atriocava, I-TREATMENT +ampliando I-TREATMENT +incisión I-TREATMENT +a I-TREATMENT +toracofrenolaparotomía I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +se I-TREATMENT +instaló I-TREATMENT +tubo I-TREATMENT +orotraqueal I-TREATMENT +7, I-TREATMENT +5 I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +aurícula I-TREATMENT +derecha, I-TREATMENT +cediendo I-TREATMENT +el I-TREATMENT +sangrado, I-TREATMENT +identificando I-TREATMENT +2 I-TREATMENT +lesiones I-TREATMENT +en I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +suprahepática I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +cm I-TREATMENT +y I-TREATMENT +una I-TREATMENT +lesión I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +cm I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +cava I-TREATMENT +retrohepática, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suturan I-TREATMENT +con I-TREATMENT +prolene I-TREATMENT +4/0, I-TREATMENT +completando, I-TREATMENT +posteriormente, I-TREATMENT +hepatectomía I-TREATMENT +izquierda. I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +transfundieron I-TREATMENT +10 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +sangre I-TREATMENT +total, I-TREATMENT +3 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +glóbulos I-TREATMENT +rojos, I-TREATMENT +5 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +crioprecipitados, I-TREATMENT +2 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +plaquetas I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +plasma. I-TREATMENT + I-TREATMENT +Ingresó B-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cuidados I-EVOLUTION +Intensivos I-EVOLUTION +(UCI) I-EVOLUTION +con I-EVOLUTION +PA I-EVOLUTION +100/60 I-EVOLUTION +mmHg, I-EVOLUTION +pulso I-EVOLUTION +162 I-EVOLUTION +x', I-EVOLUTION +PVC I-EVOLUTION +16 I-EVOLUTION +cmH2O. I-EVOLUTION +Se B-TREATMENT +conectó I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +por I-TREATMENT +48 I-TREATMENT +h, I-TREATMENT +cursando I-TREATMENT +posteriormente I-TREATMENT +con I-TREATMENT +coagulación I-TREATMENT +intravascular. I-TREATMENT +Evolucionó B-EVOLUTION +favorablemente, I-EVOLUTION +siendo I-EVOLUTION +trasladado I-EVOLUTION +al I-EVOLUTION +décimo I-EVOLUTION +día I-EVOLUTION +postoperatorio I-EVOLUTION +(03/08/1992) I-EVOLUTION +al I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Cirugía I-EVOLUTION +y I-EVOLUTION +posteriormente I-EVOLUTION +a I-EVOLUTION +mutualidad I-EVOLUTION +el I-EVOLUTION +08/08/1992, I-EVOLUTION +desde I-EVOLUTION +donde I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +el I-EVOLUTION +20/08/1992. I-EVOLUTION + I-EVOLUTION + +Mujer, B-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +asintomática B-PAST_MEDICAL_HISTORY +cardiovascular. I-PAST_MEDICAL_HISTORY +Mientras B-PRESENT_ILLNESS +realizaba I-PRESENT_ILLNESS +ejercicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +moderada I-PRESENT_ILLNESS +intensidad, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +palpitaciones I-PRESENT_ILLNESS +rápidas, I-PRESENT_ILLNESS +regulares, I-PRESENT_ILLNESS +asociadas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +progresivo. I-PRESENT_ILLNESS +Consultó B-EXPLORATION +en I-EXPLORATION +urgencia, I-EXPLORATION +documentándose I-EXPLORATION +taquicardia I-EXPLORATION +regular, I-EXPLORATION +con I-EXPLORATION +frecuencia I-EXPLORATION +de I-EXPLORATION +180 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +y I-EXPLORATION +complejo I-EXPLORATION +QRS I-EXPLORATION +angosto, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +hipotensión, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +cardioversión I-TREATMENT +eléctrica. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +hospitalizó I-EVOLUTION +para I-EVOLUTION +monitorización I-EVOLUTION +y I-EVOLUTION +estudio. I-EVOLUTION +Su B-EXPLORATION +ECG I-EXPLORATION +basal I-EXPLORATION +mostró I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +con I-EXPLORATION +complejos I-EXPLORATION +QRS I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +controlaron I-EXPLORATION +enzimas I-EXPLORATION +cardíacas I-EXPLORATION +seriadas. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +EEF I-TREATMENT +que I-TREATMENT +mostró I-TREATMENT +HPE I-TREATMENT +lateral I-TREATMENT +izquierdo I-TREATMENT +oculto I-TREATMENT +y I-TREATMENT +taquicardia I-TREATMENT +ortodrómica I-TREATMENT +por I-TREATMENT +éste, I-TREATMENT +realizándose I-TREATMENT +fulguración I-TREATMENT +exitosa. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +73 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad. I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +relevantes. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +sometida I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +cirugías I-PAST_MEDICAL_HISTORY +abdominales I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +recientemente I-PAST_MEDICAL_HISTORY +algún I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +agudo I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +traumatismos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +zona. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +digestivas I-PRESENT_ILLNESS +vagas, I-PRESENT_ILLNESS +fundamentalmente I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +dispéptico, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +flatulencia, I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tendencia I-PRESENT_ILLNESS +fluctuante I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +estitiquez. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +demostraba I-EXPLORATION +una I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +con I-EXPLORATION +mucosas I-EXPLORATION +rosadas I-EXPLORATION +y I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +nutritivo. I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +abdominal I-EXPLORATION +descartó I-EXPLORATION +visceromegalia I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +masas. I-EXPLORATION +Sin I-EXPLORATION +soplos I-EXPLORATION +abdominales, I-EXPLORATION +con I-EXPLORATION +buenos I-EXPLORATION +pulsos I-EXPLORATION +inguinales I-EXPLORATION +y I-EXPLORATION +distales. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +solicitó I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +exámenes I-EXPLORATION +bioquímicos, I-EXPLORATION +más I-EXPLORATION +una I-EXPLORATION +exploración I-EXPLORATION +abdominal I-EXPLORATION +por I-EXPLORATION +ultrasonografía I-EXPLORATION +(US). I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +demostraron I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +anemia I-EXPLORATION +y I-EXPLORATION +funciones I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +renal I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +US I-EXPLORATION +puso I-EXPLORATION +en I-EXPLORATION +evidencia I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +quístico I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +3 I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +cuerpo I-EXPLORATION +del I-EXPLORATION +páncreas. I-EXPLORATION +Este I-EXPLORATION +último I-EXPLORATION +examen I-EXPLORATION +motivó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +del I-EXPLORATION +abdomen, I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +aneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +esplénica I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +altura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +córporo-caudal I-EXPLORATION +del I-EXPLORATION +páncreas. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +programó I-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +endovascular, I-TREATMENT +efectuándose I-TREATMENT +una I-TREATMENT +exploración I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +femoral I-TREATMENT +derecha I-TREATMENT +según I-TREATMENT +método I-TREATMENT +de I-TREATMENT +Seldinger I-TREATMENT +con I-TREATMENT +técnica I-TREATMENT +coaxial, I-TREATMENT +y I-TREATMENT +embolización I-TREATMENT +mediante I-TREATMENT +coils I-TREATMENT +metálicos, I-TREATMENT +hasta I-TREATMENT +oclusión I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cavidad. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +efectuada I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +30 I-EXPLORATION +días, I-EXPLORATION +mostró I-EXPLORATION +los I-EXPLORATION +coils I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segmento I-EXPLORATION +aneurismático I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +esplénica I-EXPLORATION +con I-EXPLORATION +permeabilidad I-EXPLORATION +distal. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +ninguna I-EXPLORATION +lesión I-EXPLORATION +focal I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +isquémico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +del I-EXPLORATION +bazo. I-EXPLORATION +A B-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +del I-EVOLUTION +procedimiento, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones, I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +síntomas. I-EVOLUTION + I-EVOLUTION + +Varón, B-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +deportista, B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +claudicación I-PAST_MEDICAL_HISTORY +intermitente. I-PAST_MEDICAL_HISTORY +Consultó, B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +cabo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estos I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +necrosis I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +primer I-PRESENT_ILLNESS +dedo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacó I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulsos I-EXPLORATION +poplíteo I-EXPLORATION +y I-EXPLORATION +distales I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +comprometida I-EXPLORATION +y I-EXPLORATION +necrosis I-EXPLORATION +seca I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +distal I-EXPLORATION +del I-EXPLORATION +1er I-EXPLORATION +dedo I-EXPLORATION +derecho. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pulsos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +contralateral I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +registro I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +pulso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +extremidad I-EXPLORATION +derecha, I-EXPLORATION +evidenciándose I-EXPLORATION +alterado I-EXPLORATION +de I-EXPLORATION +rodilla I-EXPLORATION +a I-EXPLORATION +distal. I-EXPLORATION +El I-EXPLORATION +valor I-EXPLORATION +del I-EXPLORATION +índice I-EXPLORATION +tobillo-brazo I-EXPLORATION +fue I-EXPLORATION +0, I-EXPLORATION +64. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +angiografía I-EXPLORATION +por I-EXPLORATION +acceso I-EXPLORATION +femoral I-EXPLORATION +izquierdo, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +medialización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +poplítea I-EXPLORATION +derecha, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +estenosis I-EXPLORATION +irregular I-EXPLORATION +del I-EXPLORATION +lumen I-EXPLORATION +arterial I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +post-estenótica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +electiva, I-TREATMENT +abordando I-TREATMENT +el I-TREATMENT +hueco I-TREATMENT +poplíteo I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +posterior. I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +estructuras I-TREATMENT +vasculares I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +poplítea I-TREATMENT +desplazada I-TREATMENT +hacia I-TREATMENT +medial I-TREATMENT +por I-TREATMENT +la I-TREATMENT +cabeza I-TREATMENT +medial I-TREATMENT +del I-TREATMENT +gastrocnemio. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +comprometido I-TREATMENT +(el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +envió I-TREATMENT +a I-TREATMENT +estudio I-TREATMENT +histológico) I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +mediante I-TREATMENT +interposición I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +safena I-TREATMENT +externa I-TREATMENT +invertida. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +recuperó I-EVOLUTION +los I-EVOLUTION +pulsos I-EVOLUTION +poplíteo I-EVOLUTION +y I-EVOLUTION +tibial I-EVOLUTION +posterior. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +informe I-EXPLORATION +de I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +reveló I-EXPLORATION +ateroesclerosis I-EXPLORATION +hialina I-EXPLORATION +con I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +aneurisma. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +angiografía I-EXPLORATION +por I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +atrapamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +poplítea I-EXPLORATION +contralateral. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +sin I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +necrosis. I-EVOLUTION +Requirió B-TREATMENT +una I-TREATMENT +amputación I-TREATMENT +del I-TREATMENT +primer I-TREATMENT +dedo, I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +falange I-TREATMENT +proximal, I-TREATMENT +a I-TREATMENT +los I-TREATMENT +3 I-TREATMENT +meses I-TREATMENT +del I-TREATMENT +alta. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Veintiocho B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +pretrasplante I-PRESENT_ILLNESS +debutó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +orina I-PRESENT_ILLNESS +espumosa, I-PRESENT_ILLNESS +objetivándose I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +nefrótico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +proteinuria I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +g/día I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipoalbuminemia I-PRESENT_ILLNESS +1, I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +g/dL. I-PRESENT_ILLNESS +El B-EXPLORATION +clearance I-EXPLORATION +de I-EXPLORATION +creatinina I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +incluyó I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +inmunológico I-EXPLORATION +(anticuerpos I-EXPLORATION +antinucleares, I-EXPLORATION +anticuerpos I-EXPLORATION +antiADN, I-EXPLORATION +anticuerpos I-EXPLORATION +anticitoplasma I-EXPLORATION +de I-EXPLORATION +neutrófilos, I-EXPLORATION +complementemia), I-EXPLORATION +viral I-EXPLORATION +(antígeno I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +hepatitis I-EXPLORATION +B, I-EXPLORATION +anticuerpos I-EXPLORATION +antivirus I-EXPLORATION +hepatitis I-EXPLORATION +C, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana), I-EXPLORATION +y I-EXPLORATION +electroforesis I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +en I-EXPLORATION +sangre, I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +búsqueda I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +sólida I-EXPLORATION +resultó I-EXPLORATION +negativa, I-EXPLORATION +incluyendo I-EXPLORATION +mamografía, I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +pelviana, I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +y I-EXPLORATION +colonoscopia. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +24 I-EXPLORATION +meses I-EXPLORATION +pretrasplante, I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +amiloidosis. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +Rojo I-EXPLORATION +de I-EXPLORATION +Congo, I-EXPLORATION +y I-EXPLORATION +Rojo I-EXPLORATION +de I-EXPLORATION +Congo I-EXPLORATION +con I-EXPLORATION +permanganato I-EXPLORATION +de I-EXPLORATION +potasio I-EXPLORATION +fueron I-EXPLORATION +ambas I-EXPLORATION +muy I-EXPLORATION +tenuemente I-EXPLORATION +positivas I-EXPLORATION +en I-EXPLORATION +glomérulos I-EXPLORATION +y I-EXPLORATION +vasos I-EXPLORATION +sanguíneos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +microscopia I-EXPLORATION +electrónica I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +desaparición I-EXPLORATION +pedicelar I-EXPLORATION +parcelar I-EXPLORATION +y I-EXPLORATION +depósitos I-EXPLORATION +densos I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +amiloideo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +mesangial I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +algunas I-EXPLORATION +asas I-EXPLORATION +capilares I-EXPLORATION +libres, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +fibrilar, I-EXPLORATION +con I-EXPLORATION +fibrillas I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +espesor I-EXPLORATION +promedio I-EXPLORATION +de I-EXPLORATION +100 I-EXPLORATION +Angström. I-EXPLORATION +Un I-EXPLORATION +estudio I-EXPLORATION +posterior I-EXPLORATION +con I-EXPLORATION +inmunofijación I-EXPLORATION +sérica I-EXPLORATION +y I-EXPLORATION +urinaria I-EXPLORATION +resultó I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +IgA-lambda I-EXPLORATION +monoclonal. I-EXPLORATION +La I-EXPLORATION +cuantificación I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +séricas I-EXPLORATION +reveló I-EXPLORATION +IgA I-EXPLORATION +1.000 I-EXPLORATION +mg/dL, I-EXPLORATION +IgG I-EXPLORATION +852 I-EXPLORATION +mg/dL I-EXPLORATION +e I-EXPLORATION +IgM I-EXPLORATION +93 I-EXPLORATION +mg/dL. I-EXPLORATION +El I-EXPLORATION +mielograma I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +citometría I-EXPLORATION +de I-EXPLORATION +flujo I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +descartaron I-EXPLORATION +un I-EXPLORATION +mieloma I-EXPLORATION +múltiple. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +melfalán I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +prednisona I-TREATMENT +durante I-TREATMENT +6 I-TREATMENT +meses, I-TREATMENT +persistiendo I-TREATMENT +la I-TREATMENT +proteinuria I-TREATMENT +nefrótica I-TREATMENT +y I-TREATMENT +la I-TREATMENT +inmunofijación I-TREATMENT +sérica I-TREATMENT +positiva. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +sólo I-TREATMENT +con I-TREATMENT +terapia I-TREATMENT +inespecífica I-TREATMENT +que I-TREATMENT +incluyó I-TREATMENT +enalapril, I-TREATMENT +espironolactona I-TREATMENT +y I-TREATMENT +atorvastatina. I-TREATMENT +Tres B-EVOLUTION +meses I-EVOLUTION +pretrasplante I-EVOLUTION +se I-EVOLUTION +mantenía I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +proteína I-EVOLUTION +monoclonal I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +síndrome I-EVOLUTION +nefrótico, I-EVOLUTION +con I-EVOLUTION +filtración I-EVOLUTION +glomerular I-EVOLUTION +normal. I-EVOLUTION +Un B-EXPLORATION +ecocardiograma I-EXPLORATION +transtorácico I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ventriculografía I-EXPLORATION +isotópica I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +enero I-EXPLORATION +de I-EXPLORATION +2004 I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +acondicionamiento I-EXPLORATION +medular I-EXPLORATION +con I-EXPLORATION +factor I-EXPLORATION +estimulante I-EXPLORATION +de I-EXPLORATION +colonias I-EXPLORATION +granulocíticas I-EXPLORATION +por I-EXPLORATION +cinco I-EXPLORATION +días, I-EXPLORATION +y I-EXPLORATION +cosecha I-EXPLORATION +mediante I-EXPLORATION +leucoaféresis I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +periférica I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +106 I-EXPLORATION +células I-EXPLORATION +troncales I-EXPLORATION +hematopoyéticas. I-EXPLORATION +Recibió B-TREATMENT +melfalán I-TREATMENT +endovenoso I-TREATMENT +200 I-TREATMENT +mg/m2 I-TREATMENT +de I-TREATMENT +superficie I-TREATMENT +corporal I-TREATMENT +(día I-TREATMENT +0) I-TREATMENT +y I-TREATMENT +al I-TREATMENT +día I-TREATMENT +siguiente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +infusión I-TREATMENT +única I-TREATMENT +de I-TREATMENT +las I-TREATMENT +células I-TREATMENT +troncales. I-TREATMENT +A B-EXPLORATION +partir I-EXPLORATION +del I-EXPLORATION +día I-EXPLORATION +2 I-EXPLORATION +desarrolló I-EXPLORATION +IRA I-EXPLORATION +oligúrica, I-EXPLORATION +con I-EXPLORATION +fracción I-EXPLORATION +excretada I-EXPLORATION +de I-EXPLORATION +sodio I-EXPLORATION +2%, I-EXPLORATION +índice I-EXPLORATION +uricosuria/creatininuria I-EXPLORATION +<1, I-EXPLORATION +0 I-EXPLORATION +a I-EXPLORATION +pH I-EXPLORATION +urinario I-EXPLORATION +7, I-EXPLORATION +0, I-EXPLORATION +ecografía-doppler I-EXPLORATION +renal I-EXPLORATION +normal, I-EXPLORATION +creatinquinasa I-EXPLORATION +total I-EXPLORATION +sérica I-EXPLORATION +285 I-EXPLORATION +U/L, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +trombocitopenia I-EXPLORATION +o I-EXPLORATION +esquistocitosis I-EXPLORATION +y I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +ADAMTS13 I-EXPLORATION +de I-EXPLORATION +20%. I-EXPLORATION +El I-EXPLORATION +deterioro I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +se I-EXPLORATION +acompañó I-EXPLORATION +de I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +lisis I-EXPLORATION +celular I-EXPLORATION +(láctico-deshidrogenasa I-EXPLORATION +hasta I-EXPLORATION +6.710 I-EXPLORATION +U/L, I-EXPLORATION +fosfatemia I-EXPLORATION +hasta I-EXPLORATION +9, I-EXPLORATION +2 I-EXPLORATION +mg/dL, I-EXPLORATION +uricemia I-EXPLORATION +hasta I-EXPLORATION +13, I-EXPLORATION +2 I-EXPLORATION +mg/dL, I-EXPLORATION +transaminasa I-EXPLORATION +glutámico I-EXPLORATION +oxaloacética I-EXPLORATION +351 I-EXPLORATION +U/L) I-EXPLORATION +y I-EXPLORATION +rápido I-EXPLORATION +ascenso I-EXPLORATION +(hasta I-EXPLORATION +28.000 I-EXPLORATION +células/mm3) I-EXPLORATION +y I-EXPLORATION +posterior I-EXPLORATION +descenso I-EXPLORATION +del I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +glóbulos I-EXPLORATION +blancos I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +periférica, I-EXPLORATION +llegando I-EXPLORATION +hasta I-EXPLORATION +una I-EXPLORATION +completa I-EXPLORATION +aplasia I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +prolongó I-EXPLORATION +por I-EXPLORATION +12 I-EXPLORATION +días. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Tabla I-EXPLORATION +1 I-EXPLORATION +se I-EXPLORATION +detalla I-EXPLORATION +la I-EXPLORATION +evolución I-EXPLORATION +de I-EXPLORATION +algunos I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +representativos. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +requirió I-TREATMENT +del I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +factor I-TREATMENT +estimulante I-TREATMENT +de I-TREATMENT +colonias I-TREATMENT +granulocíticas I-TREATMENT +entre I-TREATMENT +los I-TREATMENT +días I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +16 I-TREATMENT +y I-TREATMENT +de I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +sustitución I-TREATMENT +renal I-TREATMENT +con I-TREATMENT +hemodiafiltración I-TREATMENT +veno-venosa I-TREATMENT +intermitente I-TREATMENT +diaria I-TREATMENT +entre I-TREATMENT +los I-TREATMENT +días I-TREATMENT +5 I-TREATMENT +al I-TREATMENT +14. I-TREATMENT +Desde B-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +13 I-EVOLUTION +recuperó I-EVOLUTION +diuresis I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +23 I-EVOLUTION +post-melfalán, I-EVOLUTION +con I-EVOLUTION +creatininemia I-EVOLUTION +1, I-EVOLUTION +2 I-EVOLUTION +mg/dL I-EVOLUTION +y I-EVOLUTION +recuento I-EVOLUTION +de I-EVOLUTION +glóbulos I-EVOLUTION +blancos I-EVOLUTION +3.000/mm3. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +control I-EVOLUTION +clínico I-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +reveló I-EVOLUTION +excelente I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +filtración I-EVOLUTION +glomerular I-EVOLUTION +y I-EVOLUTION +recuentos I-EVOLUTION +hematológicos I-EVOLUTION +normales, I-EVOLUTION +proteinuria I-EVOLUTION +<1 I-EVOLUTION +g/día, I-EVOLUTION +e I-EVOLUTION +inmunofijación I-EVOLUTION +sérica I-EVOLUTION +negativa. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dispepsia I-PAST_MEDICAL_HISTORY +inespecífica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +estos I-PRESENT_ILLNESS +síntomas. I-PRESENT_ILLNESS + B-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +no I-EXPLORATION +mostraba I-EXPLORATION +hallazgos I-EXPLORATION +anormales. I-EXPLORATION +La I-EXPLORATION +vesícula I-EXPLORATION +no I-EXPLORATION +era I-EXPLORATION +palpable. I-EXPLORATION + I-EXPLORATION +Entre I-EXPLORATION +sus I-EXPLORATION +antecedentes I-EXPLORATION +destacaba I-EXPLORATION +ecotomografía I-EXPLORATION +previa, I-EXPLORATION +años I-EXPLORATION +antes, I-EXPLORATION +que I-EXPLORATION +habría I-EXPLORATION +sido I-EXPLORATION +normal. I-EXPLORATION +Panendoscopia I-EXPLORATION +demostró I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +erosiva. I-EXPLORATION + I-EXPLORATION +Fumador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +diarios, I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +neumotórax I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +usaba I-PAST_MEDICAL_HISTORY +medicamentos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +habitual. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Fue B-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +realización I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ecotomografía I-DERIVED_FROM/TO +abdominal. I-DERIVED_FROM/TO +Examen B-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +realizado I-EXPLORATION +en I-EXPLORATION +agosto I-EXPLORATION +de I-EXPLORATION +2000, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +tumoración I-EXPLORATION +del I-EXPLORATION +lecho I-EXPLORATION +vesicular I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +sólido, I-EXPLORATION +caracterizada I-EXPLORATION +por I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +y I-EXPLORATION +cuerpo I-EXPLORATION +que I-EXPLORATION +deja I-EXPLORATION +un I-EXPLORATION +lumen I-EXPLORATION +pequeño, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +cálculos. I-EXPLORATION +Había I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +ecogénicas I-EXPLORATION +con I-EXPLORATION +artefacto I-EXPLORATION +en I-EXPLORATION +estalactita I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +espesor. I-EXPLORATION +En I-EXPLORATION +conclusión, I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +tumoración I-EXPLORATION +vesicular I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +que I-EXPLORATION +sugerían I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +probable I-EXPLORATION +de I-EXPLORATION +extensa I-EXPLORATION +adenomiomatosis I-EXPLORATION +del I-EXPLORATION +fondo I-EXPLORATION +y I-EXPLORATION +cuerpo I-EXPLORATION +vesicular. