diff --git "a/data/dev.conll" "b/data/dev.conll" new file mode 100644--- /dev/null +++ "b/data/dev.conll" @@ -0,0 +1,4651 @@ +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sana. B-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +cérvico-parotídeo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +sensible, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +refractario I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +antiinflamatorios. I-PRESENT_ILLNESS +Fue B-TREATMENT +interpretado I-TREATMENT +como I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +mononucleosis I-TREATMENT +infecciosa I-TREATMENT +y I-TREATMENT +por I-TREATMENT +su I-TREATMENT +persistencia I-TREATMENT +se I-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +empíricamente I-TREATMENT +amoxicilina-ácido I-TREATMENT +clavulánico I-TREATMENT +sin I-TREATMENT +mejoría I-TREATMENT +clínica. I-TREATMENT +Finalmente, I-TREATMENT +le I-TREATMENT +indicaron I-TREATMENT +glucocorticoides I-TREATMENT +con B-EVOLUTION +resolución I-EVOLUTION +completa I-EVOLUTION +del I-EVOLUTION +cuadro. I-EVOLUTION + I-EVOLUTION +Dos I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +consultó I-EVOLUTION +nuevamente I-EVOLUTION +por I-EVOLUTION +fiebre I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +múltiples I-EVOLUTION +adenopatías I-EVOLUTION +submandibulares I-EVOLUTION +sensibles I-EVOLUTION +e I-EVOLUTION +induradas, I-EVOLUTION +con I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +parotídeo I-EVOLUTION +ipsilateral. I-EVOLUTION +Presentaba B-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +41 I-EXPLORATION +mg/L I-EXPLORATION +y I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +neutro I-EXPLORATION +filia I-EXPLORATION +relativa. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +estaban I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +TAC I-EXPLORATION +cervical I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +parotídeo I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +grupos I-EXPLORATION +ganglionares I-EXPLORATION +cervicales I-EXPLORATION +bilaterales, I-EXPLORATION +ambos I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +derecho. I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +un I-EXPLORATION +probable I-EXPLORATION +flegmón I-EXPLORATION +cervical. I-EXPLORATION +Se I-EXPLORATION +reiniciaron I-EXPLORATION +los I-EXPLORATION +antibióticos I-EXPLORATION +(ceftriaxona I-EXPLORATION +más I-EXPLORATION +clindamicina) I-EXPLORATION +sin I-EXPLORATION +respuesta. I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +del I-TREATMENT +cuadro, I-TREATMENT +se I-TREATMENT +escaló I-TREATMENT +a I-TREATMENT +esquema I-TREATMENT +antibiótico I-TREATMENT +de I-TREATMENT +segunda I-TREATMENT +línea I-TREATMENT +(vancomicina I-TREATMENT +más I-TREATMENT +levofloxacino) I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +amplió I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax-abdomen-pelvis I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +linfonodos I-EXPLORATION +precarinales I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunológico I-EXPLORATION +con I-EXPLORATION +ANA I-EXPLORATION +e I-EXPLORATION +infeccioso I-EXPLORATION +para I-EXPLORATION +VEB, I-EXPLORATION +CMV, I-EXPLORATION +VIH, I-EXPLORATION +sífilis, I-EXPLORATION +Toxoplasma I-EXPLORATION +gondii I-EXPLORATION +y I-EXPLORATION +Bartonella I-EXPLORATION +hensenlae I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Finalmente, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +ganglio I-EXPLORATION +cervical I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +linfadenitis I-EXPLORATION +necrotizante I-EXPLORATION +histiocitaria. I-EXPLORATION +Se B-TREATMENT +suspendieron I-TREATMENT +los I-TREATMENT +antibióticos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +30 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +con I-TREATMENT +disminución I-TREATMENT +progresiva I-TREATMENT +de I-TREATMENT +las I-TREATMENT +dosis I-TREATMENT +a I-TREATMENT +partir I-TREATMENT +de I-TREATMENT +la I-TREATMENT +segunda I-TREATMENT +semana, I-TREATMENT +completando I-TREATMENT +1 I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +tratamiento. I-TREATMENT +La B-EVOLUTION +fiebre I-EVOLUTION +cedió I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +inicio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +terapia I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +recurrencias I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos, I-PAST_MEDICAL_HISTORY +a B-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +tomografía I-PRESENT_ILLNESS +computada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +abdomen I-PRESENT_ILLNESS +efectuada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +encontró I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cabeza I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +páncreas. I-PRESENT_ILLNESS +Fue B-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +una I-TREATMENT +operación I-TREATMENT +de I-TREATMENT +Whipple. I-TREATMENT +Había I-TREATMENT +2 I-TREATMENT +adenopatías I-TREATMENT +regionales I-TREATMENT +con I-TREATMENT +metástasis I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +y I-TREATMENT +no I-TREATMENT +existía I-TREATMENT +diseminación I-TREATMENT +a I-TREATMENT +distancia. I-TREATMENT +Tres I-TREATMENT +meses I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +operación I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +GEM. I-TREATMENT +Después B-EVOLUTION +de I-EVOLUTION +recibir I-EVOLUTION +11 I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +GEM, I-EVOLUTION +transcurridos I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +inicio I-EVOLUTION +y I-EVOLUTION +habiendo I-EVOLUTION +recibido I-EVOLUTION +una I-EVOLUTION +dosis I-EVOLUTION +total I-EVOLUTION +acumulada I-EVOLUTION +de I-EVOLUTION +16.400 I-EVOLUTION +mg I-EVOLUTION +(9.318 I-EVOLUTION +mg/m2), I-EVOLUTION +presentó I-EVOLUTION +edema I-EVOLUTION +palpebral I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +tobillos I-EVOLUTION +e I-EVOLUTION +hipertensión I-EVOLUTION +arterial I-EVOLUTION +de I-EVOLUTION +hasta I-EVOLUTION +160/110 I-EVOLUTION +mmHg. I-EVOLUTION +Los B-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +hematuria I-EXPLORATION +microscópica I-EXPLORATION +(26-50 I-EXPLORATION +hematíes I-EXPLORATION +por I-EXPLORATION +campo), I-EXPLORATION +proteinuria I-EXPLORATION +(1.740 I-EXPLORATION +mg/24 I-EXPLORATION +h), I-EXPLORATION +cilindruria I-EXPLORATION +granulosa, I-EXPLORATION +ascenso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +creatinina I-EXPLORATION +sérica I-EXPLORATION +hasta I-EXPLORATION +un I-EXPLORATION +máximo I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +0 I-EXPLORATION +mg/dL I-EXPLORATION +con I-EXPLORATION +caída I-EXPLORATION +del I-EXPLORATION +clearance I-EXPLORATION +de I-EXPLORATION +creatinina I-EXPLORATION +a I-EXPLORATION +52 I-EXPLORATION +ml/min/1, I-EXPLORATION +73 I-EXPLORATION +m2 I-EXPLORATION +(medido) I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +21 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +última I-EXPLORATION +dosis. I-EXPLORATION +Previo I-EXPLORATION +a I-EXPLORATION +ello I-EXPLORATION +se I-EXPLORATION +había I-EXPLORATION +observado I-EXPLORATION +anemia I-EXPLORATION +progresiva I-EXPLORATION +(hemoglobina I-EXPLORATION +6.0 I-EXPLORATION +g/dL) I-EXPLORATION +y I-EXPLORATION +trombocitopenia I-EXPLORATION +(20.000 I-EXPLORATION +mm3), I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +atribuyeron I-EXPLORATION +a I-EXPLORATION +mielodepresión I-EXPLORATION +por I-EXPLORATION +GEM. I-EXPLORATION +La I-EXPLORATION +bilirrubinemia I-EXPLORATION +total I-EXPLORATION +ascendió I-EXPLORATION +a I-EXPLORATION +1, I-EXPLORATION +79 I-EXPLORATION +mg/dL, I-EXPLORATION +la I-EXPLORATION +directa I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +93 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +LDH I-EXPLORATION +a I-EXPLORATION +701 I-EXPLORATION +U/L I-EXPLORATION +(VN: I-EXPLORATION +125-243), I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +interpretó I-EXPLORATION +como I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +toxicidad I-EXPLORATION +hepática I-EXPLORATION +por I-EXPLORATION +GEM. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +nuevas I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +GEM, I-TREATMENT +se I-TREATMENT +prescribió I-TREATMENT +furosemi-de I-TREATMENT +para I-TREATMENT +controlar I-TREATMENT +el I-TREATMENT +edema I-TREATMENT +y I-TREATMENT +olmesartán I-TREATMENT +para I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hipertensión I-TREATMENT +arterial. I-TREATMENT + I-TREATMENT +Estando B-EXPLORATION +el I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +sobre I-EXPLORATION +100.000 I-EXPLORATION +mm3 I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +percutánea I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +hallazgos I-EXPLORATION +característicos I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +microangiopatía I-EXPLORATION +trombótica I-EXPLORATION +crónica I-EXPLORATION +activa. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +microscopía I-EXPLORATION +óptica I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +glomérulos I-EXPLORATION +con I-EXPLORATION +numerosos I-EXPLORATION +dobles I-EXPLORATION +contornos I-EXPLORATION +en I-EXPLORATION +sus I-EXPLORATION +asas I-EXPLORATION +capilares I-EXPLORATION +y I-EXPLORATION +arteriolas, I-EXPLORATION +con I-EXPLORATION +intensa I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +lumen, I-EXPLORATION +hiperplasia I-EXPLORATION +concéntrica I-EXPLORATION +de I-EXPLORATION +miocélulas I-EXPLORATION +y I-EXPLORATION +depósito I-EXPLORATION +hialino I-EXPLORATION +mural I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +material I-EXPLORATION +microtrombótico I-EXPLORATION +incorporado I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +endotelio I-EXPLORATION +y I-EXPLORATION +pared. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +inmunofluorescencia I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +complejos I-EXPLORATION +inmunes I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +glomérulos. I-EXPLORATION +La I-EXPLORATION +microscopía I-EXPLORATION +electrónica I-EXPLORATION +confirmó I-EXPLORATION +las I-EXPLORATION +alteraciones I-EXPLORATION +glomerulares I-EXPLORATION +encontradas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +microscopía I-EXPLORATION +óptica; I-EXPLORATION +en I-EXPLORATION +especial, I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +dobles I-EXPLORATION +contornos I-EXPLORATION +con I-EXPLORATION +interposición I-EXPLORATION +celular I-EXPLORATION +y I-EXPLORATION +expansión I-EXPLORATION +acentuada I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lámina I-EXPLORATION +rara I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +basal I-EXPLORATION +por I-EXPLORATION +material I-EXPLORATION +electrón-lúcido I-EXPLORATION +y I-EXPLORATION +detritus I-EXPLORATION +subendotelial. I-EXPLORATION +Todas I-EXPLORATION +estas I-EXPLORATION +alteraciones I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +en I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +depósitos I-EXPLORATION +densos I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +complejo I-EXPLORATION +inmune. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +pedicelar I-EXPLORATION +fue I-EXPLORATION +moderada. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +suspensión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +GEM I-EVOLUTION +se I-EVOLUTION +acompañó I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +hematológicos. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +último I-EXPLORATION +control, I-EXPLORATION +10 I-EXPLORATION +sem I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +última I-EXPLORATION +dosis I-EXPLORATION +de I-EXPLORATION +GEM, I-EXPLORATION +la I-EXPLORATION +hemoglobina I-EXPLORATION +fue I-EXPLORATION +12, I-EXPLORATION +3 I-EXPLORATION +g/dL, I-EXPLORATION +plaquetas I-EXPLORATION +147.000 I-EXPLORATION +mm3, I-EXPLORATION +leucocitos I-EXPLORATION +4.700 I-EXPLORATION +mm3, I-EXPLORATION +creatinina I-EXPLORATION +sérica I-EXPLORATION +1, I-EXPLORATION +18 I-EXPLORATION +mg/dl, I-EXPLORATION +clearance I-EXPLORATION +de I-EXPLORATION +creatinina I-EXPLORATION +85 I-EXPLORATION +ml/min/1, I-EXPLORATION +73 I-EXPLORATION +m2 I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +normal. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +continuó I-TREATMENT +recibiendo I-TREATMENT +olmesartán I-TREATMENT +como I-TREATMENT +terapia I-TREATMENT +antihipertensiva I-TREATMENT +originada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +daño I-TREATMENT +renal I-TREATMENT +por I-TREATMENT +GEM. I-TREATMENT + I-TREATMENT +. I-TREATMENT + I-TREATMENT + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +respiratoria I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +semana I-PAST_MEDICAL_HISTORY +previa, I-PAST_MEDICAL_HISTORY +luego B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +disartria, I-PRESENT_ILLNESS +diplopía, I-PRESENT_ILLNESS +vértigo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ataxia. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +disartria, I-EXPLORATION +midriasis I-EXPLORATION +con I-EXPLORATION +reflejos I-EXPLORATION +fotomotores I-EXPLORATION +(RFM) I-EXPLORATION +disminuidos, I-EXPLORATION +paresia I-EXPLORATION +del I-EXPLORATION +recto I-EXPLORATION +superior I-EXPLORATION +izquierdo, I-EXPLORATION +nistagmus I-EXPLORATION +bihorizontal, I-EXPLORATION +ROT I-EXPLORATION +abolidos, I-EXPLORATION +dismetría I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +Romberg I-EXPLORATION +positivo. I-EXPLORATION +Se I-EXPLORATION +estudió I-EXPLORATION +con I-EXPLORATION +RM I-EXPLORATION +encéfalo I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +EMG I-EXPLORATION +presentó I-EXPLORATION +alteración I-EXPLORATION +del I-EXPLORATION +reflejo I-EXPLORATION +de I-EXPLORATION +pestañeo. I-EXPLORATION +Sin I-EXPLORATION +disociación I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +anti-GQ1b I-EXPLORATION +positivos I-EXPLORATION +en I-EXPLORATION +suero. I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +sopor, I-EVOLUTION +midriasis I-EVOLUTION +arrefléctica, I-EVOLUTION +biparesia I-EVOLUTION +facial I-EVOLUTION +y I-EVOLUTION +paresia I-EVOLUTION +de I-EVOLUTION +extremidades I-EVOLUTION +superiores. I-EVOLUTION +Requirió B-TREATMENT +intubación I-TREATMENT +para I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +vía I-TREATMENT +aérea I-TREATMENT +y I-TREATMENT +monitorización I-TREATMENT +por I-TREATMENT +disautonomía. I-TREATMENT +Se I-TREATMENT +establecieron I-TREATMENT +los I-TREATMENT +diagnósticos I-TREATMENT +de I-TREATMENT +SMF, I-TREATMENT +SGB I-TREATMENT +y I-TREATMENT +EB. I-TREATMENT +Recibió I-TREATMENT +IgIV I-TREATMENT +(0, I-TREATMENT +4 I-TREATMENT +gr/kg/día I-TREATMENT +por I-TREATMENT +5 I-TREATMENT +días I-TREATMENT +consecutivos). I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +tenía I-EVOLUTION +examen I-EVOLUTION +neurológico I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +no B-PAST_MEDICAL_HISTORY +fumadora, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +GPA I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1995. I-PAST_MEDICAL_HISTORY +Al B-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +VAS, I-PRESENT_ILLNESS +pulmón I-PRESENT_ILLNESS +(cuya I-PRESENT_ILLNESS +biopsia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +pulmonar I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +videotoracoscopía I-PRESENT_ILLNESS +mostró I-PRESENT_ILLNESS +infamación I-PRESENT_ILLNESS +granulomatosa I-PRESENT_ILLNESS +necrotizante), I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +micro-hematuria I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +diagnosticó I-PRESENT_ILLNESS +GPA I-PRESENT_ILLNESS +generalizada. I-PRESENT_ILLNESS +Al B-EXPLORATION +diagnóstico I-EXPLORATION +la I-EXPLORATION +VSG I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +113 I-EXPLORATION +mm, I-EXPLORATION +el I-EXPLORATION +ANCA I-EXPLORATION +c I-EXPLORATION +positivos I-EXPLORATION +(no I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +PR3) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +CFV I-EXPLORATION +normal. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +esteroides I-TREATMENT +y I-TREATMENT +ciclofosfamida I-TREATMENT +con I-TREATMENT +remisión I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas, I-TREATMENT +analítica I-TREATMENT +e I-TREATMENT +imágenes. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +mantenimiento I-TREATMENT +con I-TREATMENT +ciclofosfamida. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +lo I-EVOLUTION +largo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +evolución, I-EVOLUTION +presentó I-EVOLUTION +múltiples I-EVOLUTION +recaídas I-EVOLUTION +que I-EVOLUTION +respondieron I-EVOLUTION +a I-EVOLUTION +terapéutica I-EVOLUTION +específica. I-EVOLUTION +Las I-EVOLUTION +recaídas I-EVOLUTION +siempre I-EVOLUTION +fueron I-EVOLUTION +en I-EVOLUTION +VAS, I-EVOLUTION +con I-EVOLUTION +otitis, I-EVOLUTION +sinusitis I-EVOLUTION +y I-EVOLUTION +epistaxis I-EVOLUTION +recurrentes. I-EVOLUTION +Presentó I-EVOLUTION +perforación I-EVOLUTION +del I-EVOLUTION +tabique I-EVOLUTION +nasal I-EVOLUTION +y I-EVOLUTION +mielosupresión I-EVOLUTION +por I-EVOLUTION +ciclofosfamida, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +rotó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +micofenolato I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +tres I-TREATMENT +gramos I-TREATMENT +día. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +año I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +disnea I-EVOLUTION +y I-EVOLUTION +estridor I-EVOLUTION +laríngeo. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +EFR I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +curva I-EXPLORATION +cajón I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +traquea I-EXPLORATION +y I-EXPLORATION +laringe I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +ESG. I-EXPLORATION +Requirió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +radiofrecuencia I-TREATMENT +y I-TREATMENT +dilatación. I-TREATMENT +Durante I-TREATMENT +los I-TREATMENT +años I-TREATMENT +2003, I-TREATMENT +2005, I-TREATMENT +2006 I-TREATMENT +se I-TREATMENT +efectuaron I-TREATMENT +dilataciones, I-TREATMENT +llegando I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +traqueostomía I-TREATMENT +en I-TREATMENT +el I-TREATMENT +2008. I-TREATMENT +Falleció B-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +año I-EVOLUTION +2009 I-EVOLUTION +en I-EVOLUTION +contexto I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +neumonía I-EVOLUTION +nosocomial. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuerzas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +instalación I-PRESENT_ILLNESS +rápida, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +inicial I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +progresión I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +superiores I-PRESENT_ILLNESS +determinando I-PRESENT_ILLNESS +cuadriparesia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cefaloparesia. I-PRESENT_ILLNESS +Destacaba B-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +portador I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +virus I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +inmunodeficiencia I-PAST_MEDICAL_HISTORY +humana I-PAST_MEDICAL_HISTORY +(VIH) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +etapa I-PAST_MEDICAL_HISTORY +SIDA I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +cumplimiento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antiretroviral. I-PAST_MEDICAL_HISTORY +Presentaba B-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +diarias I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +vigil, I-EXPLORATION +eupneico I-EXPLORATION +y I-EXPLORATION +apirético. I-EXPLORATION +Tenía I-EXPLORATION +aceptable I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +hidratación I-EXPLORATION +y I-EXPLORATION +TA I-EXPLORATION +de I-EXPLORATION +110/70 I-EXPLORATION +mmHg. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +neuromuscular I-EXPLORATION +se I-EXPLORATION +objetivaba I-EXPLORATION +cuadriparesia I-EXPLORATION +con I-EXPLORATION +cefaloparesia. I-EXPLORATION +El I-EXPLORATION +K+pl I-EXPLORATION +al I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +fue I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +indetectable, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +K+ I-EXPLORATION +urinario I-EXPLORATION +en I-EXPLORATION +muestra I-EXPLORATION +aislada I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mEq/L. I-EXPLORATION +Presentaba I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +CK. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +reposición I-TREATMENT +hidroelectrolítica I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cuadriparesia I-TREATMENT +y I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +los I-TREATMENT +valores I-TREATMENT +de I-TREATMENT +K+pl I-TREATMENT +y I-TREATMENT +CK. I-TREATMENT +Al I-TREATMENT +igual I-TREATMENT +que I-TREATMENT +el I-TREATMENT +caso I-TREATMENT +1, I-TREATMENT +la I-TREATMENT +severa I-TREATMENT +disminución I-TREATMENT +del I-TREATMENT +potasio I-TREATMENT +plasmático I-TREATMENT +se I-TREATMENT +debió I-TREATMENT +a I-TREATMENT +una I-TREATMENT +alteración I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +balance I-TREATMENT +externo I-TREATMENT +por I-TREATMENT +pérdidas I-TREATMENT +de I-TREATMENT +origen I-TREATMENT +digestivo, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +concuerda I-TREATMENT +con I-TREATMENT +el I-TREATMENT +valor I-TREATMENT +de I-TREATMENT +K+ I-TREATMENT +en I-TREATMENT +orina I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mEq/L. I-TREATMENT +La B-EVOLUTION +reposición I-EVOLUTION +hidroelectrolítica I-EVOLUTION +revirtió I-EVOLUTION +el I-EVOLUTION +cuadro I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino. I-PRESENT_ILLNESS +Hipertensión I-PRESENT_ILLNESS +arterial I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tratamiento, I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +arterial I-PRESENT_ILLNESS +oclusiva I-PRESENT_ILLNESS +carotídea I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +estudio. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +kg, I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +saciedad I-PRESENT_ILLNESS +precoz. I-PRESENT_ILLNESS +Endoscopia B-EXPLORATION +digestiva I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +pediculada I-EXPLORATION +subcardial I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +posterior. I-EXPLORATION +Biopsia I-EXPLORATION +endoscópica: I-EXPLORATION +"tumor I-EXPLORATION +estromal I-EXPLORATION +fusocelular I-EXPLORATION +con I-EXPLORATION +> I-EXPLORATION +10 I-EXPLORATION +mitosis I-EXPLORATION +atípicas I-EXPLORATION +por I-EXPLORATION +50 I-EXPLORATION +campos", I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +GIST. I-EXPLORATION + I-EXPLORATION +Tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +abdomen: I-EXPLORATION +lesión I-EXPLORATION +subcardial I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +diámetro I-EXPLORATION +mayor, I-EXPLORATION +sin I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +diseminación I-EXPLORATION +sistémica, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tránsito I-EXPLORATION +esófago I-EXPLORATION +estómago I-EXPLORATION +y I-EXPLORATION +duodeno I-EXPLORATION +con I-EXPLORATION +sulfato I-EXPLORATION +de I-EXPLORATION +bario: I-EXPLORATION +lesión I-EXPLORATION +pediculada I-EXPLORATION +subcardial. I-EXPLORATION +Se B-TREATMENT +programa I-TREATMENT +resección I-TREATMENT +tumoral I-TREATMENT +laparoscópica: I-TREATMENT +Gastrotomía I-TREATMENT +anterior, I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +con I-TREATMENT +sutura I-TREATMENT +mecánica I-TREATMENT +a I-TREATMENT +pedículo, I-TREATMENT +gastrorrafia, I-TREATMENT +biopsia I-TREATMENT +de I-TREATMENT +serosa I-TREATMENT +gástrica I-TREATMENT +y I-TREATMENT +peritoneo. I-TREATMENT +Postoperatorio B-EXPLORATION +sin I-EXPLORATION +complicaciones. I-EXPLORATION + I-EXPLORATION +Biopsia: I-EXPLORATION +Carcinoma I-EXPLORATION +escamoso I-EXPLORATION +fusocelular I-EXPLORATION +sarcomatoide, I-EXPLORATION +polipoide I-EXPLORATION +y I-EXPLORATION +ulcerado I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +4 I-EXPLORATION +cm. I-EXPLORATION +Margen I-EXPLORATION +positivo I-EXPLORATION +de I-EXPLORATION +pedículo. I-EXPLORATION +Sin I-EXPLORATION +permeaciones I-EXPLORATION +vasculares, I-EXPLORATION +linfáticas I-EXPLORATION +ni I-EXPLORATION +perineurales. I-EXPLORATION +Peritoneo I-EXPLORATION +y I-EXPLORATION +serosa I-EXPLORATION +gástrica: I-EXPLORATION +sin I-EXPLORATION +neoplasia. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +programa I-TREATMENT +para I-TREATMENT +gastrectomía I-TREATMENT +total I-TREATMENT +más I-TREATMENT +esofagectomía I-TREATMENT +distal I-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +escamoso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +unión I-TREATMENT +gastroesofágica: I-TREATMENT +en I-TREATMENT +el I-TREATMENT +intraoperatorio I-TREATMENT +se I-TREATMENT +recibió I-TREATMENT +biopsia I-TREATMENT +rápida I-TREATMENT +de I-TREATMENT +límite I-TREATMENT +oral I-TREATMENT +infiltrado I-TREATMENT +por I-TREATMENT +carcinoma, I-TREATMENT +recorte I-TREATMENT +revela I-TREATMENT +compromiso I-TREATMENT +neoplásico I-TREATMENT +proximal I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +no I-TREATMENT +reconstituir I-TREATMENT +en I-TREATMENT +un I-TREATMENT +tiempo I-TREATMENT +por I-TREATMENT +las I-TREATMENT +condiciones I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +el I-TREATMENT +intraoperatorio, I-TREATMENT +efectuándose I-TREATMENT +esofagogastrectomía I-TREATMENT +total I-TREATMENT +transhiatal, I-TREATMENT +esofagostoma I-TREATMENT +cervical I-TREATMENT +terminal I-TREATMENT +transitorio I-TREATMENT +y I-TREATMENT +yeyunostomía I-TREATMENT +de I-TREATMENT +Wietzel, I-TREATMENT +dejando I-TREATMENT +para I-TREATMENT +un I-TREATMENT +segundo I-TREATMENT +tiempo I-TREATMENT +la I-TREATMENT +reconstitución I-TREATMENT +definitiva I-TREATMENT +del I-TREATMENT +tránsito I-TREATMENT +digestivo. I-TREATMENT + I-TREATMENT +Biopsia B-EXPLORATION +definitiva: I-EXPLORATION +Carcinoma I-EXPLORATION +espinocelular I-EXPLORATION +fusocelular I-EXPLORATION +sarcomatoide I-EXPLORATION +esofágico I-EXPLORATION +con I-EXPLORATION +extensión I-EXPLORATION +hasta I-EXPLORATION +submucosa, I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +grupo I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +5 I-EXPLORATION +(4/37), I-EXPLORATION +sin I-EXPLORATION +adenopatías I-EXPLORATION +mediastínicas. I-EXPLORATION +Nódulo I-EXPLORATION +metastásico I-EXPLORATION +en I-EXPLORATION +epiplón I-EXPLORATION +menor I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +ganglio I-EXPLORATION +N° I-EXPLORATION +5. I-EXPLORATION +Márgenes I-EXPLORATION +quirúrgicos I-EXPLORATION +sin I-EXPLORATION +neoplasia. I-EXPLORATION + I-EXPLORATION +Al B-TREATMENT +mes I-TREATMENT +postoperatorio I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +reconstrucción I-TREATMENT +con I-TREATMENT +ascenso I-TREATMENT +de I-TREATMENT +colon I-TREATMENT +derecho I-TREATMENT +e I-TREATMENT +íleon I-TREATMENT +terminal I-TREATMENT +vía I-TREATMENT +retroesternal: I-TREATMENT +esófago-íleo I-TREATMENT +anastomosis I-TREATMENT +cervical I-TREATMENT +terminolateral, I-TREATMENT +transverso-duodeno I-TREATMENT +anastomosis I-TREATMENT +laterolateral, I-TREATMENT +íleo-transverso I-TREATMENT +anastomosis I-TREATMENT +latero-lateral I-TREATMENT +y I-TREATMENT +yeyunostomía I-TREATMENT +de I-TREATMENT +Wietzel. I-TREATMENT + I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +fístula I-EVOLUTION +cervical I-EVOLUTION +de I-EVOLUTION +bajo I-EVOLUTION +débito I-EVOLUTION +sin I-EVOLUTION +repercusión I-EVOLUTION +clínica, I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +21 I-EVOLUTION +postoperatorio I-EVOLUTION +con I-EVOLUTION +régimen I-EVOLUTION +líquido I-EVOLUTION +y I-EVOLUTION +aporte I-EVOLUTION +por I-EVOLUTION +yeyunostomía. I-EVOLUTION + I-EVOLUTION +Paciente I-EVOLUTION +en I-EVOLUTION +excelentes I-EVOLUTION +condiciones I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +meses I-EVOLUTION +postoperatorios, I-EVOLUTION +autovalente, I-EVOLUTION +requirió I-EVOLUTION +dilatación I-EVOLUTION +endoscópica I-EVOLUTION +de I-EVOLUTION +anastomosis I-EVOLUTION +cervical, I-EVOLUTION +sin I-EVOLUTION +incidentes. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumador. B-PAST_MEDICAL_HISTORY +Historia B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hombro I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +8/10 I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +analgésicos, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +mucosa, I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +nocturna. I-PRESENT_ILLNESS +Examen B-EXPLORATION +físico I-EXPLORATION +inicial I-EXPLORATION +normal. I-EXPLORATION +Presentó I-EXPLORATION +anemia I-EXPLORATION +leve, I-EXPLORATION +VHS: I-EXPLORATION +96 I-EXPLORATION +mm/h, I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina, I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +lipídico I-EXPLORATION +normales. I-EXPLORATION +Tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +dorsal I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +nódulos I-EXPLORATION +subpleurales I-EXPLORATION +en I-EXPLORATION +vértices I-EXPLORATION +pulmonares I-EXPLORATION +y I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +izquierdo. I-EXPLORATION +Hemocultivos I-EXPLORATION +negativos. I-EXPLORATION +Ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +normal, I-EXPLORATION +aTAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +ateromatosis I-EXPLORATION +aórtica I-EXPLORATION +segmentaria I-EXPLORATION +en I-EXPLORATION +aorta I-EXPLORATION +descendente, I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +extraintimal, I-EXPLORATION +estenosis I-EXPLORATION +significativa I-EXPLORATION +de I-EXPLORATION +ostium I-EXPLORATION +en I-EXPLORATION +tronco I-EXPLORATION +celíaco. I-EXPLORATION +Nodulos I-EXPLORATION +pulmonares I-EXPLORATION +y I-EXPLORATION +condensaciones I-EXPLORATION +apicales I-EXPLORATION +bilaterales. I-EXPLORATION +VDRL: I-EXPLORATION +No I-EXPLORATION +reactivo, I-EXPLORATION +VIH I-EXPLORATION +negativo, I-EXPLORATION +PPD: I-EXPLORATION +10 I-EXPLORATION +mm. I-EXPLORATION +Quatiferon I-EXPLORATION +(-). I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +evolucionó I-EXPLORATION +con I-EXPLORATION +escleritis I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +fiebre I-EXPLORATION +hasta I-EXPLORATION +37, I-EXPLORATION +8 I-EXPLORATION +°C. I-EXPLORATION +Se I-EXPLORATION +sospecha I-EXPLORATION +vasculitis I-EXPLORATION +de I-EXPLORATION +grandes I-EXPLORATION +vasos. I-EXPLORATION +Nuevos I-EXPLORATION +estudios I-EXPLORATION +demostraron I-EXPLORATION +ANCA I-EXPLORATION +citoplasmático I-EXPLORATION +(C): I-EXPLORATION +positivo, I-EXPLORATION +anti I-EXPLORATION +proteinasa I-EXPLORATION +3 I-EXPLORATION +(PR3) I-EXPLORATION ++6, I-EXPLORATION +5 I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +1, I-EXPLORATION +2), I-EXPLORATION +C3 I-EXPLORATION +y I-EXPLORATION +C4 I-EXPLORATION +normales, I-EXPLORATION +ANA, I-EXPLORATION +anticuerpos I-EXPLORATION +anti-ADN I-EXPLORATION +y I-EXPLORATION +ENA I-EXPLORATION +negativos. I-EXPLORATION +Biopsia I-EXPLORATION +pulmonar: I-EXPLORATION +Nodulo I-EXPLORATION +con I-EXPLORATION +centro I-EXPLORATION +fibroso, I-EXPLORATION +necrosis I-EXPLORATION +y I-EXPLORATION +reacción I-EXPLORATION +histiocitaria, I-EXPLORATION +con I-EXPLORATION +células I-EXPLORATION +gigantes. I-EXPLORATION +Se I-EXPLORATION +reconoce I-EXPLORATION +neumonía I-EXPLORATION +organizativa I-EXPLORATION +periférica, I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +antigua, I-EXPLORATION +concordante I-EXPLORATION +con I-EXPLORATION +PG. I-EXPLORATION +Recibió B-TREATMENT +corticoterapia I-TREATMENT +y I-TREATMENT +ciclofosfamida I-TREATMENT +oral I-TREATMENT +por I-TREATMENT +un I-TREATMENT +año I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +mantención I-TREATMENT +con I-TREATMENT +azatioprina. I-TREATMENT +Presentó B-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica, I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios, I-EVOLUTION +radiografía I-EVOLUTION +y I-EVOLUTION +aTAC I-EVOLUTION +de I-EVOLUTION +tórax. I-EVOLUTION +Anti I-EVOLUTION +PR3 I-EVOLUTION +(-) I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +postquirúrgico I-PAST_MEDICAL_HISTORY +(por I-PAST_MEDICAL_HISTORY +bocio I-PAST_MEDICAL_HISTORY +nodular). I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +agosto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2008 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fatigabilidad, I-PRESENT_ILLNESS +síncopes I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +repetición I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +progresiva. I-PRESENT_ILLNESS +Dentro B-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +pesquisó I-EXPLORATION +anemia I-EXPLORATION +severa I-EXPLORATION +normocítica I-EXPLORATION +normocrómica, I-EXPLORATION +con I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +8 I-EXPLORATION +g/dL, I-EXPLORATION +leucocitos I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +normales. I-EXPLORATION +Además I-EXPLORATION +destacó I-EXPLORATION +una I-EXPLORATION +VHS I-EXPLORATION +de I-EXPLORATION +140 I-EXPLORATION +mm/h. I-EXPLORATION +Por I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +MM I-EXPLORATION +se I-EXPLORATION +continuó I-EXPLORATION +estudio I-EXPLORATION +destacando I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +14, I-EXPLORATION +6 I-EXPLORATION +g/dL, I-EXPLORATION +albúmina I-EXPLORATION +2 I-EXPLORATION +g/dL, I-EXPLORATION +calcio I-EXPLORATION +corregido I-EXPLORATION +10, I-EXPLORATION +8 I-EXPLORATION +mg/dL, I-EXPLORATION +creatinina: I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +mg/dL, I-EXPLORATION +B2 I-EXPLORATION +microglobulina I-EXPLORATION +10, I-EXPLORATION +2 I-EXPLORATION +mg/L. I-EXPLORATION +La I-EXPLORATION +electroforesis I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +peak I-EXPLORATION +monoclonal I-EXPLORATION +en I-EXPLORATION +gamma I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +vio I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +inmunoglobulina I-EXPLORATION +IgG I-EXPLORATION +de I-EXPLORATION +3.450 I-EXPLORATION +mg/dl, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +Ig I-EXPLORATION +menores I-EXPLORATION +al I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +mielograma I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +25% I-EXPLORATION +de I-EXPLORATION +plasmoblastos I-EXPLORATION +y I-EXPLORATION +plasmocitos, I-EXPLORATION +algunos I-EXPLORATION +binucleados. I-EXPLORATION +La I-EXPLORATION +serie I-EXPLORATION +radiológica I-EXPLORATION +reveló I-EXPLORATION +imágenes I-EXPLORATION +líticas I-EXPLORATION +en I-EXPLORATION +calota I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +columna I-EXPLORATION +lumbar. I-EXPLORATION +Por I-EXPLORATION +lo I-EXPLORATION +tanto, I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +MM I-EXPLORATION +IgG, I-EXPLORATION +con I-EXPLORATION +índices I-EXPLORATION +pronósticos I-EXPLORATION +de I-EXPLORATION +Durie I-EXPLORATION +Salmon I-EXPLORATION +IIIA I-EXPLORATION +e I-EXPLORATION +ISS I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +puntos. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +hidratación, I-TREATMENT +pamidronato I-TREATMENT +y I-TREATMENT +melfalán/prednisona, I-TREATMENT +recuperándose I-TREATMENT +la I-TREATMENT +hipercalcemia. I-TREATMENT +Recibió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +melfalán/prednisona I-TREATMENT +por I-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +y I-TREATMENT +radioterapia I-TREATMENT +de I-TREATMENT +columna I-TREATMENT +lumbar, I-TREATMENT +destacando I-TREATMENT +en I-TREATMENT +los I-TREATMENT +controles I-TREATMENT +ambulatorios I-TREATMENT +mejoría I-TREATMENT +en I-TREATMENT +albúmina I-TREATMENT +y I-TREATMENT +calcemia, I-TREATMENT +pero I-TREATMENT +pancitopenia I-TREATMENT +progresiva I-TREATMENT +e I-TREATMENT +infecciones I-TREATMENT +urinarias I-TREATMENT +a I-TREATMENT +repetición. I-TREATMENT +En B-EVOLUTION +marzo I-EVOLUTION +de I-EVOLUTION +2009 I-EVOLUTION +estuvo I-EVOLUTION +hospitalizada I-EVOLUTION +por I-EVOLUTION +neumonía. I-EVOLUTION +En I-EVOLUTION +noviembre I-EVOLUTION +de I-EVOLUTION +2009 I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +mayor I-EVOLUTION +dolor I-EVOLUTION +óseo I-EVOLUTION +y I-EVOLUTION +postración. I-EVOLUTION +Además, I-EVOLUTION +llamó I-EVOLUTION +la I-EVOLUTION +atención I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +lesiones I-EVOLUTION +cutáneas I-EVOLUTION +nodulares, I-EVOLUTION +violáceas, I-EVOLUTION +dolorosas I-EVOLUTION +de I-EVOLUTION +1, I-EVOLUTION +5 I-EVOLUTION +a I-EVOLUTION +2 I-EVOLUTION +cm I-EVOLUTION +en I-EVOLUTION +cuero I-EVOLUTION +cabelludo, I-EVOLUTION +ángulo I-EVOLUTION +mandibular I-EVOLUTION +izquierdo, I-EVOLUTION +cuello I-EVOLUTION +y I-EVOLUTION +dorso. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +celularidad I-EXPLORATION +constituida I-EXPLORATION +exclusivamente I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +predominando I-EXPLORATION +proplasmocitos. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +mostró I-EXPLORATION +igualmente I-EXPLORATION +infiltración I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +plasmáticas. I-EXPLORATION +Debido B-TREATMENT +a I-TREATMENT +progresión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +talidomida/dexametasona, I-TREATMENT +sin I-TREATMENT +resultados. I-TREATMENT +Se B-EVOLUTION +derivó I-EVOLUTION +a I-EVOLUTION +cuidados I-EVOLUTION +paliativos I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +por I-EVOLUTION +infección I-EVOLUTION +en I-EVOLUTION +mieloma I-EVOLUTION +refractario. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +transfusión I-PAST_MEDICAL_HISTORY +sanguínea I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1972, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +contexto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sangrado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +úlcera I-PAST_MEDICAL_HISTORY +duodenal. I-PAST_MEDICAL_HISTORY +Además, I-PAST_MEDICAL_HISTORY +cáncer I-PAST_MEDICAL_HISTORY +testicular I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hemicolectomía I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cáncer I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colon I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +46 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +1994, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +diagnosticó I-PRESENT_ILLNESS +cirrosis, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +que B-EXPLORATION +mostró I-EXPLORATION +PCR I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +VHC. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +hepatitis I-EXPLORATION +crónica I-EXPLORATION +con I-EXPLORATION +fibrosis I-EXPLORATION +grado I-EXPLORATION +III, I-EXPLORATION +sin I-EXPLORATION +cirrosis. I-EXPLORATION +Recibió B-TREATMENT +interferon I-TREATMENT +con I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +PCR I-TREATMENT ++ I-TREATMENT +de I-TREATMENT +VHC. I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +complicaciones I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +hipertensión I-EVOLUTION +portal, I-EVOLUTION +iniciando I-EVOLUTION +controles I-EVOLUTION +en I-EVOLUTION +nuestro I-EVOLUTION +centro I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +2007. I-EVOLUTION +Ese I-EVOLUTION +año I-EVOLUTION +se I-EVOLUTION +diagnosticó I-EVOLUTION +hepatocarcinoma I-EVOLUTION +que B-TREATMENT +fue I-TREATMENT +quimioembolizado. I-TREATMENT +Se I-TREATMENT +trasplantó I-TREATMENT +en I-TREATMENT +mayo I-TREATMENT +de I-TREATMENT +2008. I-TREATMENT +Post I-TREATMENT +trasplante I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +inmunosupresión I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +y I-TREATMENT +ciclosporina, I-TREATMENT +adicionando I-TREATMENT +micofenolato I-TREATMENT +por I-TREATMENT +falla I-TREATMENT +renal. I-TREATMENT +Se B-EVOLUTION +mantuvo I-EVOLUTION +con I-EVOLUTION +creatinina I-EVOLUTION +1, I-EVOLUTION +4-1, I-EVOLUTION +5 I-EVOLUTION +mg/dl, I-EVOLUTION +pero I-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +post I-EVOLUTION +trasplante I-EVOLUTION +tuvo I-EVOLUTION +alza I-EVOLUTION +hasta I-EVOLUTION +1, I-EVOLUTION +9-2, I-EVOLUTION +0 I-EVOLUTION +mg/dl. I-EVOLUTION +En B-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +ciclosporina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +agregó I-TREATMENT +sirolimus. I-TREATMENT +Presentó B-EVOLUTION +úlceras I-EVOLUTION +orales, I-EVOLUTION +suspendiéndose B-TREATMENT +micofenolato. I-TREATMENT +Por B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +falla I-EXPLORATION +renal I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +PCR I-EXPLORATION +para I-EXPLORATION +VHC, I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +negativa. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +en I-EXPLORATION +2 I-EXPLORATION +oportunidades, I-EXPLORATION +ambas I-EXPLORATION +negativas. I-EXPLORATION +Se I-EXPLORATION +interpretó I-EXPLORATION +como I-EXPLORATION +eliminación I-EXPLORATION +espontánea I-EXPLORATION +de I-EXPLORATION +VHC. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 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 +Mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +farmacológicamente. I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +otorrinolaringología I-PRESENT_ILLNESS +(ORL) I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +San I-PRESENT_ILLNESS +Juan I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Dios I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +otalgia I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +insidioso, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +aumenta I-PRESENT_ILLNESS +progresivamente I-PRESENT_ILLNESS +llegando I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +10/10 I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta, I-PRESENT_ILLNESS +según I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Escala I-PRESENT_ILLNESS +Visual I-PRESENT_ILLNESS +Análoga I-PRESENT_ILLNESS +(EVA). I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +afebril, I-EXPLORATION +sin I-EXPLORATION +embargo I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +otorrea I-EXPLORATION +purulenta, I-EXPLORATION +hipoacusia I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +preauricular I-EXPLORATION +ipsilateral. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +cuadro I-EXPLORATION +arroja I-EXPLORATION +como I-EXPLORATION +diagnóstico I-EXPLORATION +una I-EXPLORATION +otitis I-EXPLORATION +externa I-EXPLORATION +necrotizante, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +mastoiditis I-EXPLORATION +ebúrnea. I-EXPLORATION +El B-TREATMENT +manejo I-TREATMENT +inicial I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +la I-TREATMENT +hospitalización I-TREATMENT +y I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +un I-TREATMENT +esquema I-TREATMENT +empírico I-TREATMENT +enfocado I-TREATMENT +en I-TREATMENT +el I-TREATMENT +proceso I-TREATMENT +ótico I-TREATMENT +con I-TREATMENT +ceftazidima I-TREATMENT +más I-TREATMENT +clindamicina I-TREATMENT +endovenosa I-TREATMENT +y I-TREATMENT +ciprofloxacino I-TREATMENT +tópico. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +es I-EXPLORATION +objetivado I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +franca I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +erosión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +ósea I-EXPLORATION +condilar I-EXPLORATION +mandibular I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +capa I-EXPLORATION +cortical I-EXPLORATION +y I-EXPLORATION +destrucción I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +medular I-EXPLORATION +ósea. I-EXPLORATION +Por I-EXPLORATION +lo I-EXPLORATION +anterior I-EXPLORATION +se I-EXPLORATION +interconsulta I-EXPLORATION +a I-EXPLORATION +cirugía I-EXPLORATION +maxilofacial. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +el I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +preauricular I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +difusos, I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +temperatura I-EXPLORATION +local I-EXPLORATION +y I-EXPLORATION +eritema I-EXPLORATION +asociados. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +funcional I-EXPLORATION +revela I-EXPLORATION +disminución I-EXPLORATION +considerable I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +apertura I-EXPLORATION +bucal I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +mm I-EXPLORATION +aproximadamente I-EXPLORATION +con I-EXPLORATION +movimientos I-EXPLORATION +de I-EXPLORATION +lateralidad I-EXPLORATION +conservados, I-EXPLORATION +asociándose I-EXPLORATION +a I-EXPLORATION +artralgia I-EXPLORATION +exacerbada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +función. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +hay I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +piezas I-EXPLORATION +dentarias I-EXPLORATION +posteriores I-EXPLORATION +tanto I-EXPLORATION +superiores I-EXPLORATION +como I-EXPLORATION +inferiores. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +nuclear I-EXPLORATION +magnética I-EXPLORATION +(RNM) I-EXPLORATION +muestra I-EXPLORATION +cambios I-EXPLORATION +degenerativos I-EXPLORATION +y I-EXPLORATION +erosión I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cortical I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vertiente I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +cóndilo I-EXPLORATION +mandibular I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +intracapsular I-EXPLORATION +diseminado I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +masticadores I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +espacio I-EXPLORATION +temporal I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +lado. I-EXPLORATION +Con I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +clínicos I-EXPLORATION +e I-EXPLORATION +imagenológicos I-EXPLORATION +se I-EXPLORATION +plantea I-EXPLORATION +la I-EXPLORATION +hipótesis I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +artritis I-EXPLORATION +infecciosa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ATM I-EXPLORATION +por I-EXPLORATION +continuidad. I-EXPLORATION + I-EXPLORATION +Luego B-TREATMENT +de I-TREATMENT +establecido I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +otitis I-TREATMENT +necrotizante I-TREATMENT +y I-TREATMENT +mastoiditis, I-TREATMENT +es I-TREATMENT +ingresada I-TREATMENT +a I-TREATMENT +pabellón I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +ORL I-TREATMENT +para I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +mastoidectomía I-TREATMENT +radical I-TREATMENT +modificada. I-TREATMENT +Posteriormente B-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +intraarticular I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +contenido, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +contenido I-EXPLORATION +líquido I-EXPLORATION +turbio I-EXPLORATION +y I-EXPLORATION +seropurulento I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +envía I-EXPLORATION +a I-EXPLORATION +cultivo I-EXPLORATION +bacteriológico, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +resulta I-EXPLORATION +negativo I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +72 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +incubación. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +además I-EXPLORATION +una I-EXPLORATION +artroscentesis I-EXPLORATION +con I-EXPLORATION +doble I-EXPLORATION +aguja I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ATM I-EXPLORATION +según I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Nitzan I-EXPLORATION +et I-EXPLORATION +al13, I-EXPLORATION +realizando I-EXPLORATION +un I-EXPLORATION +lavado I-EXPLORATION +profuso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +articulación I-EXPLORATION +con I-EXPLORATION +solución I-EXPLORATION +salina. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +posterior I-EVOLUTION +a I-EVOLUTION +estas I-EVOLUTION +intervenciones I-EVOLUTION +mejora I-EVOLUTION +su I-EVOLUTION +condición I-EVOLUTION +general, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +franca I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología, I-EVOLUTION +del I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +volumen I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +apertura I-EVOLUTION +bucal I-EVOLUTION +llegando I-EVOLUTION +hasta I-EVOLUTION +los I-EVOLUTION +40 I-EVOLUTION +mm. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +control I-EVOLUTION +al I-EVOLUTION +mes, I-EVOLUTION +se I-EVOLUTION +presenta I-EVOLUTION +asintomática. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +se I-EVOLUTION +aprecia I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +ruido I-EVOLUTION +articular I-EVOLUTION +en I-EVOLUTION +apertura I-EVOLUTION +y I-EVOLUTION +cierre I-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +evoluciona I-EVOLUTION +a I-EVOLUTION +crépito I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +siguientes I-EVOLUTION +controles. I-EVOLUTION +Es B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +protésico I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +mejorar I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +estabilidad I-DERIVED_FROM/TO +oclusal I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +ende I-DERIVED_FROM/TO +disminuir I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +sobrecarga I-DERIVED_FROM/TO +articular. I-DERIVED_FROM/TO +Se B-EXPLORATION +pide I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +2 I-EXPLORATION +meses I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +confirma I-EXPLORATION +una I-EXPLORATION +regeneración I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cortical I-EXPLORATION +ósea I-EXPLORATION +condilar. I-EXPLORATION +Actualmente, B-EVOLUTION +cuatro I-EVOLUTION +años I-EVOLUTION +después, I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática, I-EVOLUTION +con I-EVOLUTION +dinámica I-EVOLUTION +mandibular I-EVOLUTION +conservada. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +como I-EVOLUTION +secuela I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +otitis I-EVOLUTION +media I-EVOLUTION +y I-EVOLUTION +posterior I-EVOLUTION +mastoiditis I-EVOLUTION +queda I-EVOLUTION +con I-EVOLUTION +alteraciones I-EVOLUTION +auditivas I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +ruidos I-EVOLUTION +graves I-EVOLUTION +además I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +crépito I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ATM I-EVOLUTION +derecha I-EVOLUTION +debido I-EVOLUTION +al I-EVOLUTION +daño I-EVOLUTION +irreversible I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +tejidos I-EVOLUTION +intraarticulares. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +80 I-PRESENT_ILLNESS +kg, I-PRESENT_ILLNESS +talla I-PRESENT_ILLNESS +1, I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +m, I-PRESENT_ILLNESS +IMC I-PRESENT_ILLNESS +27, I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +kg/m2, I-PRESENT_ILLNESS +portador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dislipidemia, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +familiares I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +DM. I-PAST_MEDICAL_HISTORY +Inicia B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +polidipsia, I-PRESENT_ILLNESS +poliuria, I-PRESENT_ILLNESS +cansancio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +calambres. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacan I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas I-EXPLORATION +secas, I-EXPLORATION +acantosis I-EXPLORATION +nigricans I-EXPLORATION +en I-EXPLORATION +cuello, I-EXPLORATION +normotenso I-EXPLORATION +y I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +kilos I-EXPLORATION +de I-EXPLORATION +peso. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizan I-EXPLORATION +exámenes I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +hospitaliza I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +cetoacidosis I-EXPLORATION +diabética I-EXPLORATION +(CAD). I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +solución I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +0, I-TREATMENT +9% I-TREATMENT +1.000 I-TREATMENT +cc I-TREATMENT +con I-TREATMENT +cloruro I-TREATMENT +de I-TREATMENT +potasio I-TREATMENT +e I-TREATMENT +insulina I-TREATMENT +rápida I-TREATMENT +(IR) I-TREATMENT +8 I-TREATMENT +U I-TREATMENT +endovenosa. I-TREATMENT +A I-TREATMENT +la I-TREATMENT +hora, I-TREATMENT +se I-TREATMENT +continúa I-TREATMENT +con I-TREATMENT +el I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +volumen I-TREATMENT +(3.000 I-TREATMENT +cc) I-TREATMENT +e I-TREATMENT +IR I-TREATMENT +sc I-TREATMENT +(subcutánea) I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +h, I-TREATMENT +según I-TREATMENT +glicemias I-TREATMENT +capilares. I-TREATMENT +Se B-EXPLORATION +descarta I-EXPLORATION +foco I-EXPLORATION +infeccioso. I-EXPLORATION +A B-TREATMENT +las I-TREATMENT +8 I-TREATMENT +h I-TREATMENT +de I-TREATMENT +tratamiento, I-TREATMENT +al I-TREATMENT +revertir I-TREATMENT +la I-TREATMENT +acidosis I-TREATMENT +y I-TREATMENT +lograr I-TREATMENT +glicemias I-TREATMENT +< I-TREATMENT +250 I-TREATMENT +mg/dl, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +terapia I-TREATMENT +basal I-TREATMENT +bolos I-TREATMENT +con I-TREATMENT +insulina I-TREATMENT +NPH I-TREATMENT +(Neutral I-TREATMENT +Protamine I-TREATMENT +Hagedorn) I-TREATMENT +e I-TREATMENT +IR I-TREATMENT +antes I-TREATMENT +del I-TREATMENT +desayuno I-TREATMENT +(AD) I-TREATMENT +y I-TREATMENT +cena, I-TREATMENT +más I-TREATMENT +refuerzos I-TREATMENT +de I-TREATMENT +IR I-TREATMENT +pre-prandiales, I-TREATMENT +lográndose B-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica. I-EVOLUTION +Al B-TREATMENT +alta I-TREATMENT +se I-TREATMENT +indica I-TREATMENT +régimen I-TREATMENT +con I-TREATMENT +180 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +hidratos I-TREATMENT +de I-TREATMENT +carbono, I-TREATMENT +insulina I-TREATMENT +NPH I-TREATMENT +18 I-TREATMENT +U I-TREATMENT +AD I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +U I-TREATMENT +a I-TREATMENT +las I-TREATMENT +22 I-TREATMENT +h, I-TREATMENT +con I-TREATMENT +automonitoreo I-TREATMENT +de I-TREATMENT +glicemias I-TREATMENT +capilares. I-TREATMENT + I-TREATMENT +*HCO3 I-TREATMENT +Bicarbonato I-TREATMENT +de I-TREATMENT +sodio. I-TREATMENT +**HbA1c I-TREATMENT +Hemoglobina I-TREATMENT +glicosilada I-TREATMENT +A1c. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático I-EVOLUTION +con I-EVOLUTION +glicemias I-EVOLUTION +capilares I-EVOLUTION +de I-EVOLUTION +ayunas I-EVOLUTION +70-110 I-EVOLUTION +mg/dl, I-EVOLUTION +pre-prandiales I-EVOLUTION +100-130 I-EVOLUTION +mg/dl I-EVOLUTION +y I-EVOLUTION +post-prandiales I-EVOLUTION +160-180 I-EVOLUTION +mg/dl. I-EVOLUTION +Dada B-TREATMENT +su I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +se I-TREATMENT +disminuye I-TREATMENT +la I-TREATMENT +insulina I-TREATMENT +NPH I-TREATMENT +a I-TREATMENT +6 I-TREATMENT +U I-TREATMENT +a I-TREATMENT +las I-TREATMENT +22 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +se I-TREATMENT +agrega I-TREATMENT +metformina I-TREATMENT +850 I-TREATMENT +mg I-TREATMENT +2 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Controlado B-EVOLUTION +al I-EVOLUTION +mes, I-EVOLUTION +relata I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +hipoglicemias I-EVOLUTION +de I-EVOLUTION +60 I-EVOLUTION +mg/dl I-EVOLUTION +durante I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +exámenes I-EVOLUTION +revelan I-EVOLUTION +buen I-EVOLUTION +control I-EVOLUTION +metabólico. I-EVOLUTION + I-EVOLUTION +*HbA1c I-EVOLUTION +Hemoglobina I-EVOLUTION +glicosilada I-EVOLUTION +A1c. I-EVOLUTION + I-EVOLUTION +Dado B-EXPLORATION +el I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +DM I-EXPLORATION +en I-EXPLORATION +CAD I-EXPLORATION +(sospecha I-EXPLORATION +de I-EXPLORATION +DM1), I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +características I-EXPLORATION +fenotípicas I-EXPLORATION +de I-EXPLORATION +DM2, I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +marcadores I-EXPLORATION +inmunológicos I-EXPLORATION +para I-EXPLORATION +diabetes: I-EXPLORATION +anticuerpos I-EXPLORATION +anti I-EXPLORATION +células I-EXPLORATION +beta I-EXPLORATION +(ICA), I-EXPLORATION +anticuerpos I-EXPLORATION +anti I-EXPLORATION +insulina I-EXPLORATION +(IAA), I-EXPLORATION +anticuerpos I-EXPLORATION +anti I-EXPLORATION +ácido I-EXPLORATION +glutámico I-EXPLORATION +descarboxilasa I-EXPLORATION +(anti-GAD), I-EXPLORATION +anticuerpos I-EXPLORATION +anti I-EXPLORATION +tirosina I-EXPLORATION +fosfatasa I-EXPLORATION +(IA2), I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +péptido I-EXPLORATION +C I-EXPLORATION +en I-EXPLORATION +ayunas I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +(3, I-EXPLORATION +2 I-EXPLORATION +ng/ml). I-EXPLORATION +En B-TREATMENT +estas I-TREATMENT +condiciones I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +insulina, I-TREATMENT +manteniéndose I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +no I-TREATMENT +farmacológicas I-TREATMENT +y I-TREATMENT +la I-TREATMENT +metformina. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +en I-EVOLUTION +controles I-EVOLUTION +periódicos I-EVOLUTION +durante I-EVOLUTION +24 I-EVOLUTION +meses I-EVOLUTION +post I-EVOLUTION +alta, I-EVOLUTION +lográndose I-EVOLUTION +una I-EVOLUTION +reducción I-EVOLUTION +de I-EVOLUTION +10 I-EVOLUTION +kg I-EVOLUTION +de I-EVOLUTION +peso, I-EVOLUTION +glicemias I-EVOLUTION +de I-EVOLUTION +ayunas I-EVOLUTION +inferiores I-EVOLUTION +a100 I-EVOLUTION +mg/dl, I-EVOLUTION +HbA1c I-EVOLUTION +5, I-EVOLUTION +9%, I-EVOLUTION +y I-EVOLUTION +perfil I-EVOLUTION +lipídico I-EVOLUTION +y I-EVOLUTION +presión I-EVOLUTION +arterial I-EVOLUTION +normales. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +42 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +agricultor, B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia, I-PAST_MEDICAL_HISTORY +consulta B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pesadez I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +mareos I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +analgésicos I-PRESENT_ILLNESS +comunes. I-PRESENT_ILLNESS +En B-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +presenta I-EVOLUTION +ataxia I-EVOLUTION +y I-EVOLUTION +lateropulsión I-EVOLUTION +derecha. I-EVOLUTION +Una I-EVOLUTION +semana I-EVOLUTION +previo I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +presenta I-EVOLUTION +endoforia I-EVOLUTION +derecha, I-EVOLUTION +diplopia I-EVOLUTION +y I-EVOLUTION +postración I-EVOLUTION +en I-EVOLUTION +cama I-EVOLUTION +por I-EVOLUTION +vértigo I-EVOLUTION +intenso. I-EVOLUTION +Se B-EXPLORATION +realiza I-EXPLORATION +TC I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +hemorragia I-EXPLORATION +subaracnoidea I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +traslada I-EXPLORATION +a I-EXPLORATION +hospital I-EXPLORATION +de I-EXPLORATION +nivel I-EXPLORATION +terciario. I-EXPLORATION +Ingresa B-EVOLUTION +al I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +urgencias, I-EVOLUTION +consciente I-EVOLUTION +y I-EVOLUTION +orientado, I-EVOLUTION +con I-EVOLUTION +cefalea, I-EVOLUTION +diplopia I-EVOLUTION +e I-EVOLUTION +incapacidad I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +marcha I-EVOLUTION +por I-EVOLUTION +vértigo. I-EVOLUTION +Su B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +sólo I-EXPLORATION +demostró I-EXPLORATION +endoforia I-EXPLORATION +derecha, I-EXPLORATION +marcha I-EXPLORATION +inestable I-EXPLORATION +y I-EXPLORATION +lateropulsión I-EXPLORATION +derecha. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +RM I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +contrastada I-EXPLORATION +que I-EXPLORATION +reportó I-EXPLORATION +imagen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +hemangioblastoma. I-EXPLORATION +En I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +recuento I-EXPLORATION +plaquetario I-EXPLORATION +de I-EXPLORATION +10.000/mL, I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +serie I-EXPLORATION +roja I-EXPLORATION +ni I-EXPLORATION +blanca I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +difirió I-EXPLORATION +manejo I-EXPLORATION +quirúrgico I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +iniciaron I-EXPLORATION +estudios I-EXPLORATION +complementarios. I-EXPLORATION +El I-EXPLORATION +perfil I-EXPLORATION +de I-EXPLORATION +autoinmunidad I-EXPLORATION +(ANAS, I-EXPLORATION +ENAS, I-EXPLORATION +Coombs, I-EXPLORATION +inmunoglobulinas, I-EXPLORATION +anticoagulante I-EXPLORATION +lúpico I-EXPLORATION +y I-EXPLORATION +anticardiolipinas) I-EXPLORATION +infeccioso I-EXPLORATION +(VIH, I-EXPLORATION +Hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C), I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +(PT, I-EXPLORATION +PTT) I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +micronutrientes I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +consideró I-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +dímero I-EXPLORATION +D I-EXPLORATION +y I-EXPLORATION +fibrinógeno I-EXPLORATION +ante I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +síntomas I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +coagulopatía. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +deterioro I-EVOLUTION +neurológico I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +llevar I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +urgente I-TREATMENT +previo I-TREATMENT +soporte I-TREATMENT +transfusional I-TREATMENT +de I-TREATMENT +plaquetas I-TREATMENT +para I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +en I-TREATMENT +SNC. I-TREATMENT +Por I-TREATMENT +trepanación I-TREATMENT +occipital I-TREATMENT +derecha I-TREATMENT +se I-TREATMENT +pasa I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +derivación I-TREATMENT +ventricular I-TREATMENT +externa I-TREATMENT +al I-TREATMENT +ventrículo I-TREATMENT +lateral I-TREATMENT +ipsilateral, I-TREATMENT +con I-TREATMENT +obtención I-TREATMENT +de I-TREATMENT +LCR I-TREATMENT +a I-TREATMENT +presión. I-TREATMENT +Se I-TREATMENT +identificó I-TREATMENT +tumor I-TREATMENT +en I-TREATMENT +fosa I-TREATMENT +posterior, I-TREATMENT +realizándose I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +quiste I-TREATMENT +tumoral I-TREATMENT +aspecto I-TREATMENT +de I-TREATMENT +hemangioblastoma, I-TREATMENT +muy I-TREATMENT +vascularizado, I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +macroscópica I-TREATMENT +total. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +de I-EXPLORATION +patología I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +hemangioblastoma. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +asociación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +Von I-EXPLORATION +Hippel I-EXPLORATION +Lindau, I-EXPLORATION +se I-EXPLORATION +consideró I-EXPLORATION +adicionalmente I-EXPLORATION +búsqueda I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +tumores I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +ecografía I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +Es B-EVOLUTION +trasladado I-EVOLUTION +a I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +cuidado I-EVOLUTION +crítico I-EVOLUTION +con I-EVOLUTION +excelente I-EVOLUTION +respuesta I-EVOLUTION +neurológica I-EVOLUTION +sin I-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +trombocitopenia I-EVOLUTION +–entre I-EVOLUTION +5.000 I-EVOLUTION +y I-EVOLUTION +169.000/mL– I-EVOLUTION +requiriendo I-EVOLUTION +en I-EVOLUTION +varias I-EVOLUTION +ocasiones I-EVOLUTION +soporte I-EVOLUTION +transfusional I-EVOLUTION +buscando I-EVOLUTION +recuentos I-EVOLUTION +> I-EVOLUTION +100.000/mL. I-EVOLUTION +El B-EXPLORATION +seguimiento I-EXPLORATION +tomográfico I-EXPLORATION +(Día I-EXPLORATION +2 I-EXPLORATION +y I-EXPLORATION +7 I-EXPLORATION +postoperatorio) I-EXPLORATION +demostraban I-EXPLORATION +hematoma I-EXPLORATION +subdural I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +herniación I-EXPLORATION +en I-EXPLORATION +resolución. I-EXPLORATION +Es I-EXPLORATION +llevado I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +(mielograma, I-EXPLORATION +biopsia, I-EXPLORATION +cariotipo) I-EXPLORATION +todos I-EXPLORATION +normales I-EXPLORATION +y B-TREATMENT +con I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +púrpura I-TREATMENT +trombócitopenica I-TREATMENT +inmune I-TREATMENT +(PTI) I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +glucocorticoides I-TREATMENT +(hidrocortisona I-TREATMENT +50 I-TREATMENT +mg I-TREATMENT +c/6 I-TREATMENT +h I-TREATMENT +por I-TREATMENT +2 I-TREATMENT +días, I-TREATMENT +dexametasona I-TREATMENT +4 I-TREATMENT +mg I-TREATMENT +c/6 I-TREATMENT +h I-TREATMENT +por I-TREATMENT +10 I-TREATMENT +días) I-TREATMENT +sin I-TREATMENT +respuesta. I-TREATMENT +En I-TREATMENT +vista I-TREATMENT +de I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +sangrado I-TREATMENT +intracerebral I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +aplicar I-TREATMENT +inmunoglobulina I-TREATMENT +IV I-TREATMENT +1 I-TREATMENT +g/kg I-TREATMENT +por I-TREATMENT +dos I-TREATMENT +dosis I-TREATMENT +espaciadas I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +más I-TREATMENT +prednisona I-TREATMENT +a I-TREATMENT +1 I-TREATMENT +mg/kg/día I-TREATMENT +sin I-TREATMENT +mejoría I-TREATMENT +clínica I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +para I-TREATMENT +esplenectomía I-TREATMENT +laparoscópica I-TREATMENT +20 I-TREATMENT +días I-TREATMENT +después I-TREATMENT +del I-TREATMENT +procedimiento I-TREATMENT +neuroquirúrgico. I-TREATMENT +El I-TREATMENT +procedimiento I-TREATMENT +se I-TREATMENT +desarrolla I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +y I-TREATMENT +presenta I-TREATMENT +recuento I-TREATMENT +plaquetario I-TREATMENT +de I-TREATMENT +165.000/mL I-TREATMENT +en I-TREATMENT +el I-TREATMENT +postoperatorio I-TREATMENT +inmediato, I-TREATMENT +con I-TREATMENT +bazo I-TREATMENT +histológicamente I-TREATMENT +normal. I-TREATMENT +Cuarenta B-EVOLUTION +y I-EVOLUTION +ocho I-EVOLUTION +horas I-EVOLUTION +después, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +nuevo I-EVOLUTION +deterioro I-EVOLUTION +neurológico I-EVOLUTION +requiriendo I-EVOLUTION +reingreso I-EVOLUTION +a I-EVOLUTION +UCI. I-EVOLUTION +Recuento B-EXPLORATION +plaquetario I-EXPLORATION +126.000/mL, I-EXPLORATION +tromboelastografía I-EXPLORATION +con I-EXPLORATION +MA I-EXPLORATION +elevado I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +hiperagregabilidad I-EXPLORATION +plaquetaria I-EXPLORATION +y I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +con I-EXPLORATION +hematoma I-EXPLORATION +subdural I-EXPLORATION +derecho I-EXPLORATION +subagudo I-EXPLORATION +con I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +y I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +herniación I-EXPLORATION +con I-EXPLORATION +hipodensidad I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +hemisferio I-EXPLORATION +cerebral I-EXPLORATION +ipsilateral I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +isquemia I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +lleva I-TREATMENT +nuevamente I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +de I-TREATMENT +emergencia I-TREATMENT +–drepanotomía–. I-TREATMENT +El B-EXPLORATION +TC I-EXPLORATION +posterior I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +cambios I-EXPLORATION +significativos. I-EXPLORATION +Con B-EVOLUTION +estos I-EVOLUTION +hallazgos I-EVOLUTION +se I-EVOLUTION +retira I-EVOLUTION +sedación I-EVOLUTION +del I-EVOLUTION +paciente, I-EVOLUTION +2 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +presenta I-EVOLUTION +hipernatremia I-EVOLUTION +y I-EVOLUTION +fiebre, I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +evaluaciones I-EVOLUTION +se I-EVOLUTION +declara I-EVOLUTION +muerte I-EVOLUTION +encefálica. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +81 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +portador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +poliartritis I-PAST_MEDICAL_HISTORY +simétrica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +manos, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +catalogado I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +artritis I-PAST_MEDICAL_HISTORY +seronegativa; I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +tarde I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +agregó I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +urente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +parestesias I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +extremidades I-PAST_MEDICAL_HISTORY +inferiores. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +repitió I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +estudio, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dado I-PAST_MEDICAL_HISTORY +MPO I-PAST_MEDICAL_HISTORY +(+) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +nervio I-PAST_MEDICAL_HISTORY +sural I-PAST_MEDICAL_HISTORY +compatible I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +vasculitis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vaso I-PAST_MEDICAL_HISTORY +pequeño, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +estableció I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vasculitis I-PAST_MEDICAL_HISTORY +asociada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +ANCA I-PAST_MEDICAL_HISTORY +(MPO I-PAST_MEDICAL_HISTORY +(+)), I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +(Usual I-PAST_MEDICAL_HISTORY +Interstitial I-PAST_MEDICAL_HISTORY +Pneumonia I-PAST_MEDICAL_HISTORY +[UIP], I-PAST_MEDICAL_HISTORY +demostrado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +tomografía I-PAST_MEDICAL_HISTORY +axial I-PAST_MEDICAL_HISTORY +computada I-PAST_MEDICAL_HISTORY +[TAC]), I-PAST_MEDICAL_HISTORY +articular I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +neurológico. I-PAST_MEDICAL_HISTORY +Además, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +coronaria, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +cardíaca I-PAST_MEDICAL_HISTORY +CF I-PAST_MEDICAL_HISTORY +I-II I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +(ERC) I-PAST_MEDICAL_HISTORY +etapa I-PAST_MEDICAL_HISTORY +3. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +punto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vista I-PAST_MEDICAL_HISTORY +cardiológico, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +presentado I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +coronario I-PAST_MEDICAL_HISTORY +agudo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2012, I-PAST_MEDICAL_HISTORY +cuya I-PAST_MEDICAL_HISTORY +coronariografía I-PAST_MEDICAL_HISTORY +mostraba I-PAST_MEDICAL_HISTORY +oclusión I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ramo I-PAST_MEDICAL_HISTORY +marginal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +estenosis I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +significativa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vasos I-PAST_MEDICAL_HISTORY +principales. I-PAST_MEDICAL_HISTORY +Ecocardiograma I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipertrofia I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ventrículo I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +leve I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +arteria I-PAST_MEDICAL_HISTORY +pulmonar. I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +intentó I-PAST_MEDICAL_HISTORY +usar I-PAST_MEDICAL_HISTORY +ciclofosfamida I-PAST_MEDICAL_HISTORY +oral, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +embargo, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +pancitopenia I-PAST_MEDICAL_HISTORY +severa, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +suspendió. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mantención I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +prednisona I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +azatioprina I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg/día. I-PAST_MEDICAL_HISTORY +Estable I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +asintomático. I-PAST_MEDICAL_HISTORY +Las I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +previas I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +última I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +diagnosticó I-PAST_MEDICAL_HISTORY +reactivación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vasculitis, I-PAST_MEDICAL_HISTORY +caracterizada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +reinicio I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +parestesias I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +extremidades I-PAST_MEDICAL_HISTORY +inferiores, I-PAST_MEDICAL_HISTORY +intenso I-PAST_MEDICAL_HISTORY +livedo I-PAST_MEDICAL_HISTORY +reticularis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aumento I-PAST_MEDICAL_HISTORY +progresivo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +VHS I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +PCR, I-PAST_MEDICAL_HISTORY +decidiéndose I-PAST_MEDICAL_HISTORY +inducción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +remisión I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +rituximab I-PAST_MEDICAL_HISTORY +(no I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +tomó I-PAST_MEDICAL_HISTORY +nueva I-PAST_MEDICAL_HISTORY +biopsia). I-PAST_MEDICAL_HISTORY +Exámenes I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +procedimiento: I-PAST_MEDICAL_HISTORY +Hemoglobina I-PAST_MEDICAL_HISTORY +13, I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +g/dL, I-PAST_MEDICAL_HISTORY +glóbulos I-PAST_MEDICAL_HISTORY +blancos I-PAST_MEDICAL_HISTORY +12.300/mm³, I-PAST_MEDICAL_HISTORY +VHS I-PAST_MEDICAL_HISTORY +64 I-PAST_MEDICAL_HISTORY +mm/h, I-PAST_MEDICAL_HISTORY +creatinina I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +39 I-PAST_MEDICAL_HISTORY +mg/dL, I-PAST_MEDICAL_HISTORY +nitrógeno I-PAST_MEDICAL_HISTORY +ureico I-PAST_MEDICAL_HISTORY +23 I-PAST_MEDICAL_HISTORY +mg/dL, I-PAST_MEDICAL_HISTORY +glicemia I-PAST_MEDICAL_HISTORY +101 I-PAST_MEDICAL_HISTORY +mg/dL, I-PAST_MEDICAL_HISTORY +albúmina I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +g/dL, I-PAST_MEDICAL_HISTORY +colesterol I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +145 I-PAST_MEDICAL_HISTORY +mg/dl, I-PAST_MEDICAL_HISTORY +bilirrubina I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +0, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg/dL. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +hospitalizó I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +administración, I-PAST_MEDICAL_HISTORY +premedicándose I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +metilprednisolona I-PAST_MEDICAL_HISTORY +(125 I-PAST_MEDICAL_HISTORY +mg), I-PAST_MEDICAL_HISTORY +transcurriendo I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +incidentes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +enviado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +domicilio. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +embargo, I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +24 I-PAST_MEDICAL_HISTORY +h I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +infusión I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +fiebre I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +39, I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +°C, I-PAST_MEDICAL_HISTORY +dificultad I-PAST_MEDICAL_HISTORY +respiratoria, I-PAST_MEDICAL_HISTORY +tos I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +expectoración I-PAST_MEDICAL_HISTORY +mucopurulenta I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +marcado I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +general. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +evidenció I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +(38, I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +°C), I-PRESENT_ILLNESS +hipotenso I-PRESENT_ILLNESS +(PAM I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +mmHg), I-PRESENT_ILLNESS +desaturando I-PRESENT_ILLNESS +89% I-PRESENT_ILLNESS +ambiental I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +polipneico I-PRESENT_ILLNESS +(FR I-PRESENT_ILLNESS +29x’). I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +mal I-EXPLORATION +perfundido I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +uso I-EXPLORATION +de I-EXPLORATION +musculatura I-EXPLORATION +accesoria. I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio: I-EXPLORATION +Hemoglobina I-EXPLORATION +14, I-EXPLORATION +4 I-EXPLORATION +g/dL, I-EXPLORATION +leucocitos I-EXPLORATION +5.200/mm³, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +177 I-EXPLORATION +mg/L, I-EXPLORATION +gases I-EXPLORATION +arteriales: I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +49; I-EXPLORATION +pO2 I-EXPLORATION +53 I-EXPLORATION +mmHg; I-EXPLORATION +HCO3 I-EXPLORATION +19 I-EXPLORATION +mEq/L; I-EXPLORATION +SatO2 I-EXPLORATION +91%; I-EXPLORATION +PaFi I-EXPLORATION +254, I-EXPLORATION +lactato I-EXPLORATION +arterial I-EXPLORATION +23 I-EXPLORATION +mmol, I-EXPLORATION +troponina I-EXPLORATION +0, I-EXPLORATION +07 I-EXPLORATION +ng/mL, I-EXPLORATION +BNP I-EXPLORATION +254 I-EXPLORATION +ug/l, I-EXPLORATION +creatinina I-EXPLORATION +1, I-EXPLORATION +87 I-EXPLORATION +mg/dL, I-EXPLORATION +nitrógeno I-EXPLORATION +ureico I-EXPLORATION +33 I-EXPLORATION +mg/dL. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +cardiomegalia, I-EXPLORATION +hallazgos I-EXPLORATION +secundarios I-EXPLORATION +a I-EXPLORATION +UIP, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +condensación, I-EXPLORATION +congestión I-EXPLORATION +ni I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +evidentes. I-EXPLORATION +Electrocardiograma: I-EXPLORATION +ritmo I-EXPLORATION +sinusal, I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +volemizó I-EXPLORATION +vigorosamente, I-EXPLORATION +persistiendo I-EXPLORATION +hipotenso, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +ingresó I-EXPLORATION +a I-EXPLORATION +UTI I-EXPLORATION +para I-EXPLORATION +manejo. I-EXPLORATION +Se B-TREATMENT +tomaron I-TREATMENT +hemocultivos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +empíricamente I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +moxifloxacino I-TREATMENT +(completa I-TREATMENT +10 I-TREATMENT +días) I-TREATMENT +y I-TREATMENT +oseltamivir I-TREATMENT +(completa I-TREATMENT +5 I-TREATMENT +días). I-TREATMENT +Además, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +vasoactivos I-TREATMENT +y I-TREATMENT +corticoides I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +estrés. I-TREATMENT + I-TREATMENT +Evolucionó I-TREATMENT +con I-TREATMENT +requerimientos I-TREATMENT +de I-TREATMENT +noradrenalina I-TREATMENT +hasta I-TREATMENT +0, I-TREATMENT +1 I-TREATMENT +mcg/kg/min, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +lograron I-TREATMENT +suspender I-TREATMENT +a I-TREATMENT +las I-TREATMENT +12 I-TREATMENT +h. I-TREATMENT +Se B-EXPLORATION +obtuvo I-EXPLORATION +muestra I-EXPLORATION +para I-EXPLORATION +panel I-EXPLORATION +viral I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +viral I-EXPLORATION +(-), I-EXPLORATION +hemocultivos I-EXPLORATION +(-), I-EXPLORATION +urocultivo I-EXPLORATION +(-) I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +leucocitosis I-EXPLORATION +en I-EXPLORATION +mediciones I-EXPLORATION +seriadas. I-EXPLORATION +TAC I-EXPLORATION +tórax I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +condensación I-EXPLORATION +ni I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +asociado. I-EXPLORATION + I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +rápida I-EVOLUTION +remisión I-EVOLUTION +de I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +menos I-EVOLUTION +de I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +se I-EVOLUTION +trasladó I-EVOLUTION +a I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +menor I-EVOLUTION +complejidad. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +HTA, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tabaquismo, I-PAST_MEDICAL_HISTORY +consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +origen I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +ecográfico I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +que I-EXPLORATION +visualizó I-EXPLORATION +un I-EXPLORATION +aneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +abdominal I-EXPLORATION +(diámetro I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +6 I-EXPLORATION +cm) I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +UPAA I-EXPLORATION +no I-EXPLORATION +complicada, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +derivó I-EXPLORATION +a I-EXPLORATION +nuestro I-EXPLORATION +hospital. I-EXPLORATION + I-EXPLORATION +Ingresó I-EXPLORATION +a I-EXPLORATION +nuestro I-EXPLORATION +centro I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +dolor I-EXPLORATION +fuera I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +complicación I-EXPLORATION +del I-EXPLORATION +aneurisma I-EXPLORATION +abdominal, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +sugirió I-EXPLORATION +proceso I-EXPLORATION +infeccioso I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +derecha. I-EXPLORATION +Con I-EXPLORATION +los I-EXPLORATION +antecedentes I-EXPLORATION +reunidos, I-EXPLORATION +se I-EXPLORATION +catalogó I-EXPLORATION +como I-EXPLORATION +abdomen I-EXPLORATION +agudo I-EXPLORATION +apendicular I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +exploradora I-EXPLORATION +encontrándose I-EXPLORATION +tiflitis I-EXPLORATION +y I-EXPLORATION +necrosis I-EXPLORATION +intestinal, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +efectuar I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +e I-TREATMENT +íleo-ascendo-anastomosis. I-TREATMENT + I-TREATMENT +Posteriormente, B-EXPLORATION +debido I-EXPLORATION +al I-EXPLORATION +tiempo I-EXPLORATION +transcurrido, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +nuevo I-EXPLORATION +Angio-TC I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +UPAA, I-EXPLORATION +con I-EXPLORATION +paso I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +más I-EXPLORATION +allá I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +aórtica, I-EXPLORATION +sin I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +SAA. I-EXPLORATION +Se I-EXPLORATION +efectuó I-EXPLORATION +estudio I-EXPLORATION +preoperatorio I-EXPLORATION +con I-EXPLORATION +coronariografía I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +lesiones I-EXPLORATION +significativas I-EXPLORATION +y I-EXPLORATION +ecocardiografía I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular I-EXPLORATION +izquierda, I-EXPLORATION +disfunción I-EXPLORATION +diastólica I-EXPLORATION +tipo I-EXPLORATION +II I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +aurícula I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION +Debido B-TREATMENT +al I-TREATMENT +alto I-TREATMENT +riesgo I-TREATMENT +que I-TREATMENT +representaba I-TREATMENT +la I-TREATMENT +UPAA, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +cirugía, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +5 I-TREATMENT +semanas I-TREATMENT +posterior I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +abdominal. I-TREATMENT +Se I-TREATMENT +abordó I-TREATMENT +por I-TREATMENT +esternotomía I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +bajo I-TREATMENT +CEC I-TREATMENT +reemplazo I-TREATMENT +con I-TREATMENT +prótesis I-TREATMENT +de I-TREATMENT +dacron I-TREATMENT +Gelware™#26. I-TREATMENT +Se I-TREATMENT +observó I-TREATMENT +en I-TREATMENT +el I-TREATMENT +intraoperatorio I-TREATMENT +una I-TREATMENT +lesión I-TREATMENT +pulsátil I-TREATMENT +de I-TREATMENT +alrededor I-TREATMENT +de I-TREATMENT +dos I-TREATMENT +centímetros I-TREATMENT +de I-TREATMENT +diámetro I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +AA I-TREATMENT +y, I-TREATMENT +al I-TREATMENT +diseccionar I-TREATMENT +la I-TREATMENT +AA, I-TREATMENT +se I-TREATMENT +encontraron I-TREATMENT +tres I-TREATMENT +úlceras, I-TREATMENT +una I-TREATMENT +de I-TREATMENT +ellas I-TREATMENT +a I-TREATMENT +un I-TREATMENT +centímetro I-TREATMENT +del I-TREATMENT +ostium I-TREATMENT +coronario I-TREATMENT +derecho I-TREATMENT +y I-TREATMENT +no I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +disección I-TREATMENT +aórtica.. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +postoperada I-EVOLUTION +difiriéndose I-EVOLUTION +la I-EVOLUTION +resolución I-EVOLUTION +del I-EVOLUTION +aneurisma I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +aorta I-EVOLUTION +abdominal. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +confirmó I-EXPLORATION +UPAA. I-EXPLORATION +Actualmente, B-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +diez I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +sus I-EVOLUTION +controles I-EVOLUTION +en I-EVOLUTION +Cardiología I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +sintomatología I-EVOLUTION +cardiovascular. I-EVOLUTION + I-EVOLUTION \ No newline at end of file