Caso Clinico

 

Desh Dcénbdh AHNEVPVHTBT Bntoarentos; 

◈ Iuõhz Esondbh, O``bo ◈ Iuõhz Chyhce, Veuc ◈ Nezerbh @éez, En`y ◈ Õbquo Eaubcer, Enbte

 

Ihionth 5; Dbondbes Fåsbdes

 

  N PHIB @O VH@BCC

WBTPE ENPOVBHV

WBTPE CEPOVEC

 

WBTPE ZHTPOVBHV

5. DÔN DÔN@BC @BCHT HT DD_FB _FBOVPH OVPHTT DH DHNN DEVPÉCEAH EVPBD_CEV 6. CB CBA. A. DDV_ V_[E [E@H @HTT 4. CBA CBA.. DHCE DHCEPOV POVEC EC PBF PBFBEC BEC 0. CBA CBA.. DDHCE HCEPOV POVEC EC GBF GBF_CE _CEVV ?. EVP. EVP. PBFBHGB PBFBHGBF_C F_CEV EV T_ZOVB T_ZOVBHV HV 7. IONB IONBTTDHT DHT

CBA ZHZCÉPOH HFCBD_H

Oxpensbôn `oc ton`ôn soibioifrenhsh Hrbaon; phstorbhr ec dôn`bch io`bec `o ce tbfbe Bnsordbôn; dôn`bch cetorec `oc gâiur

CBA ZHZCÉPOH EVU_OE@H Hrbaon; dere Hrbaon;  dere phstorbhr `o ce defoze `oc porhnâ Bnsordbôn; perto Bnsordbôn;  perto io`be `oc cbaeionth phpcétoh hfcbduh

 

ZEPE @O AENTH DBNPBCCE BCBHPBFBEC

so bnsorte on ce supordbo bntorne `o ce opésbs prhxbiec `o ce tbfbe. Edtûe kunth dhn oc dhcetorec io`bec on ce ostefbcbzedbôn `o ce rh`be y provbono ce oxdosbve rhtedbôn oxtorne.

 Ghrie perto `o ce enethiée `o ce perto cetorec `oc iusch, y`oquo os dhnhdb`h tonshr ce gesdbe cete. phr sor perto `oc iûsduch

 

Ihionth 6; Gbsbhpethchaée

 

GBTBHZ PHCHAÉ @O C AHN VPVHTBT Onvokodbibonth

Zrosbôn iodånbde / Preuietbsih

Aonâtbde

Io`be`hros shcufcos

Ostrâs iodånbdh

Greaionths `o ietrbz

Dhn`rhdbths Hstohfcesths

EVPVHTBT

 

GBTBHZ PHCHAÉ @O C AHN VPVHTBT Chs dhn`rhdbths edtbve`hs cbforen chdecionto aren`os dentb`e`os `o re`bdecos cbfros y dbthdbnes. Ce BC-5 euionte ce prh`uddbôn phr chs dhn`rhdbths `o iotechprhtoeses ietrbdbecos y re`bdecos cbfros rosphnsefcos `o ce `oare`edbôn `o ce ietrbz oxtredocucer. Chs dhn`rhdbths teifbân so dhiunbden dhn ces dâcuces ôsoes sufdhn`recos e trevâs `o io`be`hros dhih oc VENLC, quo ostbiuce ce roefshrdbôn ôsoe hstohdcåstbde. Chs greaionths hstohdhn`recos, prh`udths `o `oare`edbôn `o ce ietrbz `o io`be`hros prhbngceiethrbhs, dhih prhsteacen`bne (ZA) O6 , ôxb`h nétrbdh (NH), dbthdbnes, `osonde`onen ce ioifrene sbnhvbec

bngceiedbôn

`o

ce

 

IODD NBTIH @O ZVHPO IO ZVHPODDDBÔ DBÔNN VPBD_C V R T_ BNOG BNOGBD BD DB Ce bnogbdedbe `o chs ocoionths `o prhtoddbôn eareve oc pocbarh `o cosbôn ertbducer y ce eperbdbôn `o hstohertrhsbs.

Okoipch Ertrhpetée Dmerdht os une hstohertrbtbs arevo y `o `o ovhcudbôn råpb`e y surao duen`h eperodo `eõh ertbducer iénbih on prosondbe `o nourhpetée porbgârbde `o ce dhcuine phstorbhr.

 

 D VPÉC AH R T_ G_NDBÔN ON C BNT_GBDBONDB

VPBD_C V

 Ce prbiore ovb`ondbe on ce `oare`edbôn os ce gbfrbcedbôn `o ce suporgbdbo ertbducer y ce pâr`b`e `o acudhprhtoénes PAG-ζ, oc BAG-5 y chs PBIZ y ces dâcuces dhn phtondbec `o `bgorondbedbôn e dhn`rhdbths. ➐ @ogodth on oc iodenbsih `o roperedbôn osphntånoh `oc dertéceah

Oc prhdosh `o gbfrbcedbôn prhvhde gbsures y rhtures on oc dertéceah quo so puo`on oxton`or meste oc muosh sufdhn`rec  Ecths nbvocos `o prhtobneses (onzbies) quo `oare`en ce ietrbz, dhnhdb`es dhih; iotechprhtobneses (IIZ), `hs `o occes on pertbducer shn

Ces ectoredbhnos fbhiodånbdes `oc tokb`h ongorih prhvhden ro`uddbôn sbanbgbdetbve `o ce prhpbo`e`

ce ostrhiocbsbne (IIZ-4) y ce dhceaonese (IIZ-5)

ocåstbde `oc dertéceah.

 

GEDPHVOT @O VBOTAH;

 AHN VPVHTBT

 

ENEPHIÉE ZEPHCÔABDE @O CE AHNEVPVHTBT   ogbdbondbe prharosbve ertbducer

Ce dhn`bdbôn hfcbaethrbe pethcôabde os; ◈ ◈

@oaonoredbôn `oc dertéceah `o ce ertbducedbôn `o ce rh`bcce quo egodte e`oiås `o ec dertéceah dertéceah e chs cb cbaeionths aeionths ionbsdhs y iûsduchs porbertbduceros porbertbduceros..

ce pâr`b`e `oc dertéceah ertbducer mbecbnh quo so edhipeõe `o un euionth `oc osposhr y osdcorhsbs `o ce pcede ôsoeostbreibonth sufdhn`rec, prhcbgoredbôn `o hstohgbths on oc fhr`o ertbducer, `o ce dåpsuce ertbducer y `ofbcb`e` `o chs iûsduchs quo unon ce ertbducedbôn.

cosbôn ertbducer on oc dhntoxth `o une gecce `o chs iodenbsihs prhtodthros.

 

Deuses `oc `hchr ce pâr`b`e `o ce bntoarb`e` dertbceabnhse edhipeõe`e `o bnvesbôn nourhvesducer dhntrbfuyo ec `hchr

Ce `bstonsbôn depsucer phr oc céqub`h bntreertbducer ostbiuce e ces ſtfres nhdbdoptbves on ose zhne y, on dhnsoduondbe, bn`udo ce eperbdbôn `o `hchr

Ontro chs hréaonos groduontos `oc `hchr porbertbducer on ce rh`bcce ostån ce fursbtbs `o ce pete `o aensh y oc sén`rhio `o ce dbntbcce bcbhtbfbec

 

HFOTB@ @ Nuiorhshs ostu`bhs epunten ec shfroposh dhih unh `o chs gedthros `o rbosah iås biphrtentos on ce pethaonbe y prharosbôn prharosbôn `o ce ertrhsbs `o rh`bcce ihstren`h ce rocedbôn `brodte quo so onduontre ontro oc én`bdo `o iese dhrphrec y ce provecondbe `o oste pethchaée `oaonoretbve.

DETH DCÉNBDH

 

Zedbonto iukor `o 11 eõhs, eie `o dese, prosonte medo ? eõhs `hchr on eifes rh`bcces, medo 0 iosos bndroionte oc `hchr ospodbecionto on ce bzqubor`e, so edontûe ec `oeifucer, ec feker ces osdecores, esb dhih ec errh`bccerso.Ce pedbonto soõece quo rereionto pese un `ée sbn `hchr, rooro `hchr ec bnbdbh `o sus edtbvb`e`os, iokhre dhn oc rophsh, prosonte rbab`oz ietbnec `o rh`bcces `o 6:ibnuths.Oxeion Gésbdh TW; ZE; 54:/=: GD; 1= GV; 57 Pº; 47.?

Thiethiotrée; posh; =2 la Pecce; 5.?? its.Ep. DW; rub`hs der`bedhs

rétibdhs, roauceros, nh shpchs EZ EZ.. Vospbrethrbh; Fuon peseko `o iuriucch vosbducer on eifhs deiphs pucihneros, nh recos.Hstohiusducer; prosonte un `hchr e ce pecpedbôn on oc ce`h bntornh `o ce rh`bcce quo euionte dhn ce ihvbcbzedbôn on oxh-oxtonsbôn, cbibtedbôn `o ce ihvbcb`e`, `hchr e ce pecpedbôn `o ce ertbducedbôn, dropbtedbôn e ce ihvbcbzedbôn. Ostu`bhs dhipcoionterbhs; -

WTA; 50 ii/m

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Ged edth thrr Vo Voui uiet ethb hb`o `oh; h; No Noae aetb tbvh vh..

 

Tbanhs y Ténthies

-

Oxeion Gésbdh Tbanhs Wbtecos;

-

-

ZE; 54:/=:

-

GD; 1=

-

GV; 57

-

Pº; 47.?

-

Thie Th ieth thio iotr trée ée;; posh posh;; =2 la Pecce ecce;; 5. 5.?? ?? it its. s.

@h @hch chrr oonn eeif ifes es rh` h`bc bcce cess mmed edoo ? eõhs Bn Bnddroi oion onte te `hch `hchrr on on oocc ce` ce`h h bzqubor`h.

Vbab Vbab`o `ozz i iet etbn bnec ec `o rh`b rh`bcc cces es `o 6:ibnuths

BID 9 41  edthros `o rbosah

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Hfosb`e` Hdupedbôn Toxh (goionbnh)

-

O`e` (eõhs) Ged edth thro ross nutr nutrbd bdbbhn hnec ecos os

 

Oxpchredbôn Gésbde

 Post `o IdIurrey 

Zruofes `o ostrâs `o vecah

Post `o Cedmien

 

Oxåionos Dhipcoionterbhs Zruofes `o cefhrethrbh cefhrethrbh

Nh shn ospodédes pere ertrhsbs Gedthr rouiethb`o  Euthentbduorph iås eshdbe`h e ce ertrbtbs rouiethb`

 Wochdb`e` `o so`biontedbôn achfucer (WTA)

Cbqub`h sbnhvbec

Oc céqub`h ertbducer on ce ertrhsbs os eiferbnh, ostârbc,  vbsdhsh y trensperonto y oc roduonth docucer nh shfropese chs 6.::: coudhdbths phr ii4

 

Ostu`bhs `o Bieaon Ve`bharegée sbipco 

Meccezahs -

@bs bsi ibnu bnudbô dbôn ` `ooc oosspedb pedbh h ertbducer Hsto toh hſtt ſtth hs ierab erabne neccos Osdc dcoorhsbs hsbs sufd ufdhn hn` `rec En Enhr hrie iecb cb`e `e`o `oss `oc `oc dh dhnt nthr hrnh nh ôsoh

Mbpôtosbs @beanôstbdes

 

 EVPVBPBT VO_IEPHB@O

Os une ongorio`e` euthbniuno, drônbde, sbstâibde, conteionto prharosbve

Oc entéaonh prhvhde une rospuoste bniuno on oc muâspo`, `o ce duec so `orbve une roeddbôn bneiethrbe. Voedtentos `o ce geso eau`e; -

so`bio so`b iont nted edbô bôn n ach achfu fuce cerr (WT (WTA) A) prhto toén éne e D ro roed edtb tbve ve (ZD ZDV V) euio eu iont nth h `o ce ce gred greddb dbôn ôn *6*6-ac achf hfuc ucbn bne e on oc oc ospodtrh ocodtrhghrâtbdh (prhtobnhareie).

Gedthr rouiethb`oh

 rtbducer

--

I Zbeonshs Vh`bcces De`ores

Tbnthiethchaée  xtreertbducer

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Zucihner Vonec Nourhpetées TND

Wesducbtbs  

AHNEVPVHTBT

Ce ertrhsbs `o ce rh`bcce os une egoddbôn groduonto. @ofb`h e ce gundbôn `o sustontedbôn `o ce ertbducedbôn, suoco sor une cosbôn bnvecb`ento.

Ienbgostedbhnos dcénbdes

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@h @hch chrr ` `oo vver erbh bhss i ios osos os `o `ure `uredb dbôn ôn y e ionu`h os bntoribtonto y deuse `bſtducte` on ce ierdme. Bn Bnde dep pedb` edb`e` e` gun unddbh bhne necc Eare Eareve vent nto; o; ie ierd rdme me / ddec ecie ie dhn dhn oocc rrop ophs hsh h

Zrovecondbe; Iukoros

Ce os oc rosucte`h `o ertrhsbs ce pâr`b`e `o ce gundbôn ertbducer dhih dhnsoduondbe `o ce rhture `oc dertéceah ertbducer

 

VOGOVONDBET FBFCBHAVÅGBDET 5.

CE CEPPEVKOP EVKOP,, V_B[ CBE CBEV@, V@, ZV ZVÔ. Ô. ENE ENEPHI PHIÉE ÉE M_IENE ddhn hn D@-V D@-VHI. HI. O` O`bthrbec bthrbec Iâ`bde Iâ`bde Z Zeneiorb eneiorbdene. dene. OO`. `. 0ª. 6::?. 6::?.

6.

Auyth Auythn, n, E.D. E.D. Me Mecc, cc, K.O. K.O. Prete`h Prete`h `o gbs gbsbhchaée bhchaée iâ`bde iâ`bde.. 50ª 50ª o`. Ie`rb`; Ocsovbor< Ocsovbor< 6 6:65. :65.

4.

Eraont Eraontoo M, Åcvero Åcverozz I I.. To Toibhchaé ibhchaée e Iâ Iâ`bde; `bde; Gbsbhpet Gbsbhpethchaée, hchaée, Toibht Toibhtodnbe odnbe y Zrh Zrhpo`âut po`âutbde. bde. Zeneiorbdene. 6:5=.

6º o`bdbôn. Fuonhs Ebros; Iâ`bd Iâ`bde e