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +complementó I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +abdominal, I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +tumoración I-EXPLORATION +del I-EXPLORATION +área I-EXPLORATION +vesicular, I-EXPLORATION +planteando I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +vesicular I-EXPLORATION +o I-EXPLORATION +lesión I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +esplénico I-EXPLORATION +del I-EXPLORATION +colon. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +no I-EXPLORATION +infiltraba I-EXPLORATION +el I-EXPLORATION +hígado. I-EXPLORATION + B-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +operado I-TREATMENT +el I-TREATMENT +25.08.2000, I-TREATMENT +realizándose I-TREATMENT +colecistectomía. I-TREATMENT +La B-EXPLORATION +exploración I-EXPLORATION +del I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +abdominal I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +adenomiomatosis I-EXPLORATION +vesicular I-EXPLORATION +difusa. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +padres B-FAMILY_HISTORY +no I-FAMILY_HISTORY +consanguíneos, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +perinatales I-FAMILY_HISTORY +de I-FAMILY_HISTORY +relevancia; I-FAMILY_HISTORY +peso B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3-450 I-PAST_MEDICAL_HISTORY +g, I-PAST_MEDICAL_HISTORY +talla I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +49, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +circunferencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cráneo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +35, I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +cm. I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +9, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +min. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +medio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +tónico I-PRESENT_ILLNESS +clónicas I-PRESENT_ILLNESS +generalizadas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +segundos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +evolucionando I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +mioclonías I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día, I-PRESENT_ILLNESS +agregándose I-PRESENT_ILLNESS +espasmos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +flexión. I-PRESENT_ILLNESS +Recibió I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +farmacológico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ácido I-PRESENT_ILLNESS +valproico, I-PRESENT_ILLNESS +fenobarbital I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +carbamazepina, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +clínica, I-PRESENT_ILLNESS +desencadenando I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +reacción I-PRESENT_ILLNESS +adversa I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ácido I-PRESENT_ILLNESS +valproico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +hiperamonemia I-PRESENT_ILLNESS +sintomática. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +los I-EXPLORATION +3 I-EXPLORATION +y I-EXPLORATION +medio I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +edad I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +exámenes I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +metabólica, I-EXPLORATION +encontrándose I-EXPLORATION +una I-EXPLORATION +lactacidemia I-EXPLORATION +de I-EXPLORATION +26, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +(VN: I-EXPLORATION +5-15), I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +lactato I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +6 I-EXPLORATION +mg/dl I-EXPLORATION +(VN: I-EXPLORATION +10, I-EXPLORATION +8-18, I-EXPLORATION +9 I-EXPLORATION +mg/dl). I-EXPLORATION +El I-EXPLORATION +ácido I-EXPLORATION +pirúvico I-EXPLORATION +en I-EXPLORATION +plasma I-EXPLORATION +estaba I-EXPLORATION +aumentado I-EXPLORATION +(1, I-EXPLORATION +4 I-EXPLORATION +mg/dl) I-EXPLORATION +(VN: I-EXPLORATION +0, I-EXPLORATION +3-0, I-EXPLORATION +9), I-EXPLORATION +pero I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +(0, I-EXPLORATION +43 I-EXPLORATION +mg/dl) I-EXPLORATION +(VN: I-EXPLORATION +0, I-EXPLORATION +5-1, I-EXPLORATION +7) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +amonemia I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +85 I-EXPLORATION +µg/dl I-EXPLORATION +(35-100 I-EXPLORATION +µg/dl). I-EXPLORATION +La I-EXPLORATION +cuantiñ-cación I-EXPLORATION +de I-EXPLORATION +aminoácidos I-EXPLORATION +en I-EXPLORATION +suero, I-EXPLORATION +acilcarniünas I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +total, I-EXPLORATION +ácidos I-EXPLORATION +orgánicos I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +carnitina I-EXPLORATION +en I-EXPLORATION +suero I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +5 I-EXPLORATION +meses, I-EXPLORATION +el I-EXPLORATION +electroencefalograma I-EXPLORATION +(EEG) I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +actividad I-EXPLORATION +theta-delta I-EXPLORATION +polimorfa I-EXPLORATION +continua, I-EXPLORATION +considerada I-EXPLORATION +anormal I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +resonancia I-EXPLORATION +nuclear I-EXPLORATION +magnética I-EXPLORATION +mostró I-EXPLORATION +atrofia I-EXPLORATION +frontal I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +espacios I-EXPLORATION +subaracnoídeos. I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +retardo I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +desarrollo I-EVOLUTION +psicomotor I-EVOLUTION +y I-EVOLUTION +desaceleración I-EVOLUTION +del I-EVOLUTION +crecimiento I-EVOLUTION +craneano, I-EVOLUTION +ataxia I-EVOLUTION +de I-EVOLUTION +tronco I-EVOLUTION +y I-EVOLUTION +síndrome I-EVOLUTION +piramidal I-EVOLUTION +bilateral. I-EVOLUTION + I-EVOLUTION +A B-EXPLORATION +los I-EXPLORATION +7 I-EXPLORATION +meses I-EXPLORATION +ingresó I-EXPLORATION +al I-EXPLORATION +Hospital I-EXPLORATION +de I-EXPLORATION +Niños I-EXPLORATION +de I-EXPLORATION +Boston, I-EXPLORATION +de I-EXPLORATION +Estados I-EXPLORATION +Unidos I-EXPLORATION +de I-EXPLORATION +Norteamérica, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glucosa I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +de I-EXPLORATION +26 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +normoglucemia I-EXPLORATION +(84 I-EXPLORATION +mg/dl), I-EXPLORATION +obteniéndose I-EXPLORATION +una I-EXPLORATION +razón I-EXPLORATION +entre I-EXPLORATION +ambos I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +31 I-EXPLORATION +(valor I-EXPLORATION +normal I-EXPLORATION +sobre I-EXPLORATION +0, I-EXPLORATION +65+0, I-EXPLORATION +01), I-EXPLORATION +concordante I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +hipo-glucorraquia, I-EXPLORATION +sugiriéndose I-EXPLORATION +un I-EXPLORATION +SDGLUT-1. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +ha I-EXPLORATION +demostrado I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +Glut-1 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +eritrocito I-EXPLORATION +es I-EXPLORATION +idéntica I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +Glut-1 I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +endoteliales I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +capilares I-EXPLORATION +del I-EXPLORATION +cerebro, I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +respuesta I-EXPLORATION +inmunológica I-EXPLORATION +como I-EXPLORATION +química. I-EXPLORATION +Por I-EXPLORATION +esta I-EXPLORATION +razón, I-EXPLORATION +el I-EXPLORATION +transporte I-EXPLORATION +de I-EXPLORATION +glucosa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +eritrocito I-EXPLORATION +es I-EXPLORATION +comparable I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +transporte I-EXPLORATION +de I-EXPLORATION +glucosa I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +barrera I-EXPLORATION +hematoencefálica. I-EXPLORATION +Considerando I-EXPLORATION +este I-EXPLORATION +hallazgo, I-EXPLORATION +se I-EXPLORATION +desarrolló I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +3-O-metil I-EXPLORATION +D I-EXPLORATION +glucosa, I-EXPLORATION +que I-EXPLORATION +determina I-EXPLORATION +la I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +glucosa I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +eritrocito, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +permite I-EXPLORATION +la I-EXPLORATION +extrapolación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +transporte I-EXPLORATION +de I-EXPLORATION +glucosa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +barrera I-EXPLORATION +hematoencefálica11. I-EXPLORATION +En B-TREATMENT +nuestro I-TREATMENT +caso, I-TREATMENT +se I-TREATMENT +aplicó I-TREATMENT +esta I-TREATMENT +técnica, I-TREATMENT +obteniéndose I-TREATMENT +una I-TREATMENT +captación I-TREATMENT +de I-TREATMENT +glucosa I-TREATMENT +de I-TREATMENT +44% I-TREATMENT +(VN I-TREATMENT +80%-100%), I-TREATMENT +confirmándose I-TREATMENT +un I-TREATMENT +SDGLUT-1. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +se I-EXPLORATION +utilizó I-EXPLORATION +la I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +(PCR) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +polimorfismos I-EXPLORATION +por I-EXPLORATION +fragmentos I-EXPLORATION +de I-EXPLORATION +restricción I-EXPLORATION +(RFLP) I-EXPLORATION +3, I-EXPLORATION +6 I-EXPLORATION +determinándose I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +del I-EXPLORATION +upo I-EXPLORATION +deleción I-EXPLORATION +969, I-EXPLORATION +C971T, I-EXPLORATION +ubicada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +exon I-EXPLORATION +6, I-EXPLORATION +de I-EXPLORATION +gen I-EXPLORATION +Glut-1 I-EXPLORATION +(Estudio I-EXPLORATION +molecular I-EXPLORATION +realizado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Dr. I-EXPLORATION +D. I-EXPLORATION +De I-EXPLORATION +Vivo). I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +por I-EXPLORATION +emisión I-EXPLORATION +de I-EXPLORATION +fotón I-EXPLORATION +único I-EXPLORATION +(SPECT) I-EXPLORATION +mostró I-EXPLORATION +hipometabolismo I-EXPLORATION +talámico, I-EXPLORATION +parietal I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +temporal I-EXPLORATION +bilateral. I-EXPLORATION + I-EXPLORATION +Inmediatamente B-TREATMENT +se I-TREATMENT +inició I-TREATMENT +la I-TREATMENT +dieta I-TREATMENT +cetogénica, I-TREATMENT +proporcionando I-TREATMENT +90 I-TREATMENT +calorías I-TREATMENT +por I-TREATMENT +kilo I-TREATMENT +de I-TREATMENT +peso, I-TREATMENT +con I-TREATMENT +85% I-TREATMENT +de I-TREATMENT +lípidos, I-TREATMENT +9% I-TREATMENT +de I-TREATMENT +proteínas I-TREATMENT +y I-TREATMENT +6% I-TREATMENT +de I-TREATMENT +carbohidratos, I-TREATMENT +con I-TREATMENT +relación I-TREATMENT +de I-TREATMENT +3: I-TREATMENT +1 I-TREATMENT +entre I-TREATMENT +lípidos I-TREATMENT +y I-TREATMENT +proteínas I-TREATMENT +más I-TREATMENT +carbohidratos, I-TREATMENT +basándose I-TREATMENT +en I-TREATMENT +el I-TREATMENT +protocolo I-TREATMENT +utilizado I-TREATMENT +en I-TREATMENT +el I-TREATMENT +INTA, I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Universidad I-TREATMENT +de I-TREATMENT +Chile9, I-TREATMENT +10. I-TREATMENT +La I-TREATMENT +dieta I-TREATMENT +prohibe I-TREATMENT +alimentos I-TREATMENT +con I-TREATMENT +sacarosa, I-TREATMENT +sorbitol, I-TREATMENT +fructosa I-TREATMENT +y I-TREATMENT +se I-TREATMENT +restringe I-TREATMENT +el I-TREATMENT +consumo I-TREATMENT +de I-TREATMENT +lactosa, I-TREATMENT +razón I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +fue I-TREATMENT +necesario I-TREATMENT +suplementar I-TREATMENT +con I-TREATMENT +calcio I-TREATMENT +(450 I-TREATMENT +mg/día), I-TREATMENT +zinc I-TREATMENT +(5 I-TREATMENT +mg/día), I-TREATMENT +vitaminas, I-TREATMENT +especialmente I-TREATMENT +vitamina I-TREATMENT +C I-TREATMENT +(1 I-TREATMENT +g/día) I-TREATMENT +para I-TREATMENT +prevenir I-TREATMENT +oxidación I-TREATMENT +celular, I-TREATMENT +L-carnitina I-TREATMENT +(50 I-TREATMENT +mg/kg/día) I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +lipóico I-TREATMENT +(200 I-TREATMENT +mg/día). I-TREATMENT + I-TREATMENT +Después B-EVOLUTION +de I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +iniciada I-EVOLUTION +la I-EVOLUTION +dieta I-EVOLUTION +cetogénica, I-EVOLUTION +desaparecieron I-EVOLUTION +las I-EVOLUTION +crisis, I-EVOLUTION +y B-TREATMENT +conjuntamente I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +la I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +los I-TREATMENT +anticonvulsivantes. I-TREATMENT + I-TREATMENT +Actualmente B-EVOLUTION +tiene I-EVOLUTION +6 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +edad, I-EVOLUTION +mantiene I-EVOLUTION +la I-EVOLUTION +dieta I-EVOLUTION +cetogénica I-EVOLUTION +con I-EVOLUTION +83% I-EVOLUTION +de I-EVOLUTION +lípidos I-EVOLUTION +(27% I-EVOLUTION +de I-EVOLUTION +ellos I-EVOLUTION +corresponde I-EVOLUTION +a I-EVOLUTION +triglicéridos I-EVOLUTION +de I-EVOLUTION +cadena I-EVOLUTION +mediana) I-EVOLUTION +y I-EVOLUTION +17% I-EVOLUTION +de I-EVOLUTION +proteínas I-EVOLUTION +más I-EVOLUTION +carbohidratos I-EVOLUTION +(razón I-EVOLUTION +de I-EVOLUTION +2, I-EVOLUTION +5: I-EVOLUTION +1). I-EVOLUTION +La I-EVOLUTION +suplementación I-EVOLUTION +de I-EVOLUTION +nutrientes I-EVOLUTION +es I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +que I-EVOLUTION +al I-EVOLUTION +inicio, I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +ido I-EVOLUTION +adecuando I-EVOLUTION +según I-EVOLUTION +edad I-EVOLUTION +y I-EVOLUTION +estado I-EVOLUTION +nutricional. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +glicemia I-EXPLORATION +se I-EXPLORATION +mantiene I-EXPLORATION +en I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +80 I-EXPLORATION +a I-EXPLORATION +90 I-EXPLORATION +mg/dl, I-EXPLORATION +el I-EXPLORATION +colesterol I-EXPLORATION +total I-EXPLORATION +en I-EXPLORATION +187 I-EXPLORATION +mg/dl, I-EXPLORATION +la I-EXPLORATION +HDL I-EXPLORATION +en I-EXPLORATION +55 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +LDL I-EXPLORATION +en I-EXPLORATION +121 I-EXPLORATION +mg/dl. I-EXPLORATION +Calciuria I-EXPLORATION +creatininuria, I-EXPLORATION +perfil I-EXPLORATION +bioquímico, I-EXPLORATION +gases I-EXPLORATION +venosos I-EXPLORATION +y I-EXPLORATION +electrolitos I-EXPLORATION +plasmáticos I-EXPLORATION +están I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +de I-EXPLORATION +normalidad. I-EXPLORATION +El I-EXPLORATION +ácido I-EXPLORATION +beta I-EXPLORATION +hidroxibutirato I-EXPLORATION +en I-EXPLORATION +ayuno I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +µM/1 I-EXPLORATION +y I-EXPLORATION +posprandial I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +0 I-EXPLORATION +µM/l, I-EXPLORATION +considerándose I-EXPLORATION +cetogénesis I-EXPLORATION +cuando I-EXPLORATION +este I-EXPLORATION +valor I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +sobre I-EXPLORATION +2, I-EXPLORATION +0 I-EXPLORATION +µM/1. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +destaca I-EXPLORATION +una I-EXPLORATION +conducta I-EXPLORATION +hiperactiva I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +examen I-EXPLORATION +mental. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +pares I-EXPLORATION +craneanos I-EXPLORATION +presenta I-EXPLORATION +disartria I-EXPLORATION +e I-EXPLORATION +hipomimia I-EXPLORATION +facial. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +motor I-EXPLORATION +muestra I-EXPLORATION +tono I-EXPLORATION +de I-EXPLORATION +tronco I-EXPLORATION +y I-EXPLORATION +extremidades I-EXPLORATION +disminuido, I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +fuerza I-EXPLORATION +ni I-EXPLORATION +del I-EXPLORATION +trofismo I-EXPLORATION +muscular. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +cerebeloso I-EXPLORATION +existe I-EXPLORATION +un I-EXPLORATION +temblor I-EXPLORATION +fino I-EXPLORATION +de I-EXPLORATION +intención, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +sincinesias, I-EXPLORATION +dismetría I-EXPLORATION +y I-EXPLORATION +discreta I-EXPLORATION +disdiadococinesia. I-EXPLORATION +La I-EXPLORATION +marcha I-EXPLORATION +es I-EXPLORATION +inestable I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +caracteriza I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +sustentación, I-EXPLORATION +sin I-EXPLORATION +lateralización. I-EXPLORATION + I-EXPLORATION +Su I-EXPLORATION +coeficiente I-EXPLORATION +intelectual I-EXPLORATION +(CI), I-EXPLORATION +evaluado I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +inteligencia I-EXPLORATION +para I-EXPLORATION +preescolares I-EXPLORATION +de I-EXPLORATION +Wechs-ler I-EXPLORATION +(WISP) I-EXPLORATION +12, I-EXPLORATION +obtuvo I-EXPLORATION +CI I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +103 I-EXPLORATION +puntos, I-EXPLORATION +límite I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +rango I-EXPLORATION +normal I-EXPLORATION +promedio, I-EXPLORATION +corregido I-EXPLORATION +según I-EXPLORATION +normas I-EXPLORATION +norteamericanas. I-EXPLORATION +Presenta, I-EXPLORATION +sin I-EXPLORATION +embargo, I-EXPLORATION +una I-EXPLORATION +discrepancia I-EXPLORATION +significativa I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +verbal I-EXPLORATION +y I-EXPLORATION +manual, I-EXPLORATION +en I-EXPLORATION +desmedro I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +última I-EXPLORATION +(CI I-EXPLORATION +verbal: I-EXPLORATION +119, I-EXPLORATION +normal I-EXPLORATION +alto I-EXPLORATION +y I-EXPLORATION +CI I-EXPLORATION +manual: I-EXPLORATION +85, I-EXPLORATION +normal I-EXPLORATION +lento), I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +traduce I-EXPLORATION +en I-EXPLORATION +dificultades I-EXPLORATION +específicas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +organización I-EXPLORATION +visoespacial I-EXPLORATION +y I-EXPLORATION +visomotricidad. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estado I-EXPLORATION +nutricional I-EXPLORATION +es I-EXPLORATION +normal: I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +15, I-EXPLORATION +8 I-EXPLORATION +kg/m2 I-EXPLORATION +(VN I-EXPLORATION +entre I-EXPLORATION +15 I-EXPLORATION +y I-EXPLORATION +18 I-EXPLORATION +kg/m2) I-EXPLORATION +13, I-EXPLORATION +con I-EXPLORATION +peso I-EXPLORATION +(21 I-EXPLORATION +kg) I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +talla I-EXPLORATION +(1, I-EXPLORATION +16 I-EXPLORATION +m) I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad, I-EXPLORATION +ambos I-EXPLORATION +parámetros I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +percentil I-EXPLORATION +75 I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +(National I-EXPLORATION +Center I-EXPLORATION +for I-EXPLORATION +Health I-EXPLORATION +Statistics) I-EXPLORATION +14. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +multípara, B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +epilepsia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +primidona I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cáncer I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuello I-PAST_MEDICAL_HISTORY +uterino I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +etapa I-PAST_MEDICAL_HISTORY +Ib2, I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +diciembre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2000 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +posteriormente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +quimioterapia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +braquiterapia. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +posteriores, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +finalizar I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +sesiones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +radioterapia, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +sangrado I-PRESENT_ILLNESS +digestivo I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +intermitente, I-PRESENT_ILLNESS +agregándose I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +pujo, I-PRESENT_ILLNESS +tenesmo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +bajo. I-PRESENT_ILLNESS +El B-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +impresionaba I-EXPLORATION +con I-EXPLORATION +mucosa I-EXPLORATION +irregular I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +palpándose I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +ulcerada I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +iniciaba I-EXPLORATION +a I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +esfínter I-EXPLORATION +anorrectal. I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +clínicamente I-EXPLORATION +una I-EXPLORATION +rectitis I-EXPLORATION +actínica, I-EXPLORATION +indicándose I-EXPLORATION +una I-EXPLORATION +rectoscopia, I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +por I-EXPLORATION +rechazo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente. I-EXPLORATION +Inició B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +enemas I-TREATMENT +con I-TREATMENT +prednisona, I-TREATMENT +que I-TREATMENT +lograron I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +En B-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +ginecológico I-EXPLORATION +8 I-EXPLORATION +meses I-EXPLORATION +post I-EXPLORATION +cirugía I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +recto, I-EXPLORATION +a I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +ano, I-EXPLORATION +una I-EXPLORATION +área I-EXPLORATION +densa, I-EXPLORATION +irregular, I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +adherencia I-EXPLORATION +a I-EXPLORATION +parametrio I-EXPLORATION +derecho, I-EXPLORATION +que I-EXPLORATION +impresionaba I-EXPLORATION +como I-EXPLORATION +secuela I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +fibrosis I-EXPLORATION +post I-EXPLORATION +radioterapia. I-EXPLORATION +No B-EVOLUTION +se I-EVOLUTION +realizaron I-EVOLUTION +exámenes I-EVOLUTION +imagenológicos, I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +presentado I-EVOLUTION +su I-EVOLUTION +caso I-EVOLUTION +al I-EVOLUTION +comité I-EVOLUTION +oncológico, I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +realizar I-EVOLUTION +sólo I-EVOLUTION +seguimiento I-EVOLUTION +clínico. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +en I-EVOLUTION +control I-EVOLUTION +ambulatorio I-EVOLUTION +periódico, I-EVOLUTION +describiéndose I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +tactos I-EVOLUTION +rectales I-EVOLUTION +descritos I-EVOLUTION +como I-EVOLUTION +normales I-EVOLUTION +hasta I-EVOLUTION +su I-EVOLUTION +último I-EVOLUTION +control I-EVOLUTION +en I-EVOLUTION +mayo I-EVOLUTION +de I-EVOLUTION +2005. I-EVOLUTION +El I-EVOLUTION +01/02/2006, I-EVOLUTION +consultó I-EVOLUTION +en I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +urgencia I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +un I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +cólico I-EVOLUTION +difuso, I-EVOLUTION +con I-EVOLUTION +vómitos I-EVOLUTION +abundantes, I-EVOLUTION +con I-EVOLUTION +abdomen I-EVOLUTION +distendido, I-EVOLUTION +sensible I-EVOLUTION +difusamente. I-EVOLUTION +Al B-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +masa I-EXPLORATION +rectal I-EXPLORATION +indurada I-EXPLORATION +(cara I-EXPLORATION +anterior) I-EXPLORATION +con I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +purulento. I-EXPLORATION +Ingresó B-EVOLUTION +a I-EVOLUTION +pabellón I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +clínico I-EVOLUTION +de I-EVOLUTION +peritonitis I-EVOLUTION +difusa I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +probable I-EVOLUTION +perforación I-EVOLUTION +intestinal. I-EVOLUTION +Durante B-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +segmento I-TREATMENT +rectosigmoideo I-TREATMENT +este-nótico I-TREATMENT +e I-TREATMENT +indurado. I-TREATMENT +Fue I-TREATMENT +interpretado I-TREATMENT +como I-TREATMENT +tumoral, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +afectado I-TREATMENT +y I-TREATMENT +colostomía I-TREATMENT +del I-TREATMENT +cabo I-TREATMENT +proximal. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +post I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +patología I-EXPLORATION +se I-EXPLORATION +recibió I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +grueso I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +por I-EXPLORATION +8 I-EXPLORATION +y I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +perímetro I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +sección. I-EXPLORATION +Al I-EXPLORATION +corte, I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +presentaba I-EXPLORATION +zona I-EXPLORATION +cilindrica I-EXPLORATION +estenótica I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +cercana I-EXPLORATION +a I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +sección, I-EXPLORATION +con I-EXPLORATION +segmento I-EXPLORATION +proximal I-EXPLORATION +dilatado I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +áreas I-EXPLORATION +hemorrágicas I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +depósito I-EXPLORATION +superficial I-EXPLORATION +de I-EXPLORATION +fibrina. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +microscópico I-EXPLORATION +reveló I-EXPLORATION +distorsión I-EXPLORATION +marcada I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arquitectura I-EXPLORATION +intestinal, I-EXPLORATION +con I-EXPLORATION +fibrosis I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +cicatricial I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +crónico I-EXPLORATION +con I-EXPLORATION +reagudización I-EXPLORATION +hemorrágica I-EXPLORATION +en I-EXPLORATION +granulación I-EXPLORATION +superficial. I-EXPLORATION +Se I-EXPLORATION +observó I-EXPLORATION +ausencia I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +lámina I-EXPLORATION +propia I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +segmento, I-EXPLORATION +con I-EXPLORATION +glándulas I-EXPLORATION +mucosas I-EXPLORATION +suprayacentes I-EXPLORATION +penetrando I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +túnica I-EXPLORATION +muscular I-EXPLORATION +propia, I-EXPLORATION +algunas I-EXPLORATION +dilatadas, I-EXPLORATION +ubicadas I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +mitad I-EXPLORATION +externa, I-EXPLORATION +sin I-EXPLORATION +atipias I-EXPLORATION +citológicas I-EXPLORATION +ni I-EXPLORATION +arquitecturales. I-EXPLORATION +Los I-EXPLORATION +vasos I-EXPLORATION +sanguíneos I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +moderadamente I-EXPLORATION +escleróticos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +adventicia I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +adiponecro-sis I-EXPLORATION +y I-EXPLORATION +esclerosis I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +cicatricial I-EXPLORATION +con I-EXPLORATION +retracción I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +adyacente. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +mitosis I-EXPLORATION +ni I-EXPLORATION +atipias I-EXPLORATION +citológicas. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +morfológicos I-EXPLORATION +confirmaron I-EXPLORATION +secuelas I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +rectitis I-EXPLORATION +actínica. I-EXPLORATION + I-EXPLORATION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +miocar-diopatía I-PAST_MEDICAL_HISTORY +dilatada I-PAST_MEDICAL_HISTORY +avanzada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +cardíaco I-PAST_MEDICAL_HISTORY +ortotópico I-PAST_MEDICAL_HISTORY +biauricular I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás, I-PAST_MEDICAL_HISTORY +procedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +donante 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 +Presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rechazo I-PAST_MEDICAL_HISTORY +humoral I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +cuarto I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +post I-PAST_MEDICAL_HISTORY +trasplante, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +trató I-PAST_MEDICAL_HISTORY +exitosamente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +metilprednisolona; I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +esa I-PAST_MEDICAL_HISTORY +oportunidad I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +coronariografía I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY +Tiene I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +adquiridas I-PAST_MEDICAL_HISTORY +post I-PAST_MEDICAL_HISTORY +trasplante. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +azatioprina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ciclosporina, I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pravastatina, I-PAST_MEDICAL_HISTORY +aspirina, I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +amlodipino. I-PAST_MEDICAL_HISTORY +Ingresó I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +angina I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esfuerzos I-PAST_MEDICAL_HISTORY +moderados, I-PAST_MEDICAL_HISTORY +asociado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +disnea, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +cedía I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +reposo. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +sólo I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +de I-EXPLORATION +100 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cuarto I-EXPLORATION +ruido I-EXPLORATION +cardíaco. I-EXPLORATION +El I-EXPLORATION +electrocardiograma I-EXPLORATION +de I-EXPLORATION +reposo I-EXPLORATION +mostró I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +regular, I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +bloqueo I-EXPLORATION +completo I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +qS I-EXPLORATION +en I-EXPLORATION +VI, I-EXPLORATION +hemibloqueo I-EXPLORATION +izquierdo I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +alteraciones I-EXPLORATION +inespecíficas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +repolarización I-EXPLORATION +ventricular I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +anterior. I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio: I-EXPLORATION +glicemia I-EXPLORATION +de I-EXPLORATION +175 I-EXPLORATION +mg/dL, I-EXPLORATION +creatininemia I-EXPLORATION +1.29 I-EXPLORATION +mg/dL, I-EXPLORATION +coleste-rol I-EXPLORATION +LDL I-EXPLORATION +62 I-EXPLORATION +mg/dL. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +endo-miocárdica I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +rechazo I-EXPLORATION +celular. I-EXPLORATION +La I-EXPLORATION +ventriculografía I-EXPLORATION +angiográfica I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +disfunción I-EXPLORATION +leve I-EXPLORATION +a I-EXPLORATION +moderada I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +e I-EXPLORATION +hipokinesia I-EXPLORATION +anteroapical. I-EXPLORATION +El I-EXPLORATION +cateterismo I-EXPLORATION +coronario I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +crítica I-EXPLORATION +ostial I-EXPLORATION +del I-EXPLORATION +TCI, I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +descendente I-EXPLORATION +anterior I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +ocluida I-EXPLORATION +luego I-EXPLORATION +del I-EXPLORATION +nacimiento I-EXPLORATION +del I-EXPLORATION +primer I-EXPLORATION +ramo I-EXPLORATION +diagonal I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +llenaba I-EXPLORATION +por I-EXPLORATION +heterocolaterales I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +coronaria I-EXPLORATION +derecha. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +otras I-EXPLORATION +lesiones I-EXPLORATION +coronarias I-EXPLORATION +significativas. I-EXPLORATION +Luego B-TREATMENT +de I-TREATMENT +discutir I-TREATMENT +las I-TREATMENT +alternativas I-TREATMENT +terapéuticas I-TREATMENT +con I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +angioplastia I-TREATMENT +exitosa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +del I-TREATMENT +TCI, I-TREATMENT +con I-TREATMENT +implante I-TREATMENT +directo I-TREATMENT +de I-TREATMENT +sfewíTaxus® I-TREATMENT +3-5 I-TREATMENT +x I-TREATMENT +22 I-TREATMENT +mm I-TREATMENT +con I-TREATMENT +flujo I-TREATMENT +final I-TREATMENT +TIMI I-TREATMENT +3. I-TREATMENT +Un B-EXPLORATION +registro I-EXPLORATION +continuo I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +en I-EXPLORATION +doce I-EXPLORATION +derivaciones, I-EXPLORATION +detectó I-EXPLORATION +infradesnivel I-EXPLORATION +significativo I-EXPLORATION +y I-EXPLORATION +transitorio I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +derivación I-EXPLORATION +V4 I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +angioplastia. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +registraron I-EXPLORATION +otros I-EXPLORATION +incidentes I-EXPLORATION +durante I-EXPLORATION +y I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +procedimiento. I-EXPLORATION +Al I-EXPLORATION +séptimo I-EXPLORATION +día I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +cintigrama I-EXPLORATION +con I-EXPLORATION +I131 I-EXPLORATION +MIBG, I-EXPLORATION +demostrándose I-EXPLORATION +captación I-EXPLORATION +del I-EXPLORATION +radiofármaco I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +post I-EVOLUTION +angioplastia I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones, I-EVOLUTION +se B-TREATMENT +incrementó I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +estatina I-TREATMENT +(pravastatina I-TREATMENT +40 I-TREATMENT +mg/día) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +agregó I-TREATMENT +clopidogrel I-TREATMENT +a I-TREATMENT +su I-TREATMENT +terapia I-TREATMENT +habitual. I-TREATMENT +A B-EXPLORATION +los I-EXPLORATION +16 I-EXPLORATION +meses I-EXPLORATION +post I-EXPLORATION +procedimiento, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentó I-EXPLORATION +disnea I-EXPLORATION +progresiva I-EXPLORATION +realizándose I-EXPLORATION +nueva I-EXPLORATION +coronariografía. I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +reestenosis I-EXPLORATION +angiográfica I-EXPLORATION +del I-EXPLORATION +TCI I-EXPLORATION +y I-EXPLORATION +progresión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +aterosclerótica I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +circunfleja I-EXPLORATION +y I-EXPLORATION +coronaria I-EXPLORATION +derecha, I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +presentaban I-EXPLORATION +estenosis I-EXPLORATION +significativas. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +revascularización I-TREATMENT +miocárdica: I-TREATMENT +injerto I-TREATMENT +de I-TREATMENT +arteria I-TREATMENT +mamaria I-TREATMENT +interna I-TREATMENT +izquierda I-TREATMENT +a I-TREATMENT +arteria I-TREATMENT +descendente I-TREATMENT +anterior I-TREATMENT +y I-TREATMENT +puentes I-TREATMENT +venosos I-TREATMENT +sáfenos I-TREATMENT +a I-TREATMENT +arteria I-TREATMENT +descendente I-TREATMENT +anterior, I-TREATMENT +rama I-TREATMENT +posterolateral I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +circunfleja I-TREATMENT +y I-TREATMENT +coronaria I-TREATMENT +derecha. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +bloqueo I-EVOLUTION +auriculoventricular I-EVOLUTION +postoperatorio I-EVOLUTION +que I-EVOLUTION +requirió I-EVOLUTION +del I-EVOLUTION +implante I-EVOLUTION +de I-EVOLUTION +marcapaso I-EVOLUTION +definitivo I-EVOLUTION +bicameral. I-EVOLUTION +Su I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +satisfactoria I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +14 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +de I-EVOLUTION +revascularización. 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 +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cefalea I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +convulsivas I-PAST_MEDICAL_HISTORY +generalizadas I-PAST_MEDICAL_HISTORY +tónico I-PAST_MEDICAL_HISTORY +clónicas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +reciente I-PAST_MEDICAL_HISTORY +inicio. I-PAST_MEDICAL_HISTORY +Debido B-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +sintomatología I-EXPLORATION +es I-EXPLORATION +sometida I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +diagnóstica I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +malformación I-EXPLORATION +arteriovenosa I-EXPLORATION +(MAV) I-EXPLORATION +perirrolándica I-EXPLORATION +(Spetzler I-EXPLORATION +III), I-EXPLORATION +dependiente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +cerebral I-EXPLORATION +media I-EXPLORATION +derecha. I-EXPLORATION +Dadas B-TREATMENT +las I-TREATMENT +características I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +tratamiento I-TREATMENT +quirúrgico. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +recibía I-TREATMENT +tratamiento I-TREATMENT +anticonvulsivante I-TREATMENT +con I-TREATMENT +ácido I-TREATMENT +valproico I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +que I-TREATMENT +era I-TREATMENT +alérgica I-TREATMENT +a I-TREATMENT +la I-TREATMENT +fenitoína. I-TREATMENT + I-TREATMENT +El I-TREATMENT +13 I-TREATMENT +de I-TREATMENT +junio I-TREATMENT +de I-TREATMENT +2006 I-TREATMENT +a I-TREATMENT +las I-TREATMENT +08: I-TREATMENT +00 I-TREATMENT +horas, I-TREATMENT +fue I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +una I-TREATMENT +craneotomía I-TREATMENT +parietal I-TREATMENT +derecha I-TREATMENT +más I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +MAV. I-TREATMENT +Durante I-TREATMENT +las I-TREATMENT +7 I-TREATMENT +horas I-TREATMENT +que I-TREATMENT +duró I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +quirúrgico, I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +7mg/kg/h I-TREATMENT +(117 I-TREATMENT +mg/kg/min) I-TREATMENT +de I-TREATMENT +propofol I-TREATMENT +y I-TREATMENT +0, I-TREATMENT +25 I-TREATMENT +mg/ I-TREATMENT +kg/min I-TREATMENT +de I-TREATMENT +remifentanil. I-TREATMENT +La I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +MAV I-TREATMENT +pudo I-TREATMENT +ser I-TREATMENT +ejecutada I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +satisfactoria I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +incidentes I-TREATMENT +intraoperatorios. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +período I-TREATMENT +postoperatorio I-TREATMENT +inmediato I-TREATMENT +(estando I-TREATMENT +aún I-TREATMENT +en I-TREATMENT +pabellón), I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +presentó I-TREATMENT +una I-TREATMENT +crisis I-TREATMENT +convulsiva I-TREATMENT +tónico I-TREATMENT +clónica I-TREATMENT +generalizada I-TREATMENT +que I-TREATMENT +cedió I-TREATMENT +con I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +4 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +lorazepam I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endovenosa. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +16: I-EVOLUTION +00 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +mismo I-EVOLUTION +día I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +vez I-EVOLUTION +estabilizada, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +trasladada I-EVOLUTION +desde I-EVOLUTION +pabellón I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Cuidados I-EVOLUTION +Intensivos I-EVOLUTION +(UCI), I-EVOLUTION +donde I-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +en I-EVOLUTION +ventilación I-EVOLUTION +mecánica I-EVOLUTION +y B-TREATMENT +se I-TREATMENT +continúan I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +de I-TREATMENT +neuroprotección I-TREATMENT +habituales, I-TREATMENT +incluida I-TREATMENT +la I-TREATMENT +sedo-analgesia I-TREATMENT +(midazolam/ I-TREATMENT +fentanil) I-TREATMENT +y I-TREATMENT +el I-TREATMENT +control I-TREATMENT +de I-TREATMENT +las I-TREATMENT +crisis I-TREATMENT +convulsivas I-TREATMENT +con I-TREATMENT +ácido I-TREATMENT +valproico. I-TREATMENT + I-TREATMENT +Los B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +química I-EXPLORATION +sanguínea I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rangos I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +disfunción I-EXPLORATION +renal, I-EXPLORATION +hepática I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +infección I-EXPLORATION +activa. I-EXPLORATION +Sin I-EXPLORATION +embargo, I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +17: I-EXPLORATION +00 I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +acidosis I-EXPLORATION +láctica I-EXPLORATION +incipiente I-EXPLORATION +con I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +34; I-EXPLORATION +PaC02 I-EXPLORATION +36 I-EXPLORATION +mmHg, I-EXPLORATION +Bicarbonato I-EXPLORATION +19 I-EXPLORATION +mmol/L; I-EXPLORATION +BE I-EXPLORATION +- I-EXPLORATION +6, I-EXPLORATION +4 I-EXPLORATION +mmol/L I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +láctico I-EXPLORATION +4, I-EXPLORATION +1 I-EXPLORATION +mmol/L. I-EXPLORATION +En I-EXPLORATION +ese I-EXPLORATION +momento, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +estable I-EXPLORATION +en I-EXPLORATION +lo I-EXPLORATION +hemodinámico, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +media I-EXPLORATION +(PAM) I-EXPLORATION +de I-EXPLORATION +80 I-EXPLORATION +mmHg, I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +de I-EXPLORATION +70 I-EXPLORATION +lat/min I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +diuresis I-EXPLORATION +de I-EXPLORATION +60 I-EXPLORATION +a I-EXPLORATION +80 I-EXPLORATION +ml/h, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +hipoperfusión I-EXPLORATION +clínica I-EXPLORATION +(piel I-EXPLORATION +tibia I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +adecuado I-EXPLORATION +llene I-EXPLORATION +capilar). I-EXPLORATION + I-EXPLORATION +Luego I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +estabilización I-EXPLORATION +inicial, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +cambios I-EXPLORATION +post-quirúrgicos: I-EXPLORATION +lecho I-EXPLORATION +operatorio I-EXPLORATION +sin I-EXPLORATION +hematoma I-EXPLORATION +y I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +conservada. I-EXPLORATION +El I-EXPLORATION +electroencefalograma I-EXPLORATION +descartó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +actividad I-EXPLORATION +epileptógena I-EXPLORATION +y I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +ritmo I-EXPLORATION +lento I-EXPLORATION +generalizado I-EXPLORATION +atribuible I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +sedación. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +mantuvieron I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +habituales I-TREATMENT +de I-TREATMENT +manejo I-TREATMENT +post-quirúrgico, I-TREATMENT +garantizando I-TREATMENT +una I-TREATMENT +adecuada I-TREATMENT +presión I-TREATMENT +de I-TREATMENT +perfusión I-TREATMENT +cerebral. I-TREATMENT +Durante B-EVOLUTION +las I-EVOLUTION +siguientes I-EVOLUTION +horas I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +nuevas I-EVOLUTION +crisis I-EVOLUTION +convulsivas I-EVOLUTION +motoras. I-EVOLUTION + I-EVOLUTION +A B-EXPLORATION +las I-EXPLORATION +21: I-EXPLORATION +00 I-EXPLORATION +horas, I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +control I-EXPLORATION +gasométri-co I-EXPLORATION +pone I-EXPLORATION +en I-EXPLORATION +evidencia I-EXPLORATION +el I-EXPLORATION +agravamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +acidosis I-EXPLORATION +láctica: I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +12; I-EXPLORATION +PaC02 I-EXPLORATION +31 I-EXPLORATION +mmHg; I-EXPLORATION +bicarbonato I-EXPLORATION +10 I-EXPLORATION +mmol/L; I-EXPLORATION +BE I-EXPLORATION +- I-EXPLORATION +18 I-EXPLORATION +mmol/L I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +láctico I-EXPLORATION +9, I-EXPLORATION +9 I-EXPLORATION +mmol/L; I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +saturación I-EXPLORATION +venosa I-EXPLORATION +central I-EXPLORATION +de I-EXPLORATION +86%. I-EXPLORATION +El I-EXPLORATION +electrocardiograma I-EXPLORATION +no I-EXPLORATION +mostraba I-EXPLORATION +cambios I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +isquemia I-EXPLORATION +miocár-dica I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +enzimas I-EXPLORATION +cardiacas I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +contexto, I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +monitori-zación I-EXPLORATION +hemodinámica I-EXPLORATION +invasiva I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +catéter I-EXPLORATION +de I-EXPLORATION +arteria I-EXPLORATION +pulmonar, I-EXPLORATION +encontrándose I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +de I-EXPLORATION +oclusión I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +(POAP) I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +mmHg, I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +cardíaco I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +2 I-EXPLORATION +L/min/m2, I-EXPLORATION +una I-EXPLORATION +resistencia I-EXPLORATION +vascular I-EXPLORATION +sistémica I-EXPLORATION +indexada I-EXPLORATION +de I-EXPLORATION +1174 I-EXPLORATION +dinassegcm^m2 I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +saturación I-EXPLORATION +venosa I-EXPLORATION +mixta I-EXPLORATION +(Satvm) I-EXPLORATION +de I-EXPLORATION +77%. I-EXPLORATION +Se B-TREATMENT +continuó I-TREATMENT +el I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +fluidos I-TREATMENT +trazándose I-TREATMENT +como I-TREATMENT +meta I-TREATMENT +una I-TREATMENT +POAP I-TREATMENT +de I-TREATMENT +14 I-TREATMENT +a I-TREATMENT +16 I-TREATMENT +mmHg I-TREATMENT +y I-TREATMENT +se I-TREATMENT +asoció I-TREATMENT +noradrenalina I-TREATMENT +con I-TREATMENT +el I-TREATMENT +objeto I-TREATMENT +de I-TREATMENT +mantener I-TREATMENT +una I-TREATMENT +PAM I-TREATMENT +de I-TREATMENT +90 I-TREATMENT +a I-TREATMENT +100 I-TREATMENT +mmHg. I-TREATMENT +Adicionalmente, I-TREATMENT +se I-TREATMENT +incrementó I-TREATMENT +la I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +midazolam I-TREATMENT +a I-TREATMENT +20 I-TREATMENT +mg/h I-TREATMENT +y I-TREATMENT +se I-TREATMENT +reinició I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +propofol I-TREATMENT +a I-TREATMENT +3, I-TREATMENT +5 I-TREATMENT +mg/kg/h I-TREATMENT +(58 I-TREATMENT +Lig/kg/min) I-TREATMENT +para I-TREATMENT +alcanzar I-TREATMENT +un I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +en I-TREATMENT +la I-TREATMENT +escala I-TREATMENT +de I-TREATMENT +sedación-agitación I-TREATMENT +descrita I-TREATMENT +por I-TREATMENT +Riker16. I-TREATMENT + I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +pese I-EVOLUTION +a I-EVOLUTION +mantenerse I-EVOLUTION +estable I-EVOLUTION +en I-EVOLUTION +lo I-EVOLUTION +macro I-EVOLUTION +y I-EVOLUTION +microhemodinámico I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +disfunciones I-EVOLUTION +orgánicas, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +00: I-EVOLUTION +20 I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +llamativamente, I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +acidosis I-EVOLUTION +láctica: I-EVOLUTION +pH I-EVOLUTION +7, I-EVOLUTION +0 I-EVOLUTION +y I-EVOLUTION +ácido I-EVOLUTION +láctico I-EVOLUTION +8, I-EVOLUTION +5 I-EVOLUTION +con I-EVOLUTION +Satvm I-EVOLUTION +80%. I-EVOLUTION +No B-TREATMENT +fue I-TREATMENT +posible I-TREATMENT +identificar I-TREATMENT +una I-TREATMENT +causa I-TREATMENT +evidente I-TREATMENT +que I-TREATMENT +explicase I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +clínica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +soporte. I-TREATMENT +En B-EVOLUTION +las I-EVOLUTION +horas I-EVOLUTION +siguientes, I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +un I-EVOLUTION +cambio I-EVOLUTION +significativo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +acidosis I-EVOLUTION +metabólica. I-EVOLUTION + I-EVOLUTION +Finalmente, B-TREATMENT +se I-TREATMENT +sospechó I-TREATMENT +que I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +propofol I-TREATMENT +podría I-TREATMENT +ser I-TREATMENT +la I-TREATMENT +causa I-TREATMENT +desencadenante I-TREATMENT +y I-TREATMENT +la I-TREATMENT +perpetuadora I-TREATMENT +de I-TREATMENT +la I-TREATMENT +acidosis I-TREATMENT +láctica, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +suspender I-TREATMENT +la I-TREATMENT +infusión I-TREATMENT +a I-TREATMENT +las I-TREATMENT +08: I-TREATMENT +30, I-TREATMENT +habiendo I-TREATMENT +completado I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +adicionales I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía. I-TREATMENT +La B-EVOLUTION +condición I-EVOLUTION +hemodinámica I-EVOLUTION +continuó I-EVOLUTION +estable I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +mañana. I-EVOLUTION +Cuatro B-EXPLORATION +horas I-EXPLORATION +más I-EXPLORATION +tarde I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +control I-EXPLORATION +gasométrico, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +pudo I-EXPLORATION +apreciar I-EXPLORATION +la I-EXPLORATION +corrección I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +acidosis I-EXPLORATION +láctica: I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +53 I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +láctico I-EXPLORATION +2, I-EXPLORATION +9 I-EXPLORATION +mmol/ I-EXPLORATION +L I-EXPLORATION +con I-EXPLORATION +PaC02 I-EXPLORATION +24 I-EXPLORATION +mmHg. I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +19: I-EVOLUTION +00, I-EVOLUTION +once I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +del I-EVOLUTION +propofol, I-EVOLUTION +el I-EVOLUTION +acido I-EVOLUTION +láctico I-EVOLUTION +ya I-EVOLUTION +se I-EVOLUTION +había I-EVOLUTION +normalizado: I-EVOLUTION +1, I-EVOLUTION +6 I-EVOLUTION +mmol/L. I-EVOLUTION +Posteriormente, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +tuvo I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable, I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +asociadas I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +descompensación I-EVOLUTION +metabólica. I-EVOLUTION +No I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +crisis I-EVOLUTION +convulsivas, I-EVOLUTION +pudiendo I-EVOLUTION +ser I-EVOLUTION +extuba-da I-EVOLUTION +y I-EVOLUTION +trasladada I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones. I-EVOLUTION + I-EVOLUTION + +En B-DERIVED_FROM/TO +diciembre I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2004 I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Policlínica I-DERIVED_FROM/TO +Nefrológica I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Clínicas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Montevideo, I-DERIVED_FROM/TO +un B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +raza I-PRESENT_ILLNESS +blanca, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +para B-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +proteinuria I-DERIVED_FROM/TO +aislada, I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +nefrótica, I-DERIVED_FROM/TO +detectada I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +examen I-DERIVED_FROM/TO +preventivo. I-DERIVED_FROM/TO +Fue B-EXPLORATION +descartada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interrogatorio I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +orinas I-EXPLORATION +espumosas, I-EXPLORATION +edemas I-EXPLORATION +o I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +diuresis. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +120/70 I-EXPLORATION +mmHg. I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio: I-EXPLORATION +proteinuria I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +2 I-EXPLORATION +g/1, I-EXPLORATION +selectiva, I-EXPLORATION +con I-EXPLORATION +80% I-EXPLORATION +de I-EXPLORATION +albúmina, I-EXPLORATION +no I-EXPLORATION +microhematuria, I-EXPLORATION +creatininemia I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +89 I-EXPLORATION +mm/dl, I-EXPLORATION +azoemia: I-EXPLORATION +0, I-EXPLORATION +12 I-EXPLORATION +g/ I-EXPLORATION +1; I-EXPLORATION +albuminemia: I-EXPLORATION +4, I-EXPLORATION +9 I-EXPLORATION +g/dl; I-EXPLORATION +proteinemia: I-EXPLORATION +7, I-EXPLORATION +8 I-EXPLORATION +g/dl, I-EXPLORATION +gamma I-EXPLORATION +globulina: I-EXPLORATION +1, I-EXPLORATION +3 I-EXPLORATION +g/dl, I-EXPLORATION +colesterol: I-EXPLORATION +166 I-EXPLORATION +mg/dl, I-EXPLORATION +triglicéridos: I-EXPLORATION +35 I-EXPLORATION +mg/dl, I-EXPLORATION +HDL: I-EXPLORATION +39 I-EXPLORATION +mg/dl, I-EXPLORATION +LDL I-EXPLORATION +120 I-EXPLORATION +mg/ I-EXPLORATION +di; I-EXPLORATION +urocultivo: I-EXPLORATION +negativo. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(ANA) I-EXPLORATION +y I-EXPLORATION +anti-ADN I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +en I-EXPLORATION +2 I-EXPLORATION +oportunidades. I-EXPLORATION +Enzimograma I-EXPLORATION +hepático: I-EXPLORATION +BT I-EXPLORATION +0, I-EXPLORATION +82 I-EXPLORATION +mg/ I-EXPLORATION +di, I-EXPLORATION +TGO I-EXPLORATION +22, I-EXPLORATION +TGP I-EXPLORATION +15, I-EXPLORATION +FA I-EXPLORATION +2, I-EXPLORATION +26, I-EXPLORATION +yGT I-EXPLORATION +28 I-EXPLORATION +(Ul/lt). I-EXPLORATION +La I-EXPLORATION +complementemia I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +ANCA I-EXPLORATION +y I-EXPLORATION +HIV, I-EXPLORATION +Virus I-EXPLORATION +hepatitis I-EXPLORATION +C I-EXPLORATION +y I-EXPLORATION +B I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +abdominal I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +enalapril I-TREATMENT +(40 I-TREATMENT +mg/día) I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +losartán I-TREATMENT +(50 I-TREATMENT +mg/día). I-TREATMENT +Presentó B-EVOLUTION +una I-EVOLUTION +remisión I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +proteinuria, I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +total I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +iniciado I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION +La I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +normal. I-EVOLUTION +Con B-EXPLORATION +el I-EXPLORATION +planteo I-EXPLORATION +clínico I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +EFS I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +con I-EXPLORATION +microscopía I-EXPLORATION +de I-EXPLORATION +luz I-EXPLORATION +(ML), I-EXPLORATION +microscopía I-EXPLORATION +electrónica I-EXPLORATION +(ME) I-EXPLORATION +e I-EXPLORATION +inmunofluorescencia I-EXPLORATION +(IF). I-EXPLORATION + I-EXPLORATION +Histopatología. I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +20 I-EXPLORATION +glomérulos, I-EXPLORATION +1 I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +con I-EXPLORATION +esclerosis I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +50% I-EXPLORATION +del I-EXPLORATION +área I-EXPLORATION +del I-EXPLORATION +glomérulo, I-EXPLORATION +en I-EXPLORATION +tanto I-EXPLORATION +que I-EXPLORATION +4 I-EXPLORATION +evidenciaron I-EXPLORATION +esclerosis I-EXPLORATION +segmentaria I-EXPLORATION +leve, I-EXPLORATION +moderado I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +matriz I-EXPLORATION +mesangial I-EXPLORATION +y I-EXPLORATION +sinequias I-EXPLORATION +entre I-EXPLORATION +asas I-EXPLORATION +capilares I-EXPLORATION +glomerulares I-EXPLORATION +y I-EXPLORATION +cápsula I-EXPLORATION +de I-EXPLORATION +Bowman. I-EXPLORATION +Se I-EXPLORATION +encontraron I-EXPLORATION +escasos I-EXPLORATION +depósitos I-EXPLORATION +fucsinófilos I-EXPLORATION +yux-tamesangiales I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +tricrómico I-EXPLORATION +de I-EXPLORATION +Masson. I-EXPLORATION +El I-EXPLORATION +sector I-EXPLORATION +túbulo-intersticial I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +pequeño I-EXPLORATION +foco I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +tubular I-EXPLORATION +y I-EXPLORATION +algunos I-EXPLORATION +cilindros I-EXPLORATION +con I-EXPLORATION +eritrocitos I-EXPLORATION +crenados. I-EXPLORATION +Las I-EXPLORATION +arterias I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Inmunofluorescencia. I-EXPLORATION +Demostró I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +Clq I-EXPLORATION ++++, I-EXPLORATION +dominante; I-EXPLORATION +IgA++ I-EXPLORATION +perihiliar; I-EXPLORATION +IgG, I-EXPLORATION +IgM, I-EXPLORATION +C3 I-EXPLORATION +positivas++, I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +granular I-EXPLORATION +grueso, I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +a I-EXPLORATION +predominio I-EXPLORATION +mesangial I-EXPLORATION +fibrinógeno: I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Microscopía I-EXPLORATION +electrónica. I-EXPLORATION +Se I-EXPLORATION +observó I-EXPLORATION +aplanamiento I-EXPLORATION +pedicelar I-EXPLORATION +menor I-EXPLORATION +a I-EXPLORATION +20% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +asas I-EXPLORATION +capilares, I-EXPLORATION +depósitos I-EXPLORATION +electrondensos I-EXPLORATION +granulares I-EXPLORATION +paramesangiales I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +refleja I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +basal I-EXPLORATION +glomerular I-EXPLORATION +(MBG) I-EXPLORATION +y I-EXPLORATION +moderada I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +colágenas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +mesangio, I-EXPLORATION +en I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +esclerosis I-EXPLORATION +glomerular. I-EXPLORATION +El I-EXPLORATION +endotelio I-EXPLORATION +capilar I-EXPLORATION +glomerular I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +inclusiones I-EXPLORATION +túbulo I-EXPLORATION +reticulares I-EXPLORATION +(ITR). I-EXPLORATION + I-EXPLORATION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos, I-PAST_MEDICAL_HISTORY +consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +frente, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +único, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +firme, I-EXPLORATION +elástico, I-EXPLORATION +no I-EXPLORATION +adherido I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +profundos, I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +0, I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +con I-EXPLORATION +algunas I-EXPLORATION +pápulas I-EXPLORATION +eritematosas I-EXPLORATION +levemente I-EXPLORATION +translúcidas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +telangiectasias. I-EXPLORATION +Se B-TREATMENT +extrajo I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +y I-TREATMENT +se I-TREATMENT +envió I-TREATMENT +a I-TREATMENT +anatomía I-TREATMENT +patológica I-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +clínico I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +basocelular I-TREATMENT +sobre I-TREATMENT +quiste I-TREATMENT +epidérmico. I-TREATMENT +Al B-EVOLUTION +momento I-EVOLUTION +del I-EVOLUTION +control I-EVOLUTION +clínico, I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +después, I-EVOLUTION +presentó I-EVOLUTION +otro I-EVOLUTION +tumor I-EVOLUTION +más I-EVOLUTION +pequeño I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +supraciliar I-EVOLUTION +derecha, I-EVOLUTION +de I-EVOLUTION +similares I-EVOLUTION +características I-EVOLUTION +al I-EVOLUTION +primero. I-EVOLUTION +El B-EXPLORATION +examen I-EXPLORATION +anatomopatológico I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +frontal I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +SH. I-EXPLORATION +Estudios I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +(tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +y I-EXPLORATION +cuello) I-EXPLORATION +mostraron I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +nodulares I-EXPLORATION +en I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +regiones I-EXPLORATION +temporales, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +adenopatías I-EXPLORATION +submandibulares I-EXPLORATION +y I-EXPLORATION +yugulo-digástricas. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +nodulos I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +glándulas I-EXPLORATION +parótidas. I-EXPLORATION +Estudios I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +incluyeron I-EXPLORATION +hemograma I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +valores: I-EXPLORATION +hemoglobina, I-EXPLORATION +16, I-EXPLORATION +0 I-EXPLORATION +gr/dF I-EXPLORATION +(valores I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +(VR), I-EXPLORATION +13, I-EXPLORATION +5-17, I-EXPLORATION +5); I-EXPLORATION +hematocrito, I-EXPLORATION +45, I-EXPLORATION +8% I-EXPLORATION +(VR, I-EXPLORATION +41-53); I-EXPLORATION +leucocitos, I-EXPLORATION +5, I-EXPLORATION +0 I-EXPLORATION +x I-EXPLORATION +103 I-EXPLORATION +/mm3 I-EXPLORATION +(VR, I-EXPLORATION +4, I-EXPLORATION +5-11) I-EXPLORATION +y I-EXPLORATION +plaquetas, I-EXPLORATION +200 I-EXPLORATION +x I-EXPLORATION +103/mm3 I-EXPLORATION +(VR, I-EXPLORATION +140-400). I-EXPLORATION +El I-EXPLORATION +recuento I-EXPLORATION +leucocitos I-EXPLORATION +fue: I-EXPLORATION +neutrófilos, I-EXPLORATION +53%; I-EXPLORATION +eosinófilos, I-EXPLORATION +4%; I-EXPLORATION +monocitos, I-EXPLORATION +18% I-EXPLORATION +y I-EXPLORATION +linfocitos, I-EXPLORATION +25%. I-EXPLORATION +Otros I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +(perfil I-EXPLORATION +bioquímico I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +hepáticas) I-EXPLORATION +estuvieron I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +tratado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +otra I-DERIVED_FROM/TO +institución I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +desafortunadamente I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +perdió I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +seguimiento I-DERIVED_FROM/TO +clínico. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +HALLAZGOS B-EXPLORATION +HISTOLÓGICOS I-EXPLORATION + I-EXPLORATION +Microscópicamente, I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +frontal I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +celular I-EXPLORATION +atípica, I-EXPLORATION +difusa, I-EXPLORATION +en I-EXPLORATION +dermis I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +profunda, I-EXPLORATION +no I-EXPLORATION +epidermotrópica I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +Grenz. I-EXPLORATION +Constituida I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +medianas I-EXPLORATION +a I-EXPLORATION +grandes, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +epiteloideo I-EXPLORATION +y I-EXPLORATION +pleomorfismo I-EXPLORATION +variable, I-EXPLORATION +que I-EXPLORATION +incluye I-EXPLORATION +formas I-EXPLORATION +multinucleadas. I-EXPLORATION +Se I-EXPLORATION +observó I-EXPLORATION +además I-EXPLORATION +un I-EXPLORATION +componente I-EXPLORATION +linfocitario I-EXPLORATION +prominente, I-EXPLORATION +numerosas I-EXPLORATION +mitosis I-EXPLORATION +y I-EXPLORATION +cuerpos I-EXPLORATION +apoptóticos. I-EXPLORATION + I-EXPLORATION +Inmunohistoquímicamente, I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +neoplásicas I-EXPLORATION +mostraron I-EXPLORATION +reacción I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +CD43, I-EXPLORATION +CD45, I-EXPLORATION +CD4 I-EXPLORATION +(parcial), I-EXPLORATION +CD30 I-EXPLORATION +(difuso), I-EXPLORATION +CD68, I-EXPLORATION +CD163, I-EXPLORATION +mieloperoxidasa, I-EXPLORATION +lizosima I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +S-100 I-EXPLORATION +; I-EXPLORATION +y I-EXPLORATION +reacción I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +TdT, I-EXPLORATION +CD34, I-EXPLORATION +CD117, I-EXPLORATION +CD3, I-EXPLORATION +CD20, I-EXPLORATION +HMB45 I-EXPLORATION +y I-EXPLORATION +citoqueratinas I-EXPLORATION +totales. I-EXPLORATION + I-EXPLORATION +Mielograma I-EXPLORATION +y I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +hipoplasia I-EXPLORATION +medular I-EXPLORATION +con I-EXPLORATION +cambios I-EXPLORATION +displásicos I-EXPLORATION +leves. I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +clonalidad I-EXPLORATION +mediante I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +reacción I-EXPLORATION +de I-EXPLORATION +polimerasa I-EXPLORATION +en I-EXPLORATION +cadena, I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +reordenamiento I-EXPLORATION +policlonal I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +y I-EXPLORATION +B. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +81 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +deterioro I-PRESENT_ILLNESS +cognitivo I-PRESENT_ILLNESS +moderado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Alzheimer I-PRESENT_ILLNESS +e B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nodulo I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +pesquisado I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +ingreso, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +creció I-PAST_MEDICAL_HISTORY +rápidamente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +últimas I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +semanas, I-PAST_MEDICAL_HISTORY +consultando B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +reposo, I-PRESENT_ILLNESS +ortopnea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disfagia. I-PRESENT_ILLNESS +Fue B-PAST_MEDICAL_HISTORY +estudiada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +centro, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +volumen I-PAST_MEDICAL_HISTORY +tiroideo, I-PAST_MEDICAL_HISTORY +TSH I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +32, I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +mUI/ml I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anti I-PAST_MEDICAL_HISTORY +TPO I-PAST_MEDICAL_HISTORY +(++). I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +realizaron I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +punciones I-PAST_MEDICAL_HISTORY +tiroideas, I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ellas I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +muestra I-PAST_MEDICAL_HISTORY +insuficiente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +última I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +informada I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +tiroiditis I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +tomografía I-PAST_MEDICAL_HISTORY +computada I-PAST_MEDICAL_HISTORY +(TC) I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +informó I-PAST_MEDICAL_HISTORY +gran I-PAST_MEDICAL_HISTORY +masa I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +reemplaza I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tiroides, I-PAST_MEDICAL_HISTORY +infiltra I-PAST_MEDICAL_HISTORY +musculatura I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +piel I-PAST_MEDICAL_HISTORY +adyacente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +rodea I-PAST_MEDICAL_HISTORY +paquete I-PAST_MEDICAL_HISTORY +vascular I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +derecho. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +octubre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2004 I-PAST_MEDICAL_HISTORY +consultó I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +urgencia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +centro I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +disnea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +progresó I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +disnea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +reposo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +ansiosa, I-EXPLORATION +lúcida I-EXPLORATION +y I-EXPLORATION +afebril, I-EXPLORATION +taquipneica, I-EXPLORATION +con I-EXPLORATION +tiraje, I-EXPLORATION +estridor I-EXPLORATION +laríngeo I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +pétreo I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +cervical I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +múltiples I-EXPLORATION +adenopatías I-EXPLORATION +cervicales. I-EXPLORATION +Saturación I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +(VHS) I-EXPLORATION +de I-EXPLORATION +78 I-EXPLORATION +mm/h I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +de I-EXPLORATION +436 I-EXPLORATION +U/ I-EXPLORATION +L. I-EXPLORATION +Hemograma, I-EXPLORATION +perfil I-EXPLORATION +bioquímico, I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +hospitalizó I-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +cervical I-TREATMENT +anterior, I-TREATMENT +posiblemente I-TREATMENT +cáncer I-TREATMENT +tiroideo I-TREATMENT +anaplástico I-TREATMENT +y I-TREATMENT +obstrucción I-TREATMENT +secundaria I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +aérea. I-TREATMENT +Se I-TREATMENT +planteó I-TREATMENT +resección I-TREATMENT +tumoral I-TREATMENT +para I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +urgencia I-TREATMENT +obstructiva. I-TREATMENT + I-TREATMENT +En I-TREATMENT +pabellón, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +nasofibroscopia I-TREATMENT +sin I-TREATMENT +hallazgos I-TREATMENT +patológicos I-TREATMENT +y I-TREATMENT +fibrobroncoscopia I-TREATMENT +(FBC) I-TREATMENT +que I-TREATMENT +constató I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +tiroideo I-TREATMENT +una I-TREATMENT +estenosis I-TREATMENT +traqueal I-TREATMENT +severa, I-TREATMENT +extrínseca, I-TREATMENT +sin I-TREATMENT +compromiso I-TREATMENT +endoluminal I-TREATMENT +ni I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tráquea I-TREATMENT +distal, I-TREATMENT +procediendo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +intubación I-TREATMENT +nasotraqueal I-TREATMENT +(N° I-TREATMENT +5.5) I-TREATMENT +guiada I-TREATMENT +por I-TREATMENT +FBC. I-TREATMENT + I-TREATMENT +En I-TREATMENT +el I-TREATMENT +acto I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +infiltración I-TREATMENT +de I-TREATMENT +musculatura I-TREATMENT +pretlroidea I-TREATMENT +secundaria I-TREATMENT +a I-TREATMENT +tumor I-TREATMENT +subyacente, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +era I-TREATMENT +de I-TREATMENT +gran I-TREATMENT +tamaño, I-TREATMENT +aspecto I-TREATMENT +encefaloideo, I-TREATMENT +muy I-TREATMENT +vascularizado I-TREATMENT +y I-TREATMENT +mal I-TREATMENT +definido. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +istmectomía I-TREATMENT +tiroidea I-TREATMENT +para I-TREATMENT +ubicar I-TREATMENT +vía I-TREATMENT +aérea I-TREATMENT +e I-TREATMENT +instalar I-TREATMENT +traqueostomía. I-TREATMENT +La I-TREATMENT +tráquea I-TREATMENT +estaba I-TREATMENT +notoriamente I-TREATMENT +desviada I-TREATMENT +a I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +muy I-TREATMENT +profunda, I-TREATMENT +12 I-TREATMENT +cm I-TREATMENT +bajo I-TREATMENT +el I-TREATMENT +plano I-TREATMENT +cutáneo, I-TREATMENT +siendo I-TREATMENT +imposible I-TREATMENT +instalar I-TREATMENT +cánula I-TREATMENT +de I-TREATMENT +traqueostomía, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +utilizó I-TREATMENT +un I-TREATMENT +tubo I-TREATMENT +orotraqueal I-TREATMENT +N° I-TREATMENT +5.5 I-TREATMENT +con I-TREATMENT +cuff. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +examen I-EXPLORATION +anatomopatológico I-EXPLORATION +informó I-EXPLORATION +"proliferación I-EXPLORATION +celular I-EXPLORATION +linfoide, I-EXPLORATION +dispuesta I-EXPLORATION +en I-EXPLORATION +sábanas I-EXPLORATION +de I-EXPLORATION +mediano I-EXPLORATION +y I-EXPLORATION +gran I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +irregulares I-EXPLORATION +e I-EXPLORATION +hipercromáticos, I-EXPLORATION +nucléolo I-EXPLORATION +poco I-EXPLORATION +prominente I-EXPLORATION +y I-EXPLORATION +escaso I-EXPLORATION +citoplasma I-EXPLORATION +eosinófilo I-EXPLORATION +pálido, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +tejido I-EXPLORATION +tiroideo, I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +y I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +extensamente I-EXPLORATION +infiltrado I-EXPLORATION +por I-EXPLORATION +neoplasia". I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +inmunohistoquímica I-EXPLORATION +señaló I-EXPLORATION +antígeno I-EXPLORATION +leuco-citario I-EXPLORATION +común I-EXPLORATION +(+), I-EXPLORATION +CD20 I-EXPLORATION +(+) I-EXPLORATION +focalmente, I-EXPLORATION +vimentina I-EXPLORATION +(+), I-EXPLORATION +queratina I-EXPLORATION +(-), I-EXPLORATION +BCL2 I-EXPLORATION +(-), I-EXPLORATION +CD10 I-EXPLORATION +(-), I-EXPLORATION +CICLINA I-EXPLORATION +DI I-EXPLORATION +(-), I-EXPLORATION +CD30 I-EXPLORATION +(-), I-EXPLORATION +CD45RO I-EXPLORATION +(-) I-EXPLORATION +en I-EXPLORATION +células I-EXPLORATION +neoplásicas. I-EXPLORATION +Diagnóstico I-EXPLORATION +definitivo: I-EXPLORATION +linfoma I-EXPLORATION +no I-EXPLORATION +Hodgkin I-EXPLORATION +tiroideo I-EXPLORATION +difuso, I-EXPLORATION +estirpe I-EXPLORATION +B, I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +postoperatorio, I-EVOLUTION +salvo I-EVOLUTION +broncorrea I-EVOLUTION +purulenta I-EVOLUTION +por I-EVOLUTION +Pseudomona I-EVOLUTION +aeruginosa I-EVOLUTION +multisensible I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +tratada I-EVOLUTION +con I-EVOLUTION +antibióticos. I-EVOLUTION +Se B-TREATMENT +instaló I-TREATMENT +sonda I-TREATMENT +nasoye-yunal I-TREATMENT +para I-TREATMENT +iniciar I-TREATMENT +alimentación I-TREATMENT +progresiva. I-TREATMENT + I-TREATMENT +Evaluada B-EXPLORATION +por I-EXPLORATION +hematología, I-EXPLORATION +solicitaron I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +etapificación I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +otros I-EXPLORATION +focos I-EXPLORATION +tumora-les, I-EXPLORATION +confirmando I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +primario I-EXPLORATION +tiroideo I-EXPLORATION +del I-EXPLORATION +linfoma. I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +tumor I-EXPLORATION +remanente I-EXPLORATION +rodeando I-EXPLORATION +parcialmente I-EXPLORATION +la I-EXPLORATION +tráquea I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +paratraqueales I-EXPLORATION +derechas I-EXPLORATION +de I-EXPLORATION +1-2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION + I-EXPLORATION +Comenzó B-TREATMENT +tratamiento I-TREATMENT +definitivo I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +CHOP I-TREATMENT +(ciclofosfamida, I-TREATMENT +adriamicina, I-TREATMENT +vincristina I-TREATMENT +y I-TREATMENT +betametasona) I-TREATMENT +al I-TREATMENT +vigésimo I-TREATMENT +día I-TREATMENT +postoperatorio, I-TREATMENT +con I-TREATMENT +respuesta I-TREATMENT +completa I-TREATMENT +tras I-TREATMENT +primer I-TREATMENT +ciclo, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +permitió I-TREATMENT +reemplazar I-TREATMENT +tubo I-TREATMENT +orotraqueal I-TREATMENT +por I-TREATMENT +cánula I-TREATMENT +de I-TREATMENT +traqueostomía I-TREATMENT +N° I-TREATMENT +7. I-TREATMENT +Se I-TREATMENT +otorgó I-TREATMENT +el I-TREATMENT +alta I-TREATMENT +domiciliaria I-TREATMENT +al I-TREATMENT +finalizar I-TREATMENT +el I-TREATMENT +segundo I-TREATMENT +ciclo. I-TREATMENT + I-TREATMENT +Luego I-TREATMENT +del I-TREATMENT +tercer I-TREATMENT +ciclo I-TREATMENT +de I-TREATMENT +quimioterapia, I-TREATMENT +abandonó I-TREATMENT +tratamiento. I-TREATMENT +Familiares B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +trasladaron I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +adultos I-DERIVED_FROM/TO +mayores, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +falleció I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +diciembre I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2004, I-DERIVED_FROM/TO +aparentemente I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +insuficiencia I-DERIVED_FROM/TO +respiratoria I-DERIVED_FROM/TO +aguda. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Primigesta B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +gestación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +semanas, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Obstetricia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Ginecología I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Clínico I-PRESENT_ILLNESS +San I-PRESENT_ILLNESS +Borja I-PRESENT_ILLNESS +Arriarán I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2008, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +05: I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +trabajo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +parto I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fase I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dilatación I-PRESENT_ILLNESS +rápida I-PRESENT_ILLNESS +(5 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dilatación) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +expulsión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +líquido I-PRESENT_ILLNESS +amniótico I-PRESENT_ILLNESS +(LA) I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +tinte I-PRESENT_ILLNESS +meconial. I-PRESENT_ILLNESS +Tuvo I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +rotura I-PRESENT_ILLNESS +precoz I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +membranas I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +min I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-EXPLORATION +embarazo I-EXPLORATION +fue I-EXPLORATION +controlado I-EXPLORATION +regularmente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Consultorio I-EXPLORATION +de I-EXPLORATION +Maipú I-EXPLORATION +y I-EXPLORATION +fue I-EXPLORATION +considerado I-EXPLORATION +como I-EXPLORATION +fisiológico. I-EXPLORATION +Al I-EXPLORATION +ingreso, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +afebril, I-EXPLORATION +normotensa I-EXPLORATION +y I-EXPLORATION +pulso I-EXPLORATION +de I-EXPLORATION +80 I-EXPLORATION +por I-EXPLORATION +min. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +obstétrico I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +dilatación, I-EXPLORATION +presentación I-EXPLORATION +cefálica I-EXPLORATION +apoyada, I-EXPLORATION +membranas I-EXPLORATION +rotas, I-EXPLORATION +LA I-EXPLORATION +con I-EXPLORATION +tinte I-EXPLORATION +meconial I-EXPLORATION +y I-EXPLORATION +latidos I-EXPLORATION +cardiofetales I-EXPLORATION +(LCF) I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +exámenes I-EXPLORATION +hematológicos I-EXPLORATION +para I-EXPLORATION +pesquisar I-EXPLORATION +infección, I-EXPLORATION +porque I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +carecía I-EXPLORATION +de I-EXPLORATION +manifestaciones I-EXPLORATION +clínicas I-EXPLORATION +compatibles. I-EXPLORATION +Se I-EXPLORATION +indicó I-EXPLORATION +anestesia I-EXPLORATION +de I-EXPLORATION +conducción I-EXPLORATION +con I-EXPLORATION +peridural I-EXPLORATION +continua I-EXPLORATION +y I-EXPLORATION +monitorización I-EXPLORATION +electrónica I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +variabilidad I-EXPLORATION +menor I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +LCF, I-EXPLORATION +una I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +fetal I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +150 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +min I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +desaceleración I-EXPLORATION +variable I-EXPLORATION +prolongada I-EXPLORATION +(hasta I-EXPLORATION +120 I-EXPLORATION +LCF I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +durante I-EXPLORATION +3 I-EXPLORATION +min). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +reevaluó I-EXPLORATION +luego I-EXPLORATION +de I-EXPLORATION +nueva I-EXPLORATION +desaceleración I-EXPLORATION +(60 I-EXPLORATION +LCF I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +durante I-EXPLORATION +7 I-EXPLORATION +min) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +8 I-EXPLORATION +a I-EXPLORATION +9 I-EXPLORATION +cms I-EXPLORATION +de I-EXPLORATION +dilatación, I-EXPLORATION +presentación I-EXPLORATION +cefálica I-EXPLORATION +en I-EXPLORATION +II I-EXPLORATION +plano I-EXPLORATION +y I-EXPLORATION +LA I-EXPLORATION +con I-EXPLORATION +grumos I-EXPLORATION +de I-EXPLORATION +meconio I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +mal I-EXPLORATION +olor. I-EXPLORATION +Se B-TREATMENT +trasladó I-TREATMENT +inmediatamente I-TREATMENT +a I-TREATMENT +sala I-TREATMENT +de I-TREATMENT +partos I-TREATMENT +con I-TREATMENT +dilatación I-TREATMENT +completa I-TREATMENT +y I-TREATMENT +presentación I-TREATMENT +cefálica I-TREATMENT +en I-TREATMENT +tercer I-TREATMENT +plano. I-TREATMENT + I-TREATMENT +El I-TREATMENT +parto I-TREATMENT +vaginal I-TREATMENT +ocurrió I-TREATMENT +a I-TREATMENT +las I-TREATMENT +7: I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +del I-TREATMENT +11 I-TREATMENT +de I-TREATMENT +mayo I-TREATMENT +(1 I-TREATMENT +h I-TREATMENT +44 I-TREATMENT +min I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +ingreso). I-TREATMENT +Se I-TREATMENT +obtuvo I-TREATMENT +un I-TREATMENT +recién I-TREATMENT +nacido I-TREATMENT +(RN) I-TREATMENT +de I-TREATMENT +3-440 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +sexo I-TREATMENT +masculino, I-TREATMENT +con I-TREATMENT +muy I-TREATMENT +mal I-TREATMENT +olor, I-TREATMENT +muy I-TREATMENT +deprimido I-TREATMENT +con I-TREATMENT +Apgar I-TREATMENT +1 I-TREATMENT +al I-TREATMENT +minuto I-TREATMENT +y I-TREATMENT +3 I-TREATMENT +a I-TREATMENT +los I-TREATMENT +5 I-TREATMENT +min. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +describió I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +meconio I-TREATMENT +en I-TREATMENT +el I-TREATMENT +parto, I-TREATMENT +ni I-TREATMENT +en I-TREATMENT +la I-TREATMENT +aspiración I-TREATMENT +de I-TREATMENT +las I-TREATMENT +secreciones I-TREATMENT +del I-TREATMENT +RN. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +sangre I-TREATMENT +arterial I-TREATMENT +de I-TREATMENT +cordón I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +pH I-TREATMENT +6, I-TREATMENT +9, I-TREATMENT +BE I-TREATMENT +-25 I-TREATMENT +y I-TREATMENT +C02 I-TREATMENT +35. I-TREATMENT +Ingresó I-TREATMENT +intubado I-TREATMENT +grave I-TREATMENT +a I-TREATMENT +la I-TREATMENT +UCI I-TREATMENT +neonatal, I-TREATMENT +con I-TREATMENT +los I-TREATMENT +diagnósticos: I-TREATMENT +RN I-TREATMENT +de I-TREATMENT +término I-TREATMENT +adecuado I-TREATMENT +para I-TREATMENT +la I-TREATMENT +edad I-TREATMENT +gestacional, I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +semanas, I-TREATMENT +asfixia I-TREATMENT +perinatal I-TREATMENT +severa I-TREATMENT +(criterios I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Asociación I-TREATMENT +Americana I-TREATMENT +de I-TREATMENT +Pediatría) I-TREATMENT +y I-TREATMENT +probable I-TREATMENT +infección I-TREATMENT +connatal. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +RN I-EVOLUTION +evolucionó I-EVOLUTION +siempre I-EVOLUTION +grave, I-EVOLUTION +con I-EVOLUTION +compromiso I-EVOLUTION +del I-EVOLUTION +SNC, I-EVOLUTION +encefalopatía I-EVOLUTION +hipóxica I-EVOLUTION +isquémica I-EVOLUTION +grado I-EVOLUTION +III, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +shock I-EVOLUTION +séptico I-EVOLUTION +precoz, I-EVOLUTION +con I-EVOLUTION +compromiso I-EVOLUTION +multiorgánico I-EVOLUTION +y I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +apoyo I-EVOLUTION +ventilatorio I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +drogas I-EVOLUTION +vasoactivas. I-EVOLUTION + I-EVOLUTION +A B-TREATMENT +las I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +los I-TREATMENT +hemocultivos I-TREATMENT +tomados I-TREATMENT +al I-TREATMENT +nacer I-TREATMENT +fueron I-TREATMENT +positivos I-TREATMENT +para I-TREATMENT +Morganella I-TREATMENT +morganii I-TREATMENT +cambiándose I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +antibiótico I-TREATMENT +ampicilina-sulbactam I-TREATMENT +por I-TREATMENT +cefotaxima, I-TREATMENT +según I-TREATMENT +antibiograma. I-TREATMENT +Los B-EXPLORATION +exámenes I-EXPLORATION +demostraron: I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +leu-copenia, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +129 I-EXPLORATION +mg/L, I-EXPLORATION +ácido I-EXPLORATION +láctico I-EXPLORATION +138 I-EXPLORATION +mg/dL. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +reveló I-EXPLORATION +infiltrado I-EXPLORATION +parenquimatoso I-EXPLORATION +bilateral I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +bronconeumonía. I-EXPLORATION +El I-EXPLORATION +escáner I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +cerebral I-EXPLORATION +mostraron I-EXPLORATION +edema I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +hemorragia I-EXPLORATION +de I-EXPLORATION +fosa I-EXPLORATION +posterior I-EXPLORATION +izquierda I-EXPLORATION +concordante I-EXPLORATION +con I-EXPLORATION +EEG I-EXPLORATION +severamente I-EXPLORATION +alterado, I-EXPLORATION +en I-EXPLORATION +status I-EXPLORATION +convulsivo. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +neonato I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +17 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida. I-EVOLUTION +La B-EXPLORATION +autopsia I-EXPLORATION +reveló: I-EXPLORATION +RN I-EXPLORATION +de I-EXPLORATION +término, I-EXPLORATION +adecuado I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +gestacional, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +morfológicos I-EXPLORATION +de I-EXPLORATION +shock I-EXPLORATION +séptico: I-EXPLORATION +coagulación I-EXPLORATION +intravascular I-EXPLORATION +diseminada, I-EXPLORATION +infarto I-EXPLORATION +hepático, I-EXPLORATION +de I-EXPLORATION +glándulas I-EXPLORATION +suprarrenales I-EXPLORATION +y I-EXPLORATION +congestión I-EXPLORATION +esplénica. I-EXPLORATION +Bronconeumonía I-EXPLORATION +bilateral I-EXPLORATION +descamativa I-EXPLORATION +y I-EXPLORATION +hemorrágica. I-EXPLORATION +Compromiso I-EXPLORATION +cerebral I-EXPLORATION +con I-EXPLORATION +encefalopatía I-EXPLORATION +hipóxica-isquémica. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +placentaria I-EXPLORATION +reveló I-EXPLORATION +corioamnionitis I-EXPLORATION +aguda I-EXPLORATION +abscedada, I-EXPLORATION +funisitis I-EXPLORATION +aguda I-EXPLORATION +y I-EXPLORATION +perivellositis I-EXPLORATION +aguda I-EXPLORATION +focal. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +madre I-EVOLUTION +evolucionó I-EVOLUTION +afebril, I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +clínicos I-EVOLUTION +de I-EVOLUTION +infección, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +cultivo I-EVOLUTION +de I-EVOLUTION +loquios I-EVOLUTION +positivos I-EVOLUTION +para I-EVOLUTION +Morganella I-EVOLUTION +morganii, I-EVOLUTION +muestra I-EVOLUTION +tomada I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +puerperio I-EVOLUTION +del I-EVOLUTION +fondo I-EVOLUTION +de I-EVOLUTION +saco I-EVOLUTION +vaginal. I-EVOLUTION +Se B-TREATMENT +dio I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +hospitalaria I-TREATMENT +a I-TREATMENT +los I-TREATMENT +tres I-TREATMENT +días I-TREATMENT +del I-TREATMENT +parto I-TREATMENT +y I-TREATMENT +se I-TREATMENT +trató I-TREATMENT +durante I-TREATMENT +5 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +gentamicina I-TREATMENT +l60 I-TREATMENT +mg I-TREATMENT +IM I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Se I-TREATMENT +controló I-TREATMENT +a I-TREATMENT +los I-TREATMENT +11 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +puerperio I-TREATMENT +en I-TREATMENT +el I-TREATMENT +policlínico I-TREATMENT +del I-TREATMENT +Centro I-TREATMENT +Diagnóstico I-TREATMENT +Terapéutico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +dio I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +definitiva I-TREATMENT +en I-TREATMENT +buenas I-TREATMENT +condiciones I-TREATMENT +físicas. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +urbano. I-PAST_MEDICAL_HISTORY +Portador B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +linfedema I-PRESENT_ILLNESS +primario I-PRESENT_ILLNESS +tardío I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +valorado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +linfocen-tellografia I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +evidenciado I-PRESENT_ILLNESS +ausencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +drenaje I-PRESENT_ILLNESS +linfático I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dicho I-PRESENT_ILLNESS +miembro, I-PRESENT_ILLNESS +tomografía I-PRESENT_ILLNESS +computada I-PRESENT_ILLNESS +(TC) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +abdomen, I-PRESENT_ILLNESS +pelvis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +alteraciones, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +eco-Doppler I-PRESENT_ILLNESS +arterial I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +venoso I-PRESENT_ILLNESS +normales. I-PRESENT_ILLNESS +Infecciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +recurrentes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +tórpida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dicho I-PRESENT_ILLNESS +miembro. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +medio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +marcada I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +adelgazamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kilos, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +38°C I-PRESENT_ILLNESS +axilar. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +agregó I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +hemoptoica. I-PRESENT_ILLNESS +Relataba I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +linfedema I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +reciente I-PRESENT_ILLNESS +aparición. I-PRESENT_ILLNESS +Del B-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +destacaba: I-EXPLORATION +severo I-EXPLORATION +adelgazamiento, I-EXPLORATION +sin I-EXPLORATION +palidez I-EXPLORATION +ni I-EXPLORATION +fiebre. I-EXPLORATION +En I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +derecho I-EXPLORATION +presentaba I-EXPLORATION +linfedema I-EXPLORATION +hasta I-EXPLORATION +raíz I-EXPLORATION +de I-EXPLORATION +muslo I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +nodulares I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +firmes, I-EXPLORATION +violáceas, I-EXPLORATION +algunas I-EXPLORATION +descamadas I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +ulceradas I-EXPLORATION +con I-EXPLORATION +mayor I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +poplítea. I-EXPLORATION +En I-EXPLORATION +muslo I-EXPLORATION +proximal I-EXPLORATION +presentaba I-EXPLORATION +lesión, I-EXPLORATION +pediculada I-EXPLORATION +y I-EXPLORATION +ulcerada. I-EXPLORATION +Lesión I-EXPLORATION +traumática I-EXPLORATION +de I-EXPLORATION +pie I-EXPLORATION +en I-EXPLORATION +vías I-EXPLORATION +de I-EXPLORATION +cicatrización. I-EXPLORATION +Adenomegalias I-EXPLORATION +inguinales I-EXPLORATION +a I-EXPLORATION +derecha, I-EXPLORATION +firmes, I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +formaban I-EXPLORATION +conglomerados. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +pleuropulmonar I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +ruidos I-EXPLORATION +subcrepitantes I-EXPLORATION +bibasales I-EXPLORATION +escasos. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +De I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +hemograma, I-EXPLORATION +glicemia, I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +normales, I-EXPLORATION +VHS I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +hora, I-EXPLORATION +y I-EXPLORATION +pro I-EXPLORATION +teína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +de I-EXPLORATION +30 I-EXPLORATION +mg/dL. I-EXPLORATION +Serología I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +negativa. I-EXPLORATION +Baciloscopías I-EXPLORATION +y I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +Mantoux I-EXPLORATION +negativos. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostraba I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +paracardíaca I-EXPLORATION +izquierda. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +mostraba I-EXPLORATION +múltiples I-EXPLORATION +nodulos I-EXPLORATION +pulmonares I-EXPLORATION +bilaterales I-EXPLORATION +a I-EXPLORATION +predominio I-EXPLORATION +bibasal, I-EXPLORATION +mal I-EXPLORATION +delimitados I-EXPLORATION +y I-EXPLORATION +adenomegalias I-EXPLORATION +inguinales I-EXPLORATION +e I-EXPLORATION +iliacas I-EXPLORATION +externas I-EXPLORATION +derechas. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +de I-EXPLORATION +lesión I-EXPLORATION +pediculada I-EXPLORATION +del I-EXPLORATION +muslo I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +angiosarcoma, I-EXPLORATION +con I-EXPLORATION +inmunohistoquímica I-EXPLORATION +concordante I-EXPLORATION +(positividad I-EXPLORATION +para I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +endoteliales I-EXPLORATION +CD31 I-EXPLORATION +y I-EXPLORATION +CD34, I-EXPLORATION +el I-EXPLORATION +primero I-EXPLORATION +con I-EXPLORATION +elevada I-EXPLORATION +sensibilidad I-EXPLORATION +y I-EXPLORATION +especificidad12, I-EXPLORATION +13). I-EXPLORATION +Valorado B-TREATMENT +por I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +oncología I-TREATMENT +clínica I-TREATMENT +se I-TREATMENT +inicio I-TREATMENT +plan I-TREATMENT +de I-TREATMENT +poliquimioterapia. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +5 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +chileno, I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +ingeniero B-PAST_MEDICAL_HISTORY +civil I-PAST_MEDICAL_HISTORY +proveniente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Santiago, I-PAST_MEDICAL_HISTORY +residente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Valdivia I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Portador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemofilia I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +leve I-PAST_MEDICAL_HISTORY +(Factor I-PAST_MEDICAL_HISTORY +VIII I-PAST_MEDICAL_HISTORY +10%) I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +epistaxis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hemartrosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cadera I-PAST_MEDICAL_HISTORY +derecha. I-PAST_MEDICAL_HISTORY +Hasta I-PAST_MEDICAL_HISTORY +1998 I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +transfusiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +plasma I-PAST_MEDICAL_HISTORY +fresco I-PAST_MEDICAL_HISTORY +congelado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +crioprecipitados, I-PAST_MEDICAL_HISTORY +posteriormente I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +concentrados I-PAST_MEDICAL_HISTORY +liofi I-PAST_MEDICAL_HISTORY +lizados I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +pureza I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +doble I-PAST_MEDICAL_HISTORY +inactivación I-PAST_MEDICAL_HISTORY +viral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antifibrinolíticos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +procedimientos I-PAST_MEDICAL_HISTORY +dentales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +litotripsia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +urolitiasis I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2000 I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +hemorrágicas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +agosto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2007 I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +epistaxis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +equimosis I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +traumatismos I-PRESENT_ILLNESS +evidentes. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +equimosis I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +predominio I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores. I-PRESENT_ILLNESS +En B-EXPLORATION +hemograma I-EXPLORATION +trombocitopenia I-EXPLORATION +de I-EXPLORATION +23.000/mm3. I-EXPLORATION +Se I-EXPLORATION +tomó I-EXPLORATION +mielograma I-EXPLORATION +hospitalizado, I-EXPLORATION +previa I-EXPLORATION +transfusión I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +y I-EXPLORATION +concentrado I-EXPLORATION +FVIII, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +series I-EXPLORATION +hematopoyéticas I-EXPLORATION +conservadas. I-EXPLORATION +Se B-TREATMENT +iniciaron I-TREATMENT +pulsos I-TREATMENT +de I-TREATMENT +solumedrol I-TREATMENT +125 I-TREATMENT +mg I-TREATMENT +i.v. I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +prednisona I-TREATMENT +60 I-TREATMENT +mg/día I-TREATMENT +p.o., I-TREATMENT +observando I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +plaquetas I-TREATMENT +hasta I-TREATMENT +50.000/mm3 I-TREATMENT +el I-TREATMENT +cuarto I-TREATMENT +día, I-TREATMENT +siendo I-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta. I-TREATMENT + I-TREATMENT +Dentro B-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba: I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +transaminasas I-EXPLORATION +(GOT I-EXPLORATION +158/GPT I-EXPLORATION +151), I-EXPLORATION +TTPA, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +y I-EXPLORATION +albúmina I-EXPLORATION +normales, I-EXPLORATION +serología I-EXPLORATION +VHC I-EXPLORATION +positivo, I-EXPLORATION +VIH I-EXPLORATION +negativo, I-EXPLORATION +HBAgS I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antiplaquetarios I-EXPLORATION +circulantes I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Al B-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +posterior I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +las I-EVOLUTION +plaquetas I-EVOLUTION +caen I-EVOLUTION +a I-EVOLUTION +27.000/mm3. I-EVOLUTION +Se B-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +prednisona I-TREATMENT +en I-TREATMENT +60 I-TREATMENT +mg/día I-TREATMENT +con I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +trombopenia I-TREATMENT +por I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +nuevo I-TREATMENT +pulso I-TREATMENT +de I-TREATMENT +solumedrol I-TREATMENT +y I-TREATMENT +se I-TREATMENT +asoció I-TREATMENT +azatioprina I-TREATMENT +100 I-TREATMENT +mg/día I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +transcurso I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +esteroidal I-TREATMENT +desarrolló I-TREATMENT +diabetes I-TREATMENT +requiriendo I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +insulina I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +se I-TREATMENT +estabilizó I-TREATMENT +con I-TREATMENT +régimen. I-TREATMENT + I-TREATMENT +Dada I-TREATMENT +la I-TREATMENT +dependencia I-TREATMENT +a I-TREATMENT +corticoides I-TREATMENT +e I-TREATMENT +inmunosupresor I-TREATMENT +en I-TREATMENT +noviembre I-TREATMENT +de I-TREATMENT +2007 I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +esplenectomía I-TREATMENT +electiva I-TREATMENT +y I-TREATMENT +biopsia I-TREATMENT +hepática I-TREATMENT +bajo I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +reemplazo I-TREATMENT +del I-TREATMENT +factor I-TREATMENT +deficiente I-TREATMENT +ajustando I-TREATMENT +niveles I-TREATMENT +de I-TREATMENT +FVIII I-TREATMENT +en I-TREATMENT +torno I-TREATMENT +al I-TREATMENT +40% I-TREATMENT +más I-TREATMENT +antifibrinolíticos I-TREATMENT +por I-TREATMENT +diez I-TREATMENT +días I-TREATMENT +presentando I-TREATMENT +dehiscencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida I-TREATMENT +operatoria I-TREATMENT +en I-TREATMENT +el I-TREATMENT +día I-TREATMENT +21 I-TREATMENT +post I-TREATMENT +operatorio I-TREATMENT +debiendo I-TREATMENT +resuturarse. I-TREATMENT +Posterior I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +prednisona I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +azatioprina I-TREATMENT +100 I-TREATMENT +mg/día I-TREATMENT +con B-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +logró I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +50.000/mm3 I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +5 I-EXPLORATION +meses. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +esplénica I-EXPLORATION +demostró I-EXPLORATION +congestión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pulpa I-EXPLORATION +roja I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +hepática, I-EXPLORATION +hepatitis I-EXPLORATION +crónica I-EXPLORATION +con I-EXPLORATION +moderada I-EXPLORATION +actividad, I-EXPLORATION +colapso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +trama I-EXPLORATION +reticular I-EXPLORATION +y I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +puentes I-EXPLORATION +porto-portales. I-EXPLORATION +Hepatocitos I-EXPLORATION +con I-EXPLORATION +degeneración I-EXPLORATION +balonada, I-EXPLORATION +esteatosis I-EXPLORATION +microvesicular I-EXPLORATION +y I-EXPLORATION +colestasia I-EXPLORATION +intracelular. I-EXPLORATION + I-EXPLORATION +Evaluado I-EXPLORATION +por I-EXPLORATION +gastroenterólogo I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +várices I-EXPLORATION +esofágicas I-EXPLORATION +medianas I-EXPLORATION +y I-EXPLORATION +gastropatía I-EXPLORATION +congestiva, I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +VHC I-EXPLORATION +(185.120 I-EXPLORATION +UI I-EXPLORATION +RNA/ml), I-EXPLORATION +genotipo I-EXPLORATION +(1b) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +indicó I-EXPLORATION +terapia I-EXPLORATION +con I-EXPLORATION +INF I-EXPLORATION +α I-EXPLORATION +y I-EXPLORATION +ribavirina I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +realizó I-EXPLORATION +por I-EXPLORATION +razones I-EXPLORATION +previsionales. I-EXPLORATION + I-EXPLORATION +Los B-EVOLUTION +últimos I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +diversos I-EVOLUTION +episodios I-EVOLUTION +hemorragíparos I-EVOLUTION +como I-EVOLUTION +hemoptisis I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +cuadro I-EVOLUTION +bronquial, I-EVOLUTION +hematomas I-EVOLUTION +musculares I-EVOLUTION +(antebrazo I-EVOLUTION +y I-EVOLUTION +muslo), I-EVOLUTION +hemartrosis I-EVOLUTION +de I-EVOLUTION +rodilla I-EVOLUTION +y I-EVOLUTION +tobillo I-EVOLUTION +derechos, I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +mantener I-EVOLUTION +recuento I-EVOLUTION +plaquetario I-EVOLUTION +estable I-EVOLUTION +(50.000/mm3). I-EVOLUTION +TTPA I-EVOLUTION +actual I-EVOLUTION +62, I-EVOLUTION +3 I-EVOLUTION +seg I-EVOLUTION +y I-EVOLUTION +FVIII I-EVOLUTION +7%. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +autovalente, B-PAST_MEDICAL_HISTORY +independiente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +actividades I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +diaria, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +escolaridad I-PAST_MEDICAL_HISTORY +completa, I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +hipotiroidismo, I-PAST_MEDICAL_HISTORY +hipoacusia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +(DM I-PAST_MEDICAL_HISTORY +2) I-PAST_MEDICAL_HISTORY +manejada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +glibenclamida I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +metaformina I-PAST_MEDICAL_HISTORY +1.700 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +lograba I-PAST_MEDICAL_HISTORY +glicemias I-PAST_MEDICAL_HISTORY +capilares I-PAST_MEDICAL_HISTORY +adecuadas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Fue B-PRESENT_ILLNESS +llevada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +familiares I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia, I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +evaluación I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +cualitativo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +fluctuante, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +hrs I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +focalización I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +recuperación I-PRESENT_ILLNESS +espontánea I-PRESENT_ILLNESS +completa. I-PRESENT_ILLNESS +Su I-PRESENT_ILLNESS +familia I-PRESENT_ILLNESS +señaló I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ocurrencia I-PRESENT_ILLNESS +cada I-PRESENT_ILLNESS +vez I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +frecuente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +similares I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +indicando I-PRESENT_ILLNESS +además, I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +memoria I-PRESENT_ILLNESS +reciente, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +conducta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +autolimitadas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +trastorno I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esfínteres, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +repercusión I-PRESENT_ILLNESS +funcional I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +parcial I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +autovalencia. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Ingresó B-EXPLORATION +vigil, I-EXPLORATION +orientada I-EXPLORATION +témporo-espacialmente, I-EXPLORATION +atenta, I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable, I-EXPLORATION +afebril, I-EXPLORATION +sin I-EXPLORATION +apremio I-EXPLORATION +respiratorio I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +sólo I-EXPLORATION +destacó I-EXPLORATION +un I-EXPLORATION +rendimiento I-EXPLORATION +anormal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuestionario I-EXPLORATION +Mini I-EXPLORATION +Mental, I-EXPLORATION +obteniendo I-EXPLORATION +22 I-EXPLORATION +puntos, I-EXPLORATION +cuyo I-EXPLORATION +resultado I-EXPLORATION +sugiere I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +deterioro I-EXPLORATION +cognitivo I-EXPLORATION +(puntaje I-EXPLORATION +esperado I-EXPLORATION +para I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +escolaridad I-EXPLORATION +> I-EXPLORATION +24 I-EXPLORATION +puntos). I-EXPLORATION +Entre I-EXPLORATION +sus I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaron I-EXPLORATION +glicemia, I-EXPLORATION +creatininemia, I-EXPLORATION +natremia, I-EXPLORATION +calcemia, I-EXPLORATION +TSH, I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +y I-EXPLORATION +hemograma, I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +presentó I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +parámetrosinflamatorios, I-EXPLORATION +ELISA I-EXPLORATION +VIH I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +RPR I-EXPLORATION +no I-EXPLORATION +reactivo. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +no I-EXPLORATION +contrastada, I-EXPLORATION +que I-EXPLORATION +pesquisó I-EXPLORATION +un I-EXPLORATION +infarto I-EXPLORATION +lacunar I-EXPLORATION +hemorrágico I-EXPLORATION +putaminal I-EXPLORATION +izquierdo, I-EXPLORATION +probablemente I-EXPLORATION +antiguo. I-EXPLORATION +El I-EXPLORATION +electroencefalograma I-EXPLORATION +mostró I-EXPLORATION +lentitud I-EXPLORATION +intermitente I-EXPLORATION +generalizada. I-EXPLORATION +Eco-Doppler I-EXPLORATION +carotideo I-EXPLORATION +evidenció I-EXPLORATION +ateromatosis I-EXPLORATION +carotídea I-EXPLORATION +derecha I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +hemodinámico. I-EXPLORATION +Ninguno I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +logró I-EXPLORATION +explicar I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +clínico. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +manejó I-TREATMENT +con I-TREATMENT +régimen I-TREATMENT +alimentario I-TREATMENT +diabético, I-TREATMENT +sin I-TREATMENT +hipoglicemiantes I-TREATMENT +orales, I-TREATMENT +evolucionando B-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +glicemias I-EVOLUTION +en I-EVOLUTION +rango I-EVOLUTION +adecuado. I-EVOLUTION +La B-EXPLORATION +hemoglobina I-EXPLORATION +glicosilada I-EXPLORATION +A1C I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +2%, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +hizo I-EXPLORATION +sospechar I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +hipoglicemia I-EXPLORATION +recurrentes. I-EXPLORATION +Por B-TREATMENT +ello, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +suspender I-TREATMENT +glibenclamida I-TREATMENT +y I-TREATMENT +disminuir I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +metformina I-TREATMENT +previo I-TREATMENT +al I-TREATMENT +alta. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +controles I-EVOLUTION +ambulatorios, I-EVOLUTION +transcurridos I-EVOLUTION +dos I-EVOLUTION +y I-EVOLUTION +luego I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +post I-EVOLUTION +alta, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +vigil, I-EVOLUTION +orientada I-EVOLUTION +témporo-espacialmente, I-EVOLUTION +bien I-EVOLUTION +conectada I-EVOLUTION +al I-EVOLUTION +medio, I-EVOLUTION +logrando I-EVOLUTION +26 I-EVOLUTION +puntos I-EVOLUTION +en I-EVOLUTION +Mini I-EVOLUTION +Mental I-EVOLUTION +en I-EVOLUTION +ambas I-EVOLUTION +ocasiones. I-EVOLUTION +Su I-EVOLUTION +familia I-EVOLUTION +no I-EVOLUTION +refrió I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +alteración I-EVOLUTION +de I-EVOLUTION +conciencia, I-EVOLUTION +ni I-EVOLUTION +conductuales, I-EVOLUTION +interpretándose I-EVOLUTION +el I-EVOLUTION +cuadro I-EVOLUTION +original I-EVOLUTION +como I-EVOLUTION +secundario I-EVOLUTION +a I-EVOLUTION +hipoglicemias I-EVOLUTION +subclínicas I-EVOLUTION +frecuentes. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +autovalente B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +factores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +coronario I-PAST_MEDICAL_HISTORY +conocidos. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +apareció I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ejercicio I-PRESENT_ILLNESS +físico I-PRESENT_ILLNESS +moderado, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +estrés I-PRESENT_ILLNESS +emocional I-PRESENT_ILLNESS +aparente. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +asoció I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fatigabilidad. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +clínica I-EXPLORATION +inicial I-EXPLORATION +estaba I-EXPLORATION +bien I-EXPLORATION +perfundida, I-EXPLORATION +con I-EXPLORATION +pulso I-EXPLORATION +de I-EXPLORATION +105/min, I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +98/57 I-EXPLORATION +mmHg. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +cardiovascular I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +rutina I-EXPLORATION +destacaron I-EXPLORATION +un I-EXPLORATION +electrocardiograma I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +supradesnivel I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +anterior I-EXPLORATION +(V2-V4) I-EXPLORATION +y I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +daño I-EXPLORATION +miocárdico I-EXPLORATION +elevados I-EXPLORATION +(troponinas I-EXPLORATION +7, I-EXPLORATION +10 I-EXPLORATION +ng/ml, I-EXPLORATION +CK-total I-EXPLORATION +368 I-EXPLORATION +U/L I-EXPLORATION +y I-EXPLORATION +CK-MB I-EXPLORATION +57 I-EXPLORATION +U/L). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +coronariografía I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +una I-EXPLORATION +hora I-EXPLORATION +posterior I-EXPLORATION +al I-EXPLORATION +ingreso, I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +arteria I-EXPLORATION +descendente I-EXPLORATION +anterior I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +30% I-EXPLORATION +y I-EXPLORATION +flujo I-EXPLORATION +lento, I-EXPLORATION +no I-EXPLORATION +presentando I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +coronarias I-EXPLORATION +lesiones I-EXPLORATION +significativas. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ventriculografía I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +balonamiento I-EXPLORATION +apical. I-EXPLORATION +Se B-TREATMENT +planteó I-TREATMENT +como I-TREATMENT +probable I-TREATMENT +diagnóstico I-TREATMENT +STT I-TREATMENT +e I-TREATMENT +ingresó I-TREATMENT +a I-TREATMENT +Unidad I-TREATMENT +Coronaria I-TREATMENT +para I-TREATMENT +tratamiento I-TREATMENT +médico I-TREATMENT +estándar I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +coronario I-TREATMENT +agudo I-TREATMENT +(SCA). I-TREATMENT + I-TREATMENT +La B-EXPLORATION +ecocardiografía I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +segundo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización I-EXPLORATION +mostró: I-EXPLORATION +1) I-EXPLORATION +VI I-EXPLORATION +de I-EXPLORATION +dimensiones I-EXPLORATION +básales I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +normales I-EXPLORATION +con I-EXPLORATION +extensa I-EXPLORATION +akinesia I-EXPLORATION +anteroseptoapical I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +punta; I-EXPLORATION +2) I-EXPLORATION +Función I-EXPLORATION +sistólica I-EXPLORATION +global I-EXPLORATION +moderadamente I-EXPLORATION +deprimida I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fracción I-EXPLORATION +de I-EXPLORATION +eyección I-EXPLORATION +del I-EXPLORATION +VI I-EXPLORATION +estimada I-EXPLORATION +en I-EXPLORATION +40%; I-EXPLORATION +3) I-EXPLORATION +Insuficiencia I-EXPLORATION +tricuspídea I-EXPLORATION +severa I-EXPLORATION +e I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +moderada; I-EXPLORATION +4) I-EXPLORATION +Hipertensión I-EXPLORATION +pulmonar I-EXPLORATION +severa I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +sistólica I-EXPLORATION +de I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +de I-EXPLORATION +72 I-EXPLORATION +mmHg. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +tercer I-EXPLORATION +día, I-EXPLORATION +el I-EXPLORATION +control I-EXPLORATION +electrocardiográfico I-EXPLORATION +reveló I-EXPLORATION +inversión I-EXPLORATION +de I-EXPLORATION +onda I-EXPLORATION +T I-EXPLORATION +de I-EXPLORATION +derivaciones I-EXPLORATION +V2 I-EXPLORATION +a I-EXPLORATION +V6. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +fue I-EVOLUTION +favorable, I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +marcadores I-EVOLUTION +de I-EVOLUTION +daño I-EVOLUTION +miocárdico I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +noveno I-EVOLUTION +día I-EVOLUTION +hospitalización. I-EVOLUTION +El B-EXPLORATION +seguimiento I-EXPLORATION +al I-EXPLORATION +mes I-EXPLORATION +con I-EXPLORATION +ecocardiografía I-EXPLORATION +2-D I-EXPLORATION +mostró: I-EXPLORATION +1) I-EXPLORATION +Función I-EXPLORATION +sistólica I-EXPLORATION +de I-EXPLORATION +VI I-EXPLORATION +conservada; I-EXPLORATION +2) I-EXPLORATION +Insuficiencia I-EXPLORATION +mitral I-EXPLORATION +leve I-EXPLORATION +con I-EXPLORATION +válvula I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +efectuó I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +perfusión I-EXPLORATION +miocárdica I-EXPLORATION +SPECT I-EXPLORATION +gatillado I-EXPLORATION +para I-EXPLORATION +evaluar I-EXPLORATION +función I-EXPLORATION +ventricular I-EXPLORATION +con I-EXPLORATION +Tecnecio99m-SESTAMIBI I-EXPLORATION +en I-EXPLORATION +estrés I-EXPLORATION +con I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +Bruce I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +reposo; I-EXPLORATION +concluyó I-EXPLORATION +motilidad I-EXPLORATION +y I-EXPLORATION +engrasamiento I-EXPLORATION +global I-EXPLORATION +y I-EXPLORATION +segmentario I-EXPLORATION +del I-EXPLORATION +VI I-EXPLORATION +conservados, I-EXPLORATION +con I-EXPLORATION +excelente I-EXPLORATION +función I-EXPLORATION +sistólica. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hipertensa, B-PAST_MEDICAL_HISTORY +obesa I-PAST_MEDICAL_HISTORY +mórbida, I-PAST_MEDICAL_HISTORY +planificada B-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +bypass I-PRESENT_ILLNESS +gástrico. I-PRESENT_ILLNESS +Durante B-EVOLUTION +la I-EVOLUTION +inducción I-EVOLUTION +anestésica, I-EVOLUTION +sin I-EVOLUTION +haber I-EVOLUTION +modificaciones I-EVOLUTION +de I-EVOLUTION +PA I-EVOLUTION +o I-EVOLUTION +FC, I-EVOLUTION +presentó I-EVOLUTION +alteración I-EVOLUTION +del I-EVOLUTION +segmento I-EVOLUTION +ST I-EVOLUTION +sugerente I-EVOLUTION +de I-EVOLUTION +isquemia. I-EVOLUTION +La B-EXPLORATION +ETE I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +ventricular I-EXPLORATION +global I-EXPLORATION +ni I-EXPLORATION +segmentaria. I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +realizar I-TREATMENT +la I-TREATMENT +cirugía, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +transcurre I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT +Post B-EVOLUTION +operatorio I-EVOLUTION +sin I-EVOLUTION +problemas, I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Down I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +congénita I-PAST_MEDICAL_HISTORY +consistente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +canal I-PAST_MEDICAL_HISTORY +aurículo-ventricular I-PAST_MEDICAL_HISTORY +completo, I-PAST_MEDICAL_HISTORY +reparado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +período I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +lactante, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +reemplazo I-PAST_MEDICAL_HISTORY +valvular I-PAST_MEDICAL_HISTORY +mitral I-PAST_MEDICAL_HISTORY +biológico I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +abril I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2010, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +institución, I-PAST_MEDICAL_HISTORY +debido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +bradicardia, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +implantó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +marcapaso I-PAST_MEDICAL_HISTORY +definitivo I-PAST_MEDICAL_HISTORY +unicameral. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +implante I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +bolsillo I-PAST_MEDICAL_HISTORY +subcutáneo I-PAST_MEDICAL_HISTORY +prepectoral, I-PAST_MEDICAL_HISTORY +utilizando I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +electrodo I-PAST_MEDICAL_HISTORY +transvenoso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estimulación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fijación I-PAST_MEDICAL_HISTORY +activa. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +dispositivo I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +programado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +modo I-PAST_MEDICAL_HISTORY +AAI I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +frecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estimulación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +latidos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +minuto, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +frecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +histéresis I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +latidos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +minuto. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +electivamente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +cirugía I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hernia I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +complicada. I-PRESENT_ILLNESS +Por B-EXPLORATION +rutina, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +evaluación I-EXPLORATION +pre-operatoria I-EXPLORATION +por I-EXPLORATION +electro I-EXPLORATION +fisiología. I-EXPLORATION +En I-EXPLORATION +su I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +contracción I-EXPLORATION +rítmica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +pectoral I-EXPLORATION +izquierda. I-EXPLORATION +Su I-EXPLORATION +electrocardiograma I-EXPLORATION +mostraba I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +a I-EXPLORATION +60 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +con I-EXPLORATION +conducción I-EXPLORATION +aurículo-ventricular I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +interrogación I-EXPLORATION +del I-EXPLORATION +dispositivo I-EXPLORATION +mostró I-EXPLORATION +voltaje I-EXPLORATION +de I-EXPLORATION +batería I-EXPLORATION +normal I-EXPLORATION +(2.79 I-EXPLORATION +V), I-EXPLORATION +con I-EXPLORATION +impedancia I-EXPLORATION +de I-EXPLORATION +estimulación I-EXPLORATION +de I-EXPLORATION +833 I-EXPLORATION +Ohms I-EXPLORATION +y I-EXPLORATION +falla I-EXPLORATION +de I-EXPLORATION +sensado I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +captura I-EXPLORATION +auricular I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +electrodo. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +evidenciando I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +electrodo I-EXPLORATION +endocavitario I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +retraído I-EXPLORATION +fuera I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +silueta I-EXPLORATION +cardiaca, I-EXPLORATION +totalmente I-EXPLORATION +enrollado I-EXPLORATION +alrededor I-EXPLORATION +del I-EXPLORATION +generador I-EXPLORATION +de I-EXPLORATION +pulso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +del I-EXPLORATION +bolsillo I-EXPLORATION +prepectoral. I-EXPLORATION +Se B-TREATMENT +informó I-TREATMENT +a I-TREATMENT +sus I-TREATMENT +tratantes I-TREATMENT +y I-TREATMENT +se I-TREATMENT +optó I-TREATMENT +por I-TREATMENT +abandonar I-TREATMENT +el I-TREATMENT +dispositivo, I-TREATMENT +apagando I-TREATMENT +el I-TREATMENT +marcapaso, I-TREATMENT +dado I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +presentaba I-TREATMENT +síntomas I-TREATMENT +de I-TREATMENT +bradicardia, I-TREATMENT +su I-TREATMENT +Holter I-TREATMENT +ECG I-TREATMENT +no I-TREATMENT +mostró I-TREATMENT +arritmias I-TREATMENT +y I-TREATMENT +la I-TREATMENT +indicación I-TREATMENT +original I-TREATMENT +era I-TREATMENT +cuestionable. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +su I-TREATMENT +herniorrafia I-TREATMENT +abdominal I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +quirúrgicas I-TREATMENT +ni I-TREATMENT +cardiovasculares, I-TREATMENT +y B-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +asintomático I-EVOLUTION +a I-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +tabáquico, B-PAST_MEDICAL_HISTORY +obeso I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertenso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +losartán I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +parestesias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pies I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +impedían I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +estaba I-EXPLORATION +consciente I-EXPLORATION +y I-EXPLORATION +orientado, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +tetraparesia I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +proximal, I-EXPLORATION +arreflexia I-EXPLORATION +generalizada I-EXPLORATION +y I-EXPLORATION +paresia I-EXPLORATION +facial I-EXPLORATION +derecha. I-EXPLORATION +Presión I-EXPLORATION +arterial I-EXPLORATION +(PA) I-EXPLORATION +177/62 I-EXPLORATION +mmHg. I-EXPLORATION +Hemograma, I-EXPLORATION +creatinina, I-EXPLORATION +nitrógeno I-EXPLORATION +ureico, I-EXPLORATION +electrolitos I-EXPLORATION +plasmáticos, I-EXPLORATION +gases I-EXPLORATION +arteriales I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +Inmunoglobulinas I-EXPLORATION +A, I-EXPLORATION +G I-EXPLORATION +y I-EXPLORATION +M I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +Síndrome I-TREATMENT +de I-TREATMENT +Guillain-Barré, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +inmunoglobulina I-TREATMENT +endovenosa I-TREATMENT +0, I-TREATMENT +4 I-TREATMENT +g/kg I-TREATMENT +de I-TREATMENT +peso I-TREATMENT +(Inmunoglobulina I-TREATMENT +G I-TREATMENT +endovenosa I-TREATMENT +UNC, I-TREATMENT +Argentina). I-TREATMENT +Dos B-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +completada I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +infusión, I-EVOLUTION +desarrolló I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +conciencia I-EVOLUTION +y I-EVOLUTION +agitación I-EVOLUTION +psicomotora, I-EVOLUTION +que I-EVOLUTION +obligó I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +sedación. I-EVOLUTION +Su I-EVOLUTION +PA I-EVOLUTION +era I-EVOLUTION +de I-EVOLUTION +181/90 I-EVOLUTION +mmHg I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +notó I-EVOLUTION +una I-EVOLUTION +agravación I-EVOLUTION +motora, I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +paresia I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +terceros I-EVOLUTION +pares I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +pares I-EVOLUTION +bulbares, I-EVOLUTION +obligando B-TREATMENT +a I-TREATMENT +la I-TREATMENT +intubación I-TREATMENT +orotraqueal I-TREATMENT +y I-TREATMENT +ventilación I-TREATMENT +mecánica. I-TREATMENT +La B-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +mostró I-EXPLORATION +borramiento I-EXPLORATION +de I-EXPLORATION +surcos I-EXPLORATION +y I-EXPLORATION +discreto I-EXPLORATION +colapso I-EXPLORATION +ventricular, I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +edema I-EXPLORATION +cerebral. I-EXPLORATION +La I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +dio I-EXPLORATION +salida I-EXPLORATION +a I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo I-EXPLORATION +claro. I-EXPLORATION +Su I-EXPLORATION +estudio I-EXPLORATION +reveló I-EXPLORATION +0, I-EXPLORATION +60 I-EXPLORATION +g/l I-EXPLORATION +de I-EXPLORATION +proteínas, I-EXPLORATION +glucosa I-EXPLORATION +0, I-EXPLORATION +75 I-EXPLORATION +g/l I-EXPLORATION +y I-EXPLORATION +1, I-EXPLORATION +6 I-EXPLORATION +leucocitos I-EXPLORATION +por I-EXPLORATION +mm3. I-EXPLORATION +La I-EXPLORATION +electromiografía I-EXPLORATION +definió I-EXPLORATION +una I-EXPLORATION +polineuropatía I-EXPLORATION +desmielinizante I-EXPLORATION +aguda. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +Igev I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +plasmaféresis I-TREATMENT +ese I-TREATMENT +mismo I-TREATMENT +día. I-TREATMENT +Durante B-EVOLUTION +cuatro I-EVOLUTION +días I-EVOLUTION +permaneció I-EVOLUTION +comprometido I-EVOLUTION +de I-EVOLUTION +conciencia. I-EVOLUTION +Al B-TREATMENT +quinto I-TREATMENT +día I-TREATMENT +fue I-TREATMENT +extubado I-TREATMENT +por I-TREATMENT +la I-TREATMENT +notable I-TREATMENT +recuperación I-TREATMENT +motora, I-TREATMENT +que I-TREATMENT +incluía I-TREATMENT +la I-TREATMENT +oculomotilidad, I-TREATMENT +aunque I-TREATMENT +persistía I-TREATMENT +leve I-TREATMENT +paresia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +aducción I-TREATMENT +y I-TREATMENT +elevación I-TREATMENT +del I-TREATMENT +ojo I-TREATMENT +izquierdo. I-TREATMENT +La B-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +realizada I-EXPLORATION +al I-EXPLORATION +séptimo I-EXPLORATION +día, I-EXPLORATION +mostró I-EXPLORATION +regresión I-EXPLORATION +del I-EXPLORATION +edema I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +EEG I-EXPLORATION +realizado I-EXPLORATION +ese I-EXPLORATION +día I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Completó B-TREATMENT +5 I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +plasmaféresis I-TREATMENT +logrando B-EVOLUTION +bipedestación I-EVOLUTION +al I-EVOLUTION +décimo I-EVOLUTION +día. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Calama. I-PAST_MEDICAL_HISTORY +Dentro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +trombosis I-PAST_MEDICAL_HISTORY +retinal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +actual I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +operada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +feocromocitoma I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +26 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +Historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +paroxísticas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cefalea, I-PAST_MEDICAL_HISTORY +naúseas, I-PAST_MEDICAL_HISTORY +sudoración, I-PAST_MEDICAL_HISTORY +palpitaciones, I-PAST_MEDICAL_HISTORY +asociadas I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +severa. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +beta I-PAST_MEDICAL_HISTORY +bloqueadores I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +inhibidores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enzima I-PAST_MEDICAL_HISTORY +convertidora I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +angiotensina. I-PAST_MEDICAL_HISTORY +Por B-EXPLORATION +aumento I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +frecuencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +crisis I-EXPLORATION +fue I-EXPLORATION +hospitalizada I-EXPLORATION +destacando I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico: I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +158/111 I-EXPLORATION +mmHg, I-EXPLORATION +pulso I-EXPLORATION +93 I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +examen I-EXPLORATION +cardiopulmonar I-EXPLORATION +normal, I-EXPLORATION +abdomen I-EXPLORATION +blando, I-EXPLORATION +depresible, I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +palpables. I-EXPLORATION + I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +ingreso; I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +75 I-EXPLORATION +mg/dL, I-EXPLORATION +calcemia I-EXPLORATION +10, I-EXPLORATION +3 I-EXPLORATION +mg/dL, I-EXPLORATION +fosfemia I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +mg/dL, I-EXPLORATION +TSH I-EXPLORATION +0, I-EXPLORATION +45 I-EXPLORATION +uUI/mL I-EXPLORATION +(0,4-4,0), I-EXPLORATION +T4 I-EXPLORATION +libre I-EXPLORATION +0, I-EXPLORATION +91 I-EXPLORATION +ng/dL I-EXPLORATION +(0,81,8), I-EXPLORATION +aldosterona I-EXPLORATION +plasmática I-EXPLORATION +22, I-EXPLORATION +7 I-EXPLORATION +ng/dL I-EXPLORATION +(1,0-16), I-EXPLORATION +actividad I-EXPLORATION +renina I-EXPLORATION +plasmática I-EXPLORATION +20 I-EXPLORATION +ng/mL/h I-EXPLORATION +(1, I-EXPLORATION +6 I-EXPLORATION +± I-EXPLORATION +0, I-EXPLORATION +83), I-EXPLORATION +noradrenalina I-EXPLORATION +plasmática I-EXPLORATION +7192 I-EXPLORATION +pg/mL I-EXPLORATION +(41773), I-EXPLORATION +adrenalina I-EXPLORATION +plasmática I-EXPLORATION +< I-EXPLORATION +20 I-EXPLORATION +pg/mL I-EXPLORATION +(20-82), I-EXPLORATION +normetanefrinas I-EXPLORATION +urinarias I-EXPLORATION +4816 I-EXPLORATION +ug/g I-EXPLORATION +creatinina I-EXPLORATION +(46-256), I-EXPLORATION +metanefrinas I-EXPLORATION +urinarias I-EXPLORATION +122 I-EXPLORATION +ug/g I-EXPLORATION +creatinina I-EXPLORATION +(25-155), I-EXPLORATION +calcitonina I-EXPLORATION +plasmática I-EXPLORATION +ultrasensible I-EXPLORATION +< I-EXPLORATION +0, I-EXPLORATION +2 I-EXPLORATION +pg/mL I-EXPLORATION +(< I-EXPLORATION +7, I-EXPLORATION +5), I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario I-EXPLORATION +1, I-EXPLORATION +14 I-EXPLORATION +ng/mL I-EXPLORATION +(<4,2). I-EXPLORATION +Las I-EXPLORATION +mediciones I-EXPLORATION +de I-EXPLORATION +estas I-EXPLORATION +hormonas I-EXPLORATION +fueron I-EXPLORATION +realizadas I-EXPLORATION +bajo I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +amlodipino, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +tiene I-EXPLORATION +mínima I-EXPLORATION +influencia I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +renina-angiotensina-aldosterona I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +afecta I-EXPLORATION +la I-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +metanefrinas I-EXPLORATION +urinarias2, I-EXPLORATION +3. I-EXPLORATION + I-EXPLORATION +Ecografía I-EXPLORATION +tiroidea I-EXPLORATION +evidenció I-EXPLORATION +nódulos I-EXPLORATION +tiroideos I-EXPLORATION +bilaterales I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +coloideo, I-EXPLORATION +el I-EXPLORATION +mayor I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +mm. I-EXPLORATION +Tomografía I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +angioTAC I-EXPLORATION +renal I-EXPLORATION +mostraron I-EXPLORATION +3 I-EXPLORATION +masas I-EXPLORATION +retroperitoneales: I-EXPLORATION +una I-EXPLORATION +pararrenal I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +cm, I-EXPLORATION +otra I-EXPLORATION +en I-EXPLORATION +hilio I-EXPLORATION +renal I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tercera I-EXPLORATION +paraaórtica I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +cierto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +compresión I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +arterias I-EXPLORATION +renales I-EXPLORATION +izquierda. I-EXPLORATION +Fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +y I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +y I-EXPLORATION +cuello I-EXPLORATION +descartaron I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +hemangiomas I-EXPLORATION +retínales I-EXPLORATION +y I-EXPLORATION +hemangioblastomas I-EXPLORATION +cerebrales. I-EXPLORATION +En I-EXPLORATION +base I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +elementos I-EXPLORATION +clínicos I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +neurofibromatosis I-EXPLORATION +tipo I-EXPLORATION +1 I-EXPLORATION +(NF1), I-EXPLORATION +neoplasia I-EXPLORATION +endocrina I-EXPLORATION +múltiple I-EXPLORATION +tipo I-EXPLORATION +2 I-EXPLORATION +(NEM I-EXPLORATION +2) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +von I-EXPLORATION +Hippel-Lindau I-EXPLORATION +(VHL), I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +masas I-EXPLORATION +extraadrenales I-EXPLORATION +y B-FAMILY_HISTORY +considerando I-FAMILY_HISTORY +el I-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +materno I-FAMILY_HISTORY +de I-FAMILY_HISTORY +feocromocitoma, I-FAMILY_HISTORY +se B-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +paraganglioma I-EXPLORATION +hereditario. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente, I-EXPLORATION +realizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +del I-EXPLORATION +Prof. I-EXPLORATION +Hartmut I-EXPLORATION +P.H. I-EXPLORATION +Neumann I-EXPLORATION +(Universidad I-EXPLORATION +de I-EXPLORATION +Freiburg, I-EXPLORATION +Alemania) I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +mutación I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +succinato I-EXPLORATION +deshidrogenasa I-EXPLORATION +SDHB I-EXPLORATION +Exon I-EXPLORATION +2 I-EXPLORATION +c.300_304 I-EXPLORATION +del I-EXPLORATION +CCTCA I-EXPLORATION +(p.P56delYfsX5), I-EXPLORATION +siendo I-EXPLORATION +negativo I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +hija. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +cirugía, I-TREATMENT +resecándose I-TREATMENT +3 I-TREATMENT +masas I-TREATMENT +retro-peritoneales I-TREATMENT +que I-TREATMENT +se I-TREATMENT +correspondían I-TREATMENT +en I-TREATMENT +ubicación I-TREATMENT +y I-TREATMENT +tamaño I-TREATMENT +con I-TREATMENT +la I-TREATMENT +TAC I-TREATMENT +abdominal. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +informó I-EXPLORATION +paragangliomas. I-EXPLORATION +Las I-EXPLORATION +normetanefrinas I-EXPLORATION +urinarias I-EXPLORATION +se I-EXPLORATION +normalizaron I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +resonancias I-EXPLORATION +magnéticas I-EXPLORATION +de I-EXPLORATION +cabeza, I-EXPLORATION +cuello, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +Tórax I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +dilatada I-PAST_MEDICAL_HISTORY +idiopática I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +permanente I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Evoluciona B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +cardiaca I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +capacidad I-PRESENT_ILLNESS +funcional I-PRESENT_ILLNESS +III I-PRESENT_ILLNESS +(NYHA) I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pesar I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +adecuado. I-PRESENT_ILLNESS +Su B-EXPLORATION +ecocardiograma I-EXPLORATION +evidenció I-EXPLORATION +dilatación I-EXPLORATION +moderada I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +(DFDVI I-EXPLORATION +64 I-EXPLORATION +mm), I-EXPLORATION +deterioro I-EXPLORATION +severo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +sistólica I-EXPLORATION +ventricular I-EXPLORATION +izquierda I-EXPLORATION +(FE I-EXPLORATION +30%) I-EXPLORATION +e I-EXPLORATION +importante I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +izquierda I-EXPLORATION +(diámetro I-EXPLORATION +56 I-EXPLORATION +mm). I-EXPLORATION +Su B-DERIVED_FROM/TO +cardiólogo I-DERIVED_FROM/TO +tratante I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +Institución I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +terapia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +resincronización I-DERIVED_FROM/TO +biventricular. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-TREATMENT +planificó I-TREATMENT +el I-TREATMENT +implante I-TREATMENT +con I-TREATMENT +abordaje I-TREATMENT +habitual I-TREATMENT +por I-TREATMENT +el I-TREATMENT +lado I-TREATMENT +izquierdo. I-TREATMENT +Se I-TREATMENT +confeccionó I-TREATMENT +un I-TREATMENT +bolsillo I-TREATMENT +subcutáneo I-TREATMENT +prepectoral I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +punción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +axilar I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +Seldinger, I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT +Al I-TREATMENT +avanzar I-TREATMENT +la I-TREATMENT +guía, I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +un I-TREATMENT +trayecto I-TREATMENT +inusual I-TREATMENT +desde I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +subclavia I-TREATMENT +izquierda I-TREATMENT +hacia I-TREATMENT +inferior I-TREATMENT +por I-TREATMENT +la I-TREATMENT +región I-TREATMENT +paravertebral I-TREATMENT +izquierda, I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +una I-TREATMENT +VCSIP. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +venograma I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +VCSIP, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +comunicación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +sistema I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +superior I-EXPLORATION +derecha. I-EXPLORATION +Además I-EXPLORATION +el I-EXPLORATION +venograma I-EXPLORATION +permitió I-EXPLORATION +corroborar I-EXPLORATION +drenaje I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +VCSIP I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +coronario, I-EXPLORATION +sin I-EXPLORATION +cortocircuito I-EXPLORATION +intracardiaco. I-EXPLORATION +A B-TREATMENT +continuación, I-TREATMENT +se I-TREATMENT +avanzó I-TREATMENT +a I-TREATMENT +través I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +coronario I-TREATMENT +un I-TREATMENT +electrodo I-TREATMENT +ventricular I-TREATMENT +de I-TREATMENT +fijación I-TREATMENT +activa I-TREATMENT +Medtronic® I-TREATMENT +modelo I-TREATMENT +4076 I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +aurícula I-TREATMENT +derecha, I-TREATMENT +dirigiéndolo I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +válvula I-TREATMENT +tricúspide I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +región I-TREATMENT +septo I-TREATMENT +infundibular I-TREATMENT +del I-TREATMENT +ventrículo I-TREATMENT +derecho. I-TREATMENT +Se I-TREATMENT +obtuvo I-TREATMENT +una I-TREATMENT +onda I-TREATMENT +R I-TREATMENT +sensada I-TREATMENT +de I-TREATMENT +12, I-TREATMENT +6 I-TREATMENT +mV, I-TREATMENT +un I-TREATMENT +umbral I-TREATMENT +de I-TREATMENT +estimulación I-TREATMENT +ventricular I-TREATMENT +derecho I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +4 I-TREATMENT +V I-TREATMENT +a I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +ms, I-TREATMENT +con I-TREATMENT +impedancia I-TREATMENT +de I-TREATMENT +estimulación I-TREATMENT +de I-TREATMENT +550 I-TREATMENT +Ohms. I-TREATMENT +Posteriormente, I-TREATMENT +utilizando I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +Ber-mann I-TREATMENT +con I-TREATMENT +orificios I-TREATMENT +proximales I-TREATMENT +al I-TREATMENT +balón, I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +inyección I-TREATMENT +de I-TREATMENT +medio I-TREATMENT +de I-TREATMENT +contraste I-TREATMENT +desde I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +medial I-TREATMENT +del I-TREATMENT +seno I-TREATMENT +coronario, I-TREATMENT +evidenciando I-TREATMENT +un I-TREATMENT +seno I-TREATMENT +coronario I-TREATMENT +dilatado, I-TREATMENT +sin I-TREATMENT +lograr I-TREATMENT +contrastar I-TREATMENT +ramas I-TREATMENT +de I-TREATMENT +venas I-TREATMENT +coronarias I-TREATMENT +laterales. I-TREATMENT +Luego, I-TREATMENT +utilizando I-TREATMENT +una I-TREATMENT +vaina I-TREATMENT +larga I-TREATMENT +y I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +guía I-TREATMENT +Medtronic® I-TREATMENT +ángulo I-TREATMENT +de I-TREATMENT +130° I-TREATMENT +(modelo I-TREATMENT +6248 I-TREATMENT +del I-TREATMENT +130) I-TREATMENT +se I-TREATMENT +canuló I-TREATMENT +una I-TREATMENT +vena I-TREATMENT +coronaria I-TREATMENT +póstero-lateral I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +se I-TREATMENT +avanzó I-TREATMENT +un I-TREATMENT +electrodo I-TREATMENT +de I-TREATMENT +estimulación I-TREATMENT +bipolar I-TREATMENT +Medtronic® I-TREATMENT +modelo I-TREATMENT +4196, I-TREATMENT +logrando I-TREATMENT +una I-TREATMENT +ubicación I-TREATMENT +satisfactoria I-TREATMENT +para I-TREATMENT +estimulación I-TREATMENT +ventricular I-TREATMENT +izquierda, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +obtuvo I-TREATMENT +una I-TREATMENT +onda I-TREATMENT +R I-TREATMENT +sensada I-TREATMENT +de I-TREATMENT +19, I-TREATMENT +9 I-TREATMENT +mV, I-TREATMENT +un I-TREATMENT +umbral I-TREATMENT +de I-TREATMENT +estimulación I-TREATMENT +ventricular I-TREATMENT +izquierdo I-TREATMENT +de I-TREATMENT +2, I-TREATMENT +0 I-TREATMENT +V I-TREATMENT +a I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +ms, I-TREATMENT +con I-TREATMENT +impedancia I-TREATMENT +de I-TREATMENT +estimulación I-TREATMENT +de I-TREATMENT +1.200 I-TREATMENT +Ohms. I-TREATMENT +Se I-TREATMENT +fijó I-TREATMENT +ambos I-TREATMENT +electrodos I-TREATMENT +a I-TREATMENT +la I-TREATMENT +fascia I-TREATMENT +prepectoral I-TREATMENT +y I-TREATMENT +se I-TREATMENT +conectaron I-TREATMENT +a I-TREATMENT +los I-TREATMENT +puertos I-TREATMENT +respectivos I-TREATMENT +del I-TREATMENT +generador I-TREATMENT +Medtronic® I-TREATMENT +Insync I-TREATMENT +III I-TREATMENT +modelo I-TREATMENT +8042, I-TREATMENT +ocluyendo I-TREATMENT +el I-TREATMENT +puerto I-TREATMENT +auricular. I-TREATMENT +Finalmente, I-TREATMENT +se I-TREATMENT +completó I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +realizando I-TREATMENT +fulguración I-TREATMENT +del I-TREATMENT +nodo I-TREATMENT +AV I-TREATMENT +compacto. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +satisfactoria, I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +capacidad I-EVOLUTION +funcional. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +control I-EVOLUTION +del I-EVOLUTION +dispositivo I-EVOLUTION +que I-EVOLUTION +confirmó I-EVOLUTION +99% I-EVOLUTION +de I-EVOLUTION +estimulación I-EVOLUTION +biventricular. I-EVOLUTION +Se B-EXPLORATION +midió I-EXPLORATION +una I-EXPLORATION +onda I-EXPLORATION +R I-EXPLORATION +de I-EXPLORATION +11, I-EXPLORATION +2 I-EXPLORATION +-15, I-EXPLORATION +68 I-EXPLORATION +mV I-EXPLORATION +en I-EXPLORATION +ventrículo I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +umbral I-EXPLORATION +de I-EXPLORATION +estimulación I-EXPLORATION +ventricular I-EXPLORATION +derecho I-EXPLORATION +menor I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +V I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +ms I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +impedancia I-EXPLORATION +de I-EXPLORATION +430 I-EXPLORATION +Ohms. I-EXPLORATION +La I-EXPLORATION +onda I-EXPLORATION +R I-EXPLORATION +sensada I-EXPLORATION +en I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +fue I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +22, I-EXPLORATION +4 I-EXPLORATION +mV, I-EXPLORATION +el I-EXPLORATION +umbral I-EXPLORATION +de I-EXPLORATION +estimulación I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +V I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +ms I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +impedancia I-EXPLORATION +de I-EXPLORATION +776 I-EXPLORATION +Ohms. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +10 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +en I-EVOLUTION +control I-EVOLUTION +regular I-EVOLUTION +con I-EVOLUTION +su I-EVOLUTION +cardiólogo I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +capacidad I-EVOLUTION +funcional I-EVOLUTION +I-II I-EVOLUTION +(NYHA). I-EVOLUTION +El I-EVOLUTION +último I-EVOLUTION +control I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +dispositivo I-EVOLUTION +mostró I-EVOLUTION +99% I-EVOLUTION +de I-EVOLUTION +estimulación I-EVOLUTION +biventricular I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +de I-EVOLUTION +sensado I-EVOLUTION +y I-EVOLUTION +estimulación I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +electrodos I-EVOLUTION +son I-EVOLUTION +adecuados. I-EVOLUTION +El B-EXPLORATION +electrodo I-EXPLORATION +ventricular I-EXPLORATION +derecho I-EXPLORATION +sensa I-EXPLORATION +onda I-EXPLORATION +R I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +0 I-EXPLORATION +mV, I-EXPLORATION +tiene I-EXPLORATION +umbral I-EXPLORATION +de I-EXPLORATION +estimulación I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +0 I-EXPLORATION +V I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +ms, I-EXPLORATION +con I-EXPLORATION +impedancia I-EXPLORATION +de I-EXPLORATION +480 I-EXPLORATION +Ohms. I-EXPLORATION +El I-EXPLORATION +electrodo I-EXPLORATION +ventricular I-EXPLORATION +izquierdo I-EXPLORATION +sensa I-EXPLORATION +una I-EXPLORATION +onda I-EXPLORATION +R I-EXPLORATION +de I-EXPLORATION +12, I-EXPLORATION +0 I-EXPLORATION +mV, I-EXPLORATION +tiene I-EXPLORATION +umbral I-EXPLORATION +de I-EXPLORATION +estimulación I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +V I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +ms, I-EXPLORATION +con I-EXPLORATION +impedancia I-EXPLORATION +de I-EXPLORATION +971 I-EXPLORATION +Ohms. I-EXPLORATION +Mantiene I-EXPLORATION +bloqueo I-EXPLORATION +aurículo-ventricular I-EXPLORATION +completo I-EXPLORATION +con I-EXPLORATION +escape I-EXPLORATION +nodal I-EXPLORATION +a I-EXPLORATION +44 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +domiciliada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +sector I-PRESENT_ILLNESS +rural I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +conocidos. I-PAST_MEDICAL_HISTORY +Inició B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +deterioro I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +(aproximadamente I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +oportunidades I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +rural I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +sector I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +trató I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +sintomática. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipoglicemia I-PRESENT_ILLNESS +(26 I-PRESENT_ILLNESS +mg/dl) I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +trató I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +infusión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +solución I-PRESENT_ILLNESS +glucosada I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +10%. I-PRESENT_ILLNESS +Evolucionó B-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +normalización I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +glicemia I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +trasladada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +hospital. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +ocupación I-EXPLORATION +pleural I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +desviación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +estructuras I-EXPLORATION +mediastínicas. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +pleural I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +densidad I-EXPLORATION +heterogénea, I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +el I-EXPLORATION +hemitórax I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +efecto I-EXPLORATION +compresivo, I-EXPLORATION +atelectasia I-EXPLORATION +pulmonar I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +desplazamiento I-EXPLORATION +del I-EXPLORATION +mediastino. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +otros I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +no I-EXPLORATION +destacaron I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION + I-EXPLORATION +Durante B-EVOLUTION +la I-EVOLUTION +hospitalización I-EVOLUTION +presentó I-EVOLUTION +varios I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +hipoglicemia I-EVOLUTION +sintomática I-EVOLUTION +caracterizada I-EVOLUTION +por I-EVOLUTION +somnolencia, I-EVOLUTION +deterioro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +agudeza I-EVOLUTION +visual, I-EVOLUTION +debilidad I-EVOLUTION +muscular, I-EVOLUTION +sudoración, I-EVOLUTION +palpitaciones I-EVOLUTION +y I-EVOLUTION +palidez. I-EVOLUTION +Estas I-EVOLUTION +hipoglicemias I-EVOLUTION +fueron I-EVOLUTION +en I-EVOLUTION +días I-EVOLUTION +diferentes I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +registraron I-EVOLUTION +al I-EVOLUTION +menos I-EVOLUTION +7 I-EVOLUTION +mediciones I-EVOLUTION +de I-EVOLUTION +glicemia I-EVOLUTION +entre I-EVOLUTION +27 I-EVOLUTION +y I-EVOLUTION +58 I-EVOLUTION +mg/dl, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +se I-EVOLUTION +registraron I-EVOLUTION +dos I-EVOLUTION +hipoglicemias. I-EVOLUTION +Fue B-TREATMENT +tratada I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +episodio I-TREATMENT +con I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +solución I-TREATMENT +glucosada I-TREATMENT +al I-TREATMENT +10%. I-TREATMENT +Debido I-TREATMENT +al I-TREATMENT +difícil I-TREATMENT +control I-TREATMENT +metabólico, I-TREATMENT +se I-TREATMENT +trató I-TREATMENT +y I-TREATMENT +estudió I-TREATMENT +en I-TREATMENT +conjunto I-TREATMENT +con I-TREATMENT +el I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +endocrinología. I-TREATMENT +Las B-EXPLORATION +mediciones I-EXPLORATION +de I-EXPLORATION +insulinemia I-EXPLORATION +basal, I-EXPLORATION +cortisol, I-EXPLORATION +prolactina I-EXPLORATION +y I-EXPLORATION +hormona I-EXPLORATION +tiroestimulante I-EXPLORATION +(TSH) I-EXPLORATION +estaban I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +de I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +guiada I-EXPLORATION +por I-EXPLORATION +tomografía I-EXPLORATION +computada, I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +concluyó I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +era I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +TFSP. I-EXPLORATION + I-EXPLORATION +Descartada B-TREATMENT +otra I-TREATMENT +causa I-TREATMENT +de I-TREATMENT +hipoglicemia I-TREATMENT +y I-TREATMENT +en I-TREATMENT +el I-TREATMENT +contexto I-TREATMENT +de I-TREATMENT +un I-TREATMENT +TFSP, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +quirúrgico. I-TREATMENT + I-TREATMENT +Procedimiento I-TREATMENT +quirúrgico I-TREATMENT + I-TREATMENT +Con I-TREATMENT +intubación I-TREATMENT +monobronquial I-TREATMENT +(tubo I-TREATMENT +endotraqueal I-TREATMENT +de I-TREATMENT +doble I-TREATMENT +lumen) I-TREATMENT +y I-TREATMENT +en I-TREATMENT +decúbito I-TREATMENT +lateral I-TREATMENT +izquierdo. I-TREATMENT +Se I-TREATMENT +abordó I-TREATMENT +por I-TREATMENT +amplia I-TREATMENT +toracotomía I-TREATMENT +posterolateral I-TREATMENT +derecha, I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +un I-TREATMENT +tumor I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +encapsulado I-TREATMENT +que I-TREATMENT +ocupaba I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +pleural I-TREATMENT +y I-TREATMENT +desplazaba I-TREATMENT +las I-TREATMENT +estructuras I-TREATMENT +mediastínicas I-TREATMENT +sin I-TREATMENT +infiltrarlas. I-TREATMENT +Se I-TREATMENT +encontraba I-TREATMENT +adherido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +pleura I-TREATMENT +parietal, I-TREATMENT +con I-TREATMENT +base I-TREATMENT +de I-TREATMENT +implantación I-TREATMENT +ancha I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +pedículo I-TREATMENT +identificable. I-TREATMENT +Se I-TREATMENT +liberaron I-TREATMENT +las I-TREATMENT +adherencias I-TREATMENT +y I-TREATMENT +se I-TREATMENT +resecó I-TREATMENT +macroscópicamente I-TREATMENT +el I-TREATMENT +tumor I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +completa. I-TREATMENT +Se I-TREATMENT +observó I-TREATMENT +adecuada I-TREATMENT +expansión I-TREATMENT +pulmonar I-TREATMENT +derecha I-TREATMENT +post I-TREATMENT +exéresis I-TREATMENT +del I-TREATMENT +tumor. I-TREATMENT +Se I-TREATMENT +instalaron I-TREATMENT +dos I-TREATMENT +tubos I-TREATMENT +pleurales I-TREATMENT +(28 I-TREATMENT +Fr.) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cerró I-TREATMENT +la I-TREATMENT +toracotomía I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +habitual. I-TREATMENT + I-TREATMENT +Evolución B-EVOLUTION +postoperatoria I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +sin I-EVOLUTION +incidentes. I-EVOLUTION +No I-EVOLUTION +presentó I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +hipoglicemia. I-EVOLUTION +Se I-EVOLUTION +retiraron I-EVOLUTION +los I-EVOLUTION +tubos I-EVOLUTION +pleurales I-EVOLUTION +al I-EVOLUTION +séptimo I-EVOLUTION +día I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +al I-EVOLUTION +décimo I-EVOLUTION +día I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +concluyó: I-EXPLORATION +TFSP I-EXPLORATION +de I-EXPLORATION +27 I-EXPLORATION +x I-EXPLORATION +25 I-EXPLORATION +x I-EXPLORATION +11, I-EXPLORATION +5 I-EXPLORATION +centímetros I-EXPLORATION +y I-EXPLORATION +peso I-EXPLORATION +de I-EXPLORATION +3.450 I-EXPLORATION +gramos, I-EXPLORATION +con I-EXPLORATION +características I-EXPLORATION +histológicas I-EXPLORATION +de I-EXPLORATION +malignidad. I-EXPLORATION +El I-EXPLORATION +TFSP I-EXPLORATION +tenía I-EXPLORATION +necrosis I-EXPLORATION +tumoral I-EXPLORATION +macro I-EXPLORATION +y I-EXPLORATION +microscópica I-EXPLORATION +extensa, I-EXPLORATION +hasta I-EXPLORATION +2 I-EXPLORATION +mitosis I-EXPLORATION +en I-EXPLORATION +10 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +aumento I-EXPLORATION +mayor I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +quirúrgicos I-EXPLORATION +estaban I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +lesión. I-EXPLORATION +La I-EXPLORATION +inmunohistoquímica I-EXPLORATION +presentó I-EXPLORATION +positividad I-EXPLORATION +intensa I-EXPLORATION +para I-EXPLORATION +Vimentina I-EXPLORATION +y I-EXPLORATION +CD34. I-EXPLORATION + I-EXPLORATION +Actualmente, B-EVOLUTION +a I-EVOLUTION +15 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +control I-EVOLUTION +metabólico I-EVOLUTION +adecuado, I-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +glicemia I-EVOLUTION +y I-EVOLUTION +asintomática I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +respiratorio, I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +clínicas I-EVOLUTION +ni I-EVOLUTION +radiológicas I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +del I-EVOLUTION +tumor. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +residencia I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +IX I-PAST_MEDICAL_HISTORY +región, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +déficit I-PRESENT_ILLNESS +motot I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +(hemiparesia I-PRESENT_ILLNESS +braquiocrural I-PRESENT_ILLNESS +izquierda) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +progresiva. I-PRESENT_ILLNESS +La B-EXPLORATION +TC I-EXPLORATION +cerebral I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +quiste I-EXPLORATION +intraxial I-EXPLORATION +temporal I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +60 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +bien I-EXPLORATION +delimitado, I-EXPLORATION +isodenso I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +LCR, I-EXPLORATION +sin I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION +Significativo I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +de I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +mm I-EXPLORATION +y I-EXPLORATION +herniación I-EXPLORATION +uncal. I-EXPLORATION +Se B-TREATMENT +planteó I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +quiste I-TREATMENT +hidatídico I-TREATMENT +temporal I-TREATMENT +derecho; I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +intacta I-TREATMENT +del I-TREATMENT +quiste I-TREATMENT +y I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +anatomopatológico I-TREATMENT +confirmó I-TREATMENT +la I-TREATMENT +etiología I-TREATMENT +hidatídica. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +lesiones I-EXPLORATION +quísticas. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +quirúrgicas I-EVOLUTION +ni I-EVOLUTION +déficit I-EVOLUTION +neurológico. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +conserje, B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +activo. I-PAST_MEDICAL_HISTORY +Presentaba I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +hospitalizaciones I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +distintos I-PAST_MEDICAL_HISTORY +centros I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2010 I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemoptisis I-PAST_MEDICAL_HISTORY +autolimitada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +escasa I-PAST_MEDICAL_HISTORY +cuantía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +esfuerzo I-PAST_MEDICAL_HISTORY +físico. I-PAST_MEDICAL_HISTORY +Al B-PRESENT_ILLNESS +preguntar I-PRESENT_ILLNESS +dirigidamente, I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +adinamia, I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +esfuerzos I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +través I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +empeorando I-PRESENT_ILLNESS +apareciendo I-PRESENT_ILLNESS +ortopnea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +ante I-PRESENT_ILLNESS +pequeños I-PRESENT_ILLNESS +esfuerzos, I-PRESENT_ILLNESS +mialgias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +piernas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rigidez I-PRESENT_ILLNESS +matinal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +articulaciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +manos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10-15 I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +artralgias. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +endoscopía I-EXPLORATION +digestiva I-EXPLORATION +alta, I-EXPLORATION +ecocardio-grama, I-EXPLORATION +perfil I-EXPLORATION +bioquímico, I-EXPLORATION +creatinina I-EXPLORATION +plasmática, I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +normales. I-EXPLORATION +Tuvo I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +anemia I-EXPLORATION +(hematocrito I-EXPLORATION +35%) I-EXPLORATION +y I-EXPLORATION +VHS I-EXPLORATION +elevada. I-EXPLORATION +En B-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +persistió I-EVOLUTION +con I-EVOLUTION +anemia I-EVOLUTION +normocítica-normocrómica I-EVOLUTION +de I-EVOLUTION +carácter I-EVOLUTION +leve, I-EVOLUTION +pero I-EVOLUTION +VHS I-EVOLUTION +se I-EVOLUTION +normalizó. I-EVOLUTION + I-EVOLUTION +Presentó B-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +3 I-EXPLORATION +días I-EXPLORATION +post I-EXPLORATION +hemoptisis, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +"vidrio I-EXPLORATION +esmerilado" I-EXPLORATION +difusas I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +alveolar I-EXPLORATION +y I-EXPLORATION +enfisema I-EXPLORATION +pulmonar, I-EXPLORATION +pero I-EXPLORATION +en I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +sólo I-EXPLORATION +enfisema I-EXPLORATION +leve. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +fibrobroncoscopía I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal, I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +lavado I-EXPLORATION +bronco I-EXPLORATION +alveolar. I-EXPLORATION +Presentaba I-EXPLORATION +exámenes I-EXPLORATION +inmuno-reumatológicos I-EXPLORATION +negativos I-EXPLORATION +(ANA, I-EXPLORATION +AntiDNAds, I-EXPLORATION +ANCA I-EXPLORATION +por I-EXPLORATION +IFI, I-EXPLORATION +Coombs I-EXPLORATION +directo I-EXPLORATION +e I-EXPLORATION +indirecto, I-EXPLORATION +FR). I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +manos I-EXPLORATION +mostraba I-EXPLORATION +leves I-EXPLORATION +cambios I-EXPLORATION +degenerativos I-EXPLORATION +en I-EXPLORATION +articulaciones I-EXPLORATION +interfalángicas I-EXPLORATION +distales. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +se I-EXPLORATION +pesquisó I-EXPLORATION +distrofia I-EXPLORATION +ungueal, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +de I-EXPLORATION +manos I-EXPLORATION +sin I-EXPLORATION +edema, I-EXPLORATION +pigmentación I-EXPLORATION +anaranjada I-EXPLORATION +de I-EXPLORATION +párpados I-EXPLORATION +con I-EXPLORATION +petequias I-EXPLORATION +perioculares I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +macroglosia. I-EXPLORATION +Por I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +sugirió I-EXPLORATION +descartar I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +depósito, I-EXPLORATION +postulando I-EXPLORATION +como I-EXPLORATION +hipótesis I-EXPLORATION +diagnóstica I-EXPLORATION +amiloidosis I-EXPLORATION +sistémica. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +de I-EXPLORATION +párpado, I-EXPLORATION +mejilla I-EXPLORATION +y I-EXPLORATION +mano, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +amorfo I-EXPLORATION +intersticial I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +hialino I-EXPLORATION +eosinofílico I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +amiloideo, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +microhemorragia. I-EXPLORATION +Las I-EXPLORATION +tinciones I-EXPLORATION +de I-EXPLORATION +Cresil I-EXPLORATION +violeta I-EXPLORATION +y I-EXPLORATION +rojo I-EXPLORATION +Congo I-EXPLORATION +fueron I-EXPLORATION +positivas I-EXPLORATION +con I-EXPLORATION +dicroísmo I-EXPLORATION +verde I-EXPLORATION +manzana I-EXPLORATION +positivo I-EXPLORATION +bajo I-EXPLORATION +luz I-EXPLORATION +polarizada I-EXPLORATION +y I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +permanganato I-EXPLORATION +de I-EXPLORATION +potasio. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +ecocardiograma I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +hipertrofia I-EXPLORATION +de I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +depósito I-EXPLORATION +amiloideo. I-EXPLORATION +Con I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +tiroides I-EXPLORATION +y I-EXPLORATION +electroforesis I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +normales, I-EXPLORATION +se I-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +amiloidosis I-EXPLORATION +AA. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +64 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hipertenso B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +atenolol I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +mantenía I-PAST_MEDICAL_HISTORY +cifras I-PAST_MEDICAL_HISTORY +tensionales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +140/85 I-PAST_MEDICAL_HISTORY +mm I-PAST_MEDICAL_HISTORY +Hg. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +ecocardiograma I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +buena I-EXPLORATION +función I-EXPLORATION +sistólica I-EXPLORATION +e I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular I-EXPLORATION +izquierda. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +lobectomía I-TREATMENT +hepática I-TREATMENT +derecha, I-TREATMENT +sin I-TREATMENT +incidentes I-TREATMENT +de I-TREATMENT +importancia I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +intraoperatorio. I-TREATMENT +Aproximadamente B-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +12 I-EVOLUTION +h I-EVOLUTION +del I-EVOLUTION +post I-EVOLUTION +operatorio I-EVOLUTION +presentó I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +presión I-EVOLUTION +arterial I-EVOLUTION +hasta I-EVOLUTION +80/50 I-EVOLUTION +mm I-EVOLUTION +Hg I-EVOLUTION +y I-EVOLUTION +frecuencia I-EVOLUTION +cardiaca I-EVOLUTION +de I-EVOLUTION +135, I-EVOLUTION +sin I-EVOLUTION +respuesta I-EVOLUTION +a B-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +500 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +Voluven®. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +dobutamina I-TREATMENT +que I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +hasta I-TREATMENT +7 I-TREATMENT +ug/kg/min, I-TREATMENT +observándose I-TREATMENT +mayor I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +las I-TREATMENT +condiciones I-TREATMENT +hemodinámicas, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +arteria I-TREATMENT +pulmonar I-TREATMENT +que I-TREATMENT +mostraba I-TREATMENT +una I-TREATMENT +presión I-TREATMENT +de I-TREATMENT +capilar I-TREATMENT +pulmonar I-TREATMENT +(PCP) I-TREATMENT +de I-TREATMENT +18 I-TREATMENT +mmHg, I-TREATMENT +y I-TREATMENT +un I-TREATMENT +índice I-TREATMENT +cardiaco I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +2 I-TREATMENT +lt/ I-TREATMENT +m2. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +ETE I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +hipertrófico, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +cavidad I-EXPLORATION +pequeña, I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +función I-EXPLORATION +global I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +motilidad I-EXPLORATION +segmentaria, I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +válvula I-EXPLORATION +aortica I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +y I-EXPLORATION +movilidad I-EXPLORATION +normal. I-EXPLORATION +Durante I-EXPLORATION +el I-EXPLORATION +sístole, I-EXPLORATION +la I-EXPLORATION +valva I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +mitral I-EXPLORATION +se I-EXPLORATION +desplaza I-EXPLORATION +obstruyendo I-EXPLORATION +el I-EXPLORATION +70% I-EXPLORATION +del I-EXPLORATION +TSVI, I-EXPLORATION +y I-EXPLORATION +produciendo I-EXPLORATION +una I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +(IM) I-EXPLORATION +moderada. I-EXPLORATION +Se B-TREATMENT +hizo I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +SAM, I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +1.000 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +Voluven®, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +noradrenalina I-TREATMENT +hasta I-TREATMENT +2 I-TREATMENT +ug/kg/min, I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +dobutamina, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +administran I-TREATMENT +3 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +metoprolol. I-TREATMENT +Dentro B-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +siguientes I-EVOLUTION +20 I-EVOLUTION +min I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +obstrucción I-EVOLUTION +del I-EVOLUTION +TSVI I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +IM, I-EVOLUTION +la I-EVOLUTION +presión I-EVOLUTION +arterial I-EVOLUTION +se I-EVOLUTION +estabilizó I-EVOLUTION +en I-EVOLUTION +100/60 I-EVOLUTION +mm I-EVOLUTION +Hg I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +frecuencia I-EVOLUTION +cardiaca I-EVOLUTION +en I-EVOLUTION +100. I-EVOLUTION +Doce I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +se I-EVOLUTION +presentó I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +compromiso I-EVOLUTION +hemodinámico I-EVOLUTION +de I-EVOLUTION +características I-EVOLUTION +similares. I-EVOLUTION +Por B-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +hemoperitoneo I-EXPLORATION +que I-EXPLORATION +pudiera I-EXPLORATION +perpetuar I-EXPLORATION +una I-EXPLORATION +condición I-EXPLORATION +de I-EXPLORATION +hipovolemia I-EXPLORATION +que I-EXPLORATION +favoreciera I-EXPLORATION +el I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +SAM, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +exploradora, I-EXPLORATION +encontrándose I-EXPLORATION +300 I-EXPLORATION +ml I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +antigua, I-EXPLORATION +sin I-EXPLORATION +identificarse I-EXPLORATION +un I-EXPLORATION +sitio I-EXPLORATION +de I-EXPLORATION +sangrado. I-EXPLORATION +Se B-TREATMENT +aportó I-TREATMENT +volumen, I-TREATMENT +la I-TREATMENT +norepinefrina I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +05 I-TREATMENT +a I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +ug/kg/min, I-TREATMENT +restableciéndose I-TREATMENT +PA I-TREATMENT +de I-TREATMENT +100/70 I-TREATMENT +mm I-TREATMENT +Hg, I-TREATMENT +PCP I-TREATMENT +de I-TREATMENT +22 I-TREATMENT +mm I-TREATMENT +Hg, I-TREATMENT +e I-TREATMENT +IC I-TREATMENT +3, I-TREATMENT +2 I-TREATMENT +lt/m2. I-TREATMENT +No B-EVOLUTION +se I-EVOLUTION +observaron I-EVOLUTION +otros I-EVOLUTION +problemas I-EVOLUTION +hemodinámicos I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +post I-EVOLUTION +operatorio. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +30 I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +colecciones I-EVOLUTION +intra-abdominales I-EVOLUTION +que B-TREATMENT +requirieron I-TREATMENT +drenaje I-TREATMENT +percutáneo. I-TREATMENT + I-TREATMENT + +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 +y B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tronco I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +clínico I-EXPLORATION +constató I-EXPLORATION +múltiples I-EXPLORATION +placas I-EXPLORATION +y I-EXPLORATION +nódulos I-EXPLORATION +eritemato-violáceos, I-EXPLORATION +no I-EXPLORATION +dolorosos I-EXPLORATION +ni I-EXPLORATION +pruriginosos, I-EXPLORATION +que I-EXPLORATION +fluctuaban I-EXPLORATION +entre I-EXPLORATION +0, I-EXPLORATION +3 I-EXPLORATION +y I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +ubicados I-EXPLORATION +principalmente I-EXPLORATION +en I-EXPLORATION +tronco. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +constataron I-EXPLORATION +linfoadenopatías I-EXPLORATION +ni I-EXPLORATION +visceromegalias. I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +mostró I-EXPLORATION +leucopenia I-EXPLORATION +(leucocitos: I-EXPLORATION +3.600/mm3 I-EXPLORATION +[basófilos: I-EXPLORATION +1, I-EXPLORATION +1%, I-EXPLORATION +eosinófilos: I-EXPLORATION +2, I-EXPLORATION +1%, I-EXPLORATION +neutrófilos: I-EXPLORATION +56, I-EXPLORATION +9%, I-EXPLORATION +linfocitos: I-EXPLORATION +33, I-EXPLORATION +2%, I-EXPLORATION +monocitos: I-EXPLORATION +6, I-EXPLORATION +7%], I-EXPLORATION +hematocrito: I-EXPLORATION +46%, I-EXPLORATION +hemoglobina: I-EXPLORATION +15, I-EXPLORATION +8 I-EXPLORATION +g/dL, I-EXPLORATION +plaquetas: I-EXPLORATION +445.000 I-EXPLORATION +mm3, I-EXPLORATION +VHS: I-EXPLORATION +5 I-EXPLORATION +mm/h); I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +y I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +anátomo-patológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +demostró I-EXPLORATION +fragmento I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +con I-EXPLORATION +denso I-EXPLORATION +infiltrado I-EXPLORATION +nodular I-EXPLORATION +dermo-hipodérmico, I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +mediano I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +inmaduro, I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +irregulares, I-EXPLORATION +nucléolos I-EXPLORATION +inconspicuos, I-EXPLORATION +citoplasma I-EXPLORATION +escaso I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +gránulos I-EXPLORATION +azurófilos. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +epidermotropismo, I-EXPLORATION +necrosis I-EXPLORATION +ni I-EXPLORATION +angioinvasión. I-EXPLORATION +La I-EXPLORATION +inmunohistoquímica I-EXPLORATION +resultó I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +CD56, I-EXPLORATION +CD4, I-EXPLORATION +CD I-EXPLORATION +123, I-EXPLORATION +CD45, I-EXPLORATION +CD43, I-EXPLORATION +y I-EXPLORATION +TdT; I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +CD3, I-EXPLORATION +CD45RO, I-EXPLORATION +CD20, I-EXPLORATION +CD79a, I-EXPLORATION +CD5, I-EXPLORATION +CD117 I-EXPLORATION +y I-EXPLORATION +MPO I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +clínicos I-EXPLORATION +e I-EXPLORATION +histopatológicos I-EXPLORATION +fueron I-EXPLORATION +concluyentes I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +NBCDP. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +etapificación I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +cuello, I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +mostró I-EXPLORATION +adenopatías I-EXPLORATION +peritraqueales I-EXPLORATION +y I-EXPLORATION +carinales I-EXPLORATION +de I-EXPLORATION +hasta I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +cm. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +cresta I-EXPLORATION +iliaca. I-EXPLORATION + I-EXPLORATION +En B-TREATMENT +la I-TREATMENT +actualidad I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +transcurridos I-TREATMENT +5 I-TREATMENT +meses, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +en I-TREATMENT +4° I-TREATMENT +ciclo I-TREATMENT +de I-TREATMENT +ciclofosfamida-doxorubicina-vincristina-prednisona I-TREATMENT +(CHOP) I-TREATMENT +con I-TREATMENT +regresión I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +cutáneas. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +hipertensa B-PAST_MEDICAL_HISTORY +controlada, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +holocránea I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +cuya I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +llegó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +10/10 I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tercer I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La B-DERIVED_FROM/TO +aparición I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +compromiso I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +conciencia I-DERIVED_FROM/TO +obligó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +consultar I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Urgencias. I-DERIVED_FROM/TO +Ingresó B-EXPLORATION +confusa, I-EXPLORATION +lenguaje I-EXPLORATION +poco I-EXPLORATION +fluente, I-EXPLORATION +rigidez I-EXPLORATION +de I-EXPLORATION +nuca, I-EXPLORATION +pupilas I-EXPLORATION +isocoricas I-EXPLORATION +reactivas I-EXPLORATION +y I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +papila I-EXPLORATION +bilateral. I-EXPLORATION +Movilizaba I-EXPLORATION +las I-EXPLORATION +4 I-EXPLORATION +extremidades, I-EXPLORATION +tenía I-EXPLORATION +reflejos I-EXPLORATION +osteotendíneos I-EXPLORATION +vivos I-EXPLORATION +y I-EXPLORATION +Babinski I-EXPLORATION +bilateral. I-EXPLORATION +Presión I-EXPLORATION +arterial I-EXPLORATION +108/64 I-EXPLORATION +mmHg, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +56 I-EXPLORATION +lmp, I-EXPLORATION +subfebril I-EXPLORATION +(t° I-EXPLORATION +37, I-EXPLORATION +2°C). I-EXPLORATION +Sin I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +mucosas I-EXPLORATION +o I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +focos I-EXPLORATION +dentarios, I-EXPLORATION +sinusales, I-EXPLORATION +oticos I-EXPLORATION +o I-EXPLORATION +respiratorio. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +cerebral I-EXPLORATION +(TC) I-EXPLORATION +mostró I-EXPLORATION +hipodensidad I-EXPLORATION +frontal I-EXPLORATION +izquierda I-EXPLORATION +redondeada, I-EXPLORATION +con I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +local I-EXPLORATION +sobre I-EXPLORATION +estructuras I-EXPLORATION +adyacentes. I-EXPLORATION +Líquido I-EXPLORATION +cefalorraquídeo I-EXPLORATION +citrino, I-EXPLORATION +760 I-EXPLORATION +leucocitos I-EXPLORATION +mm3 I-EXPLORATION +(97% I-EXPLORATION +PMN), I-EXPLORATION +proteínas I-EXPLORATION +101, I-EXPLORATION +8 I-EXPLORATION +mg/dL, I-EXPLORATION +glucosa I-EXPLORATION +69 I-EXPLORATION +mg/dL I-EXPLORATION +(hemoglucotest I-EXPLORATION +de I-EXPLORATION +116 I-EXPLORATION +mg/dL), I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +Gram I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +Hematocrito I-EXPLORATION +29, I-EXPLORATION +9%, I-EXPLORATION +hemoglobina I-EXPLORATION +9, I-EXPLORATION +8 I-EXPLORATION +g/L, I-EXPLORATION +leucocitos I-EXPLORATION +25.800 I-EXPLORATION +k/uL, I-EXPLORATION +(91, I-EXPLORATION +9% I-EXPLORATION +segmentados), I-EXPLORATION +plaquetas I-EXPLORATION +286.000 I-EXPLORATION +uL, I-EXPLORATION +PCR I-EXPLORATION +428 I-EXPLORATION +mg/L, I-EXPLORATION +protrombina I-EXPLORATION +66%, I-EXPLORATION +y I-EXPLORATION +electrolitos I-EXPLORATION +plasmáticos I-EXPLORATION +normales. I-EXPLORATION +VHB, I-EXPLORATION +VHC, I-EXPLORATION +HTLV-1, I-EXPLORATION +Chagas I-EXPLORATION +y I-EXPLORATION +VIH I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +endovenoso I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +c/12 I-TREATMENT +h, I-TREATMENT +clindamicina I-TREATMENT +600 I-TREATMENT +mg I-TREATMENT +c/8 I-TREATMENT +h, I-TREATMENT +vancomicina I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +c/12 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +betametasona I-TREATMENT +4 I-TREATMENT +mg I-TREATMENT +c/8 I-TREATMENT +h. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +persistió I-EVOLUTION +comprometida I-EVOLUTION +de I-EVOLUTION +conciencia I-EVOLUTION +(Glasgow I-EVOLUTION +12), I-EVOLUTION +con I-EVOLUTION +rigidez I-EVOLUTION +de I-EVOLUTION +nuca I-EVOLUTION +y I-EVOLUTION +opistótono. I-EVOLUTION +Pupilas B-EXPLORATION +isocóricas I-EXPLORATION +reactivas, I-EXPLORATION +reflejos I-EXPLORATION +oculocefálicos I-EXPLORATION +y I-EXPLORATION +corneales I-EXPLORATION +conservados, I-EXPLORATION +mantenía I-EXPLORATION +el I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +papila, I-EXPLORATION +la I-EXPLORATION +hiperreflexia I-EXPLORATION +generalizada I-EXPLORATION +y I-EXPLORATION +Babinski I-EXPLORATION +bilateral. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM), I-EXPLORATION +realizada I-EXPLORATION +al I-EXPLORATION +segundo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización, I-EXPLORATION +definió I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +bifrontal I-EXPLORATION +paramediano I-EXPLORATION +anterior, I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +difusión I-EXPLORATION +restringida I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +vasogénico I-EXPLORATION +perilesional. I-EXPLORATION +Se I-EXPLORATION +observó I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +leptomeníngeo I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +identificó I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +subdural I-EXPLORATION +fronto-temporal I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm. I-EXPLORATION +La I-EXPLORATION +angioresonancia I-EXPLORATION +no I-EXPLORATION +agregó I-EXPLORATION +elementos I-EXPLORATION +significativos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +interpretó I-EXPLORATION +como I-EXPLORATION +cerebritis I-EXPLORATION +bifrontal I-EXPLORATION +abscedada, I-EXPLORATION +empiema I-EXPLORATION +fronto-parietal I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +leptomeningitis. I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +neuroquirúrgica I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +dicho I-EXPLORATION +momento I-EXPLORATION +sugirió I-EXPLORATION +manejo I-EXPLORATION +medico I-EXPLORATION +del I-EXPLORATION +cuadro. I-EXPLORATION +El I-EXPLORATION +ecocardiograma I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +abdomino-pélvica I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Los I-EXPLORATION +hemocultivos, I-EXPLORATION +urocultivos, I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +secreción I-EXPLORATION +bronquial I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Al B-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +se I-EVOLUTION +acentuó I-EVOLUTION +el I-EVOLUTION +compromiso I-EVOLUTION +de I-EVOLUTION +conciencia I-EVOLUTION +(Glasgow I-EVOLUTION +4). I-EVOLUTION +TC B-EXPLORATION +cerebral I-EXPLORATION +mostró I-EXPLORATION +significativo I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +edema I-EXPLORATION +cerebral I-EXPLORATION +sin I-EXPLORATION +cambios I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +descritas. I-EXPLORATION +La B-TREATMENT +reevaluación I-TREATMENT +neuroquirúrgica I-TREATMENT +decidió I-TREATMENT +evacuar I-TREATMENT +la I-TREATMENT +colección I-TREATMENT +subdural I-TREATMENT +izquierda, I-TREATMENT +dando I-TREATMENT +salida I-TREATMENT +a I-TREATMENT +material I-TREATMENT +purulento. I-TREATMENT +El B-EVOLUTION +procedimiento I-EVOLUTION +se I-EVOLUTION +desarrolló I-EVOLUTION +sin I-EVOLUTION +incidencias. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +etapa I-EVOLUTION +inmediata I-EVOLUTION +post-quirúrgica I-EVOLUTION +necesitó I-EVOLUTION +apoyo I-EVOLUTION +con I-EVOLUTION +drogas I-EVOLUTION +vasoactivas, I-EVOLUTION +no I-EVOLUTION +recuperó I-EVOLUTION +la I-EVOLUTION +conciencia, I-EVOLUTION +quedando I-EVOLUTION +en I-EVOLUTION +coma, I-EVOLUTION +con I-EVOLUTION +pupilas I-EVOLUTION +midriáticas I-EVOLUTION +arreflécticas, I-EVOLUTION +sin I-EVOLUTION +respuestas I-EVOLUTION +de I-EVOLUTION +tronco. I-EVOLUTION +La B-EXPLORATION +TC I-EXPLORATION +mostró I-EXPLORATION +colapso I-EXPLORATION +ventricular, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +surcos I-EXPLORATION +y I-EXPLORATION +borramiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cisternas I-EXPLORATION +basales. I-EXPLORATION +Conectada I-EXPLORATION +a I-EXPLORATION +ventilador, I-EXPLORATION +el I-EXPLORATION +electroencefalograma I-EXPLORATION +mostró I-EXPLORATION +trazado I-EXPLORATION +plano. I-EXPLORATION +Se I-EXPLORATION +definió I-EXPLORATION +muerte I-EXPLORATION +cerebral. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +colección I-EXPLORATION +subdural I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Streptococcus I-EXPLORATION +del I-EXPLORATION +grupo I-EXPLORATION +anginosus I-EXPLORATION +(SAG). I-EXPLORATION + I-EXPLORATION + Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